Geldsetzer Pascal, Reinmuth Marcel, Ouma Paul O, Lautenbach Sven, Okiro Emelda A, Bärnighausen Till, Zipf Alexander
Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
medRxiv. 2020 Aug 26:2020.07.17.20152389. doi: 10.1101/2020.07.17.20152389.
SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time to the healthcare facility. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km × 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA.
We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km × 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km × 1km grid using a cost-distance algorithm.
9.6% (95% CI: 5.2% - 16.9%) of adults aged ≥60 years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged ≥60 years had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged ≥60 years with the longest travel times was 348 minutes (equal to 5.8 hours; IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (equal to 27.6 hours; IQR: 1065 - 2440 minutes) in Gabon.
Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是导致2019冠状病毒病（COVID-19）的病毒，正在撒哈拉以南非洲（SSA）迅速传播。老年人尤其经常需要基于医院的COVID-19护理。然而，在撒哈拉以南非洲，获得医院护理的一个关键障碍是前往医疗机构的时间。为了为额外医疗资源的地理定位提供信息，本研究旨在确定撒哈拉以南非洲60岁及以上成年人到最近医院以及到任何类型最近医疗机构的估计出行时间，分辨率为1公里×1公里。
我们利用来自开放街道地图项目和肯尼亚医学研究协会惠康信托计划的数据，汇编了一个关于医疗机构地理位置的独特数据集，分别针对医院和任何类型的医疗机构（包括初级保健机构），并包括私营和公共部门的机构。1公里×1公里分辨率的人口数据来自世界人口数据。我们使用成本距离算法估计每个1公里×1公里网格到最近医疗机构的出行时间。
9.6%（95%置信区间：5.2% - 16.9%）的60岁及以上成年人到最近医院的估计出行时间超过6小时，在布隆迪和冈比亚为0.0%（95%置信区间：0.0% - 3.7%），在苏丹为40.9%（95%置信区间：31.8% - 50.7%）。11.2%（95%置信区间：6.4% - 18.9%）的60岁及以上成年人到任何类型最近医疗机构（无论是初级还是二级/三级护理机构）的估计出行时间超过3小时，在布隆迪为0.1%（95%置信区间：0.0% - 3.8%），在苏丹为55.5%（95%置信区间：52.8% - 64.9%）。撒哈拉以南非洲的大多数国家都有人口密集地区，其中60岁及以上成年人到最近医院的出行时间超过12小时，到任何类型最近医疗机构的出行时间超过6小时。在整个撒哈拉以南非洲人口中，出行时间最长的五分之一60岁及以上成年人到最近医院的中位出行时间为348分钟（相当于5.8小时；四分位距：240 - 576分钟），在布隆迪为41分钟（四分位距：34 - 54分钟），在加蓬为1655分钟（相当于27.6小时；四分位距：1065 - 2440分钟）。
我们绘制的到医院和任何类型医疗机构的估计出行时间的高分辨率地图可供政策制定者和非政府组织使用，以帮助将额外的医疗资源，如新的临时医院或到现有医疗机构的交通项目，定位到获得医疗服务最少的老年人。此外，该分析精确显示了哪些人群由于获得医疗设施的机会少而特别可能少报COVID-19症状。除了应对COVID-19之外，本研究还可为各国改善对老年人常见疾病（如慢性非传染性疾病）的护理工作提供信息。
