马拉维全国范围内的横断面家庭调查：医疗条件下获得医疗保健的交通障碍。
TRANSPORTATION BARRIERS TO ACCESS HEALTH CARE FOR SURGICAL CONDITIONS IN MALAWI a cross sectional nationwide household survey.
机构信息
Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.
University of Malawi, College of Medicine, Lilongwe, Malawi.
出版信息
BMC Public Health. 2019 Mar 5;19(1):264. doi: 10.1186/s12889-019-6577-8.
BACKGROUND
It is estimated that nearly five billion people worldwide do not have access to safe surgery. This access gap disproportionately affects low-and middle-income countries (LMICs). One of the barriers to healthcare in LMICs is access to transport to a healthcare facility. Both availability and affordability of transport can be issues delaying access to health care. This study aimed to describe the main transportation factors affecting access and delay in reaching a facility for health care in Malawi.
METHODS
This was a multi-stage, clustered, probability sampling with systematic sampling of households for transportation access to general health and surgical care. Malawi has an estimated population of nearly 18 million people, with a total of 48,233 registered settlements spread over 28 administrative districts. 55 settlements per district were randomly selected for data collection, and 2-4 households were selected, depending on the size. Two persons per household were interviewed. The Surgeons Overseas Assessment of Surgical need (SOSAS) tool was used by trained personnel to collect data during the months of July and August 2016. Analysis of data from 1479 households and 2958 interviewees was by univariate and multivariate methods.
RESULTS
Analysis showed that 90.1% were rural inhabitants, and 40% were farmers. No formal employment was reported for 24.9% persons. Animal drawn carts prevailed as the most common mode of transport from home to the primary health facility - normally a health centre. Travel to secondary and tertiary level health facilities was mostly by public transport, 31.5 and 43.4% respectively. Median travel time from home to a health centre was 1 h, and 2.5 h to a central hospital. Thirty nine percent of male and 59% of female head of households reported lack financial resources to go to a hospital.
CONCLUSION
In Malawi, lack of suitable transport, finances and prolonged travel time to a health care centre, all pose barriers to timely access of health care. Improving the availability of transport between rural health centres and district hospitals, and between the district and central hospitals, could help overcome the transportation barriers to health care.
背景
据估计，全球有近 50 亿人无法获得安全的手术。这种获取差距不成比例地影响了低收入和中等收入国家（LMICs）。LMICs 中医疗保健的一个障碍是获得医疗设施的交通工具。交通的可用性和可负担性都可能成为延迟获得医疗保健的问题。本研究旨在描述影响马拉维获得医疗保健和到达医疗设施的主要交通因素。
方法
这是一个多阶段、聚类、概率抽样，对一般医疗和外科护理的交通可达性进行系统抽样的家庭。马拉维估计人口近 1800 万，共有 48233 个注册定居点分布在 28 个行政区。每个地区随机选择 55 个定居点进行数据收集，并根据大小选择 2-4 个家庭。每个家庭有 2 人接受采访。2016 年 7 月和 8 月，由经过培训的人员使用海外外科医生评估手术需求（SOSAS）工具收集数据。对来自 1479 户家庭和 2958 名受访者的数据进行了单变量和多变量分析。
结果
分析表明，90.1%的人是农村居民，40%的人是农民。24.9%的人没有正式工作。从家到初级卫生保健机构（通常是保健中心）最常见的交通方式是动物拉车。前往二级和三级卫生保健机构的交通主要是公共交通工具，分别为 31.5%和 43.4%。从家到保健中心的旅行时间中位数为 1 小时，到中心医院为 2.5 小时。39%的男性和 59%的女性家庭户主报告说缺乏去医院的资金。
结论
在马拉维，缺乏合适的交通工具、资金以及到医疗保健中心的旅行时间延长，都对及时获得医疗保健构成障碍。改善农村卫生中心和地区医院之间以及地区和中央医院之间的交通可用性，有助于克服医疗保健的交通障碍。
Zotero 插件