Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Western Cape Department of Health, Cape Town, South Africa.
S Afr Med J. 2024 Apr 18;114(4). doi: 10.7196/SAMJ.2024.v114i4.1393.
The ability to access effective hospital care for children is a significant determinant of good health outcomes. The Western Cape is a large land area with a wide array of human settlements- both in urban and rural spaces. For many children in the Western Cape, after-hours access to healthcare becomes constrained when primary care clinics close and hospitals are either far away or difficult to get to. The cumulative travel burden of communities across this area is not known. The recently established data gathering capacity of the Provincial Health Data Centre of the Western Cape represents a new capacity to study this.
This study intends to describe the cumulative travel burdens of children in communities throughout the Western Cape, and how they compare relative to one another, with a particular focus on the after-hours period in a week.
Over a period of 5 years from 2017-2021, all the admission details to every hospital in the Western Cape of children under 18 years of age were collected, with basic demographic and disease data including place of residence. The distance each child travelled to their first admission facility was calculated and represented within defined communities across the metro of Cape Town and the rural Western Cape.
There were 574 220 admissions over the 5-year period, of which 360 783 were able to be used for travel analysis. The majority of admissions were for children under 5 years of age, were in the City of Cape Town and occurred after hours. Median travel distance was less for children outside of Cape Town, but the range of travelled distances was greater. Communities across the Western Cape, particularly rural communities, reflected significant variation in their cumulative travel burdens.
Using a large health dataset, this study demonstrates in a novel way for South Africa, the distances children travel to access admission facilities. A wide variation exists across all parts of the province, but particularly in rural areas. These findings could be further interrogated for people's choices of facility and method of travel. Detailed service area modelling and extending primary care working hours are potential considerations for improving access at scale and at the local community level.
儿童能够获得有效的医院护理是良好健康结果的重要决定因素。西开普省是一个拥有广泛人类住区的大地区，包括城市和农村地区。对于西开普省的许多儿童来说，当初级保健诊所关闭，医院离家远或难以到达时，他们在非工作时间获得医疗保健的机会就会受到限制。目前还不知道该地区所有社区的累积旅行负担。西开普省省级卫生数据中心最近建立的数据收集能力代表了研究这一问题的新能力。
本研究旨在描述西开普省各社区儿童的累积旅行负担，以及它们彼此之间的比较情况，特别是在一周的非工作时间。
在 2017 年至 2021 年的 5 年期间，收集了西开普省所有 18 岁以下儿童在每所医院的入院详细信息，包括基本人口统计学和疾病数据，包括居住地。计算了每个孩子到他们第一次入院的设施的旅行距离，并在开普敦大都市区和西开普省农村地区的指定社区内进行表示。
在 5 年期间共有 574 220 例入院，其中 360 783 例可用于旅行分析。大多数入院病例是 5 岁以下的儿童，发生在开普敦市，并且是在非工作时间。城外儿童的平均旅行距离较短，但旅行距离范围较大。西开普省各地的社区，特别是农村社区，反映出其累积旅行负担存在显著差异。
本研究使用大型健康数据集，以新颖的方式展示了南非儿童为获得入院设施而旅行的距离。该省各地都存在很大差异，但在农村地区尤为明显。这些发现可以进一步探讨人们对设施的选择和旅行方式。详细的服务区建模和延长初级保健工作时间是改善整体和当地社区层面获得服务的潜在考虑因素。
