Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Bloomberg Philanthropies, Kigoma, United Republic of Tanzania.
Glob Health Sci Pract. 2017 Sep 28;5(3):430-445. doi: 10.9745/GHSP-D-17-00110. Print 2017 Sep 27.
Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the proportion of live births (a proxy indicator of women needing delivery care) with poor geographic access to EmONC services.
The 2014 Reproductive Health Survey of Kigoma Region identified 4 primary means of transportation used to travel to health facilities: walking, cycling, motorcycle, and 4-wheeled motor vehicle. A raster-based travel time model was used to map the 2-hour travel time catchment for each mode of transportation. Live birth density distributions were aggregated by travel time catchments, and by administrative council, to estimate the proportion of births with poor access.
Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmONC facilities within 2 hours on foot, 33% in areas that can be reached within 2 hours only by motorized vehicles, and 32% where it is impossible to reach EmONC facilities within 2 hours. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles.
Significant differences in geographic access to EmONC in Kigoma Region, Tanzania, were observed both by location and by primary transportation type. As most of the population may only have good EmONC access when using mechanized or motorized vehicles, bicycles and motorcycles should be incorporated into the health transportation strategy. Collaboration between private transportation sectors and obstetric service providers could improve access to EmONC services among most populations. In areas where residents may not access EmONC facilities within 2 hours regardless of the type of transportation used, upgrading EmONC capacity among nearby non-EmONC facilities may be required to improve accessibility.
获得交通工具对于减少前往紧急产科和新生儿护理（EmONC）的出行时间至关重要，这是为了管理并发症并预防母婴不良结局。本研究使用各种交通方案，考察了坦桑尼亚基戈马地区前往 EmONC 的出行时间分布，以评估地理上难以获得 EmONC 服务的活产比例（分娩护理需求的替代指标）。
基戈马地区 2014 年生殖健康调查确定了用于前往卫生设施的 4 种主要交通方式：步行、骑自行车、骑摩托车和四轮机动车。使用基于栅格的出行时间模型来绘制每种交通方式的 2 小时出行时间覆盖范围。通过出行时间覆盖范围和行政区，汇总活产密度分布，以估计难以获得服务的分娩比例。
在基戈马地区所有活产中，有 13%的分娩发生在妇女步行 2 小时内可到达 EmONC 设施的地区，33%的分娩发生在只能乘坐机动车 2 小时内到达的地区，32%的分娩发生在 2 小时内无法到达 EmONC 设施的地区。在 8 个行政区中的 3 个行政区，超过 50%的分娩存在估计较差的获得途径。如果所有女性居民都能获得机动车，那么在一半的行政区中，不良获得途径的分娩比例可降低至不超过 12%。
在坦桑尼亚基戈马地区，通过位置和主要交通方式观察到 EmONC 获得途径存在显著差异。由于大多数人口可能只有在使用机械化或机动车时才能获得良好的 EmONC 服务，因此应将自行车和摩托车纳入卫生交通战略中。私营交通部门与产科服务提供者之间的合作可以改善大多数人群对 EmONC 服务的获得。在居民无论使用何种交通工具都无法在 2 小时内到达 EmONC 设施的地区，可能需要升级附近非 EmONC 设施的 EmONC 能力，以提高可达性。
