Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
Sunyani Technical University Clinic, Sunyani, Bono Region, Ghana.
BMC Health Serv Res. 2024 Oct 29;24(1):1303. doi: 10.1186/s12913-024-11830-2.
Diabetes mellitus, human immunodeficiency virus (HIV), hepatitis B and anaemia are major global public health issues according to the World Health Organization (WHO). Access to diagnostic testing is essential for their prompt detection and treatment. The WHO has recommended a list of essential in-vitro diagnostics for testing at all levels of care. However, a survey preceding this study showed limited availability of point-of-care (POC) tests for these conditions in the Bono Region (BR) of Ghana. This study assessed the geographical access to diabetes, anaemia, hepatitis B, and HIV POC testing in the BR, Ghana for targeted improvement.
We gathered the geolocated data of 137 facilities (CHPS, Clinics, healthcare centres, and hospitals) in the BR that were providing glucose, haemoglobin (Hb), Hepatitis B Surface Antigen (Hep B), and HIV POC testing services in July 2022. We used ArcGIS 10.1 to quantify the geographical access (distance and travel time) to the nearest available testing site for each test and show places with inadequate access, for targeted improvement. The journey time was calculated assuming a speed of 20 kilometres (km)/h. ArcMap 10.1 was employed to run spatial autocorrelation (Moran Index (MI)) to determine the spatial distribution of the facilities providing the tests investigated.
Of the 137 facilities, the glucose test was available in 67 (49%), the Hb test in 55 (40%), the Hep B test in 44 (32%), and the HIV test in 73 (53%). The mean (standard deviation (SD)) for obtaining glucose tests in the region was 7.4 ± 3.7 km, Hb was 8.1 ± 4.06 km, Hep B was 8.2 ± 4.1 km, and HIV test was 7.3 ± 3.7 km by a motorised cycle. The mean SD travel time in the region to obtain the glucose test was 94.4 ± 47.2 min compared to 95.7 ± 47.8 min for Hb, 95.9 ± 47.93 min for Hep B, and 92.7 ± 46.3 min for the HIV test. Three districts (Berekum East, Dormaa East, and Jaman North) recorded shorter distances (< 10 km) and a shorter travel time to the glucose, Hb, Hep B, and HIV tests compared to the Banda district, which recorded more than 10 km for all tests investigated. Positive IM values were recorded for all the POC tests, suggesting that the health facilities providing the glucose, Hb, Hep B, and HIV tests in the BR were spatially distributed at random.
The findings revealed moderate access to all the tests in districts across the region. However, geographical access to glucose, Hb, Hep B, and HIV POC testing was poor (distance ≥ 10 km and travel time of ≥ 93 min), in the Banda district. This study showed the need to prioritise the Banda district for targeted improvement for all the tests. A further study is recommended to identify potential solutions to addressing the POC testing implementation in the BR, as demonstrated by this study.
根据世界卫生组织（WHO）的说法，糖尿病、人类免疫缺陷病毒（HIV）、乙型肝炎和贫血是全球主要的公共卫生问题。获得诊断检测对于及时发现和治疗这些疾病至关重要。WHO 已经推荐了一份基本体外诊断清单，用于各级医疗保健机构的检测。然而，在此项研究之前的一项调查显示，加纳博诺地区（BR）的这些条件的即时检测（POC）测试的可及性有限。本研究评估了加纳博诺地区糖尿病、贫血、乙型肝炎和 HIV POC 检测的地理可达性，以便有针对性地进行改进。
我们收集了 2022 年 7 月在博诺地区提供葡萄糖、血红蛋白（Hb）、乙型肝炎表面抗原（Hep B）和 HIV POC 检测服务的 137 个设施（CHPS、诊所、医疗中心和医院）的地理位置数据。我们使用 ArcGIS 10.1 来量化每个测试的最近可用测试站点的地理可达性（距离和旅行时间），并展示可达性不足的地方，以便有针对性地进行改进。假设速度为 20 公里/小时，计算了旅行时间。ArcMap 10.1 用于运行空间自相关（Moran 指数（MI）），以确定提供研究中测试的设施的空间分布。
在 137 个设施中，有 67 个（49%）提供葡萄糖测试，55 个（40%）提供 Hb 测试，44 个（32%）提供 Hep B 测试，73 个（53%）提供 HIV 测试。该地区获得葡萄糖检测的平均值（标准偏差（SD））为 7.4 ± 3.7 公里，Hb 为 8.1 ± 4.06 公里，Hep B 为 8.2 ± 4.1 公里，HIV 检测为 7.3 ± 3.7 公里通过机动自行车。该地区获得葡萄糖检测的平均 SD 旅行时间为 94.4 ± 47.2 分钟，而 Hb 为 95.7 ± 47.8 分钟，Hep B 为 95.9 ± 47.93 分钟，HIV 检测为 92.7 ± 46.3 分钟。与班达地区相比，三个地区（贝雷库姆东、多马阿东和贾曼北）记录的葡萄糖、Hb、Hep B 和 HIV 检测的距离（<10 公里）和旅行时间（<93 分钟）更短，而班达地区记录的所有检测距离都超过 10 公里。所有 POC 测试的阳性 IM 值均被记录，表明博诺地区提供葡萄糖、Hb、Hep B 和 HIV 检测的卫生设施的空间分布是随机的。
研究结果表明，该地区所有地区的所有检测都有中等的可达性。然而，在班达地区，葡萄糖、Hb、Hep B 和 HIV POC 检测的可达性较差（距离≥10 公里，旅行时间≥93 分钟）。本研究表明，需要优先考虑班达地区进行有针对性的改进，以满足所有测试的需求。建议进一步研究以确定解决本研究中所示即时检测实施的潜在解决方案。
