Research Unit, Common Management Unit [TB, HIV/AIDS & Malaria], Islamabad, Pakistan.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Glob Health Action. 2022 Dec 31;15(1):2095782. doi: 10.1080/16549716.2022.2095782.
Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan.
We aimed to determine the geographical access to child TB services in Pakistan.
We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization's (WHO) recommended 5-km distance.
At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services.
With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.
儿童结核病难以发现，通常需要专家诊断；卫生系统应在未能确诊患儿疾病时将其转至更高层次的医疗保健机构。在巴基斯坦，基层医疗保健机构通常无法诊断儿童结核病，只能将患儿转至二级或三级保健医院的儿科医生处。我们旨在确定巴基斯坦儿童结核病服务的卫生服务可及性。
我们旨在确定巴基斯坦儿童结核病服务的地理可及性。
我们使用地理空间分析，使用 qGIS 计算离最近的公共卫生机构与定居点的距离，以及居住在世界卫生组织（WHO）建议的 5 公里距离内的人口。
在基层医疗保健层面，14.1%的机构向国家结核病规划报告儿童结核病病例，74%的人口在 5 公里半径内可获得一般初级卫生保健。到二级和三级保健机构，33.5%的人口在 5 公里半径内可获得地理上的医疗服务。从所有定居点到最近的儿童结核病点，诊断儿童结核病的设施的平均距离为 26.3 公里。一个省（俾路支省）的人口到医疗服务的距离更长。
尽管初级保健服务覆盖率相当高，但儿童结核病专科医疗服务覆盖率较低，卫生系统严重依赖社区的良好转诊系统。
