Chowdhury Atique Iqbal, Haider Rafiqul, Abdullah Abu Yousuf Md, Christou Aliki, Ali Nabeel Ashraf, Rahman Ahmed Ehsnaur, Iqbal Afrin, Bari Sanwarul, Hoque D M Emdadul, Arifeen Shams El, Kissoon Niranjan, Larson Charles P
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
PLoS One. 2018 Jan 16;13(1):e0191054. doi: 10.1371/journal.pone.0191054. eCollection 2018.
A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project.
A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities.
Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project's transport doubled and referral compliance from distant zones similarly increased.
The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings.
在紧急转诊系统中，基于地理信息系统（GIS）的交通网络可能是减少卫生系统延误并增加生存几率的关键，尤其是在紧急情况下。我们在“阻断脓毒症传播途径倡议”（IPSI）项目中，利用GIS设计了一个紧急运输系统，用于快速转运疑似脓毒症的孕妇、产后早期妇女、新生儿及5岁以下儿童。
通过绘制研究区域的村庄、道路及相关地理特征，开发了一个GIS数据库。开发了一种行程时间算法，将不同当地交通方式到达卫生中心所需的时间纳入其中。这些算法用于网络分析，以确定从村庄到医院的最短路线，根据村庄与最近医院的距离将其分为绿区、黄区和红区，以便提供运输设施。为该项目设立的紧急呼叫中心管理运输系统，并利用其数据评估该运输系统在偏远社区的使用情况。
确定了15条现有路线和2条新路线为前往卫生中心的最短路线。呼叫中心工作人员利用这些路线信息，将患者和运输司机引导至最近的运输枢纽或接送点。在IPSI运输系统运行的地区，对转诊建议的依从性很高。在研究期间，该项目运输的利用率翻了一番，偏远地区的转诊依从性也同样提高。
本研究创建的GIS系统利用当地现有的交通和资源，促进了偏远地区患者在紧急情况下的快速转诊。本研究中描述的开发和实施紧急运输系统的方法可应用于类似的农村低收入国家环境。
