Ekholuenetale Michael
Faculty of Science and Health, School of Health and Care Professions, University of Portsmouth, Hampshire, United Kingdom.
PLoS One. 2025 Apr 16;20(4):e0321850. doi: 10.1371/journal.pone.0321850. eCollection 2025.
The burden of distance to healthcare facility is a factor of maternal morbidity and mortality in resource-constrained settings. In Senegal, little is known about distance or travel time as a barrier to health facility visit. The objective of this study was to assess distance as a barrier in reaching a health facility and its contributory factors among Senegalese women.
The data from 2023 Senegal Demographic and Health Survey (SDHS) was used in this study. A total sample of 16,583 women aged 15-49 years was analysed. Kaplan-Meier plot was used to estimate the median time to healthcare facilities. Furthermore, the factors of distance as a barrier in reaching a health facility were examined using multivariable Cox regression and reported as adjusted hazard ratio (aHR) with its 95% confidence intervals (CI). The statistical significance was determined at p < 0.05.
Overall, 35.8% of women reported distance as a barrier to reaching a health facility. The median time to a health facility was 13 minutes. Approximately two-thirds of the women reported walking to the nearest healthcare facility (66.4%), while others used animal-drawn cart (12.5%), motorcycle/scooter (9.3%) and car/truck (7.8%) respectively. Poular, Serer and Mandingue women had 10% (aHR= 0.90; 95% CI: 0.84-0.98), 19% (aHR= 0.81; 95% CI: 0.74-0.90) and 14% (aHR= 0.86; 95% CI: 0.76-0.97) reduction in the risk of reporting distance as a barrier in reaching a health facility, when compared with Wolof women. In addition, women from Dakar, Ziguinchor, Saint-Louis, Tambacounda, Kaolack, Thiès, Louga, Fatick, Kolda, Matam, Kaffrine, Kedougou and Sedhiou had higher risk of reporting distance as a barrier in reaching a health facility, when compared with women from Diourbel region. Rural women had 36% higher risk of reporting distance as a barrier in reaching a health facility (aHR= 1.36; 95% CI: 1.27-1.44), when compared with their urban counterparts.
Based on the findings of this study, rural and remote women have distance as a barrier to health facility visit. The travel time to a health facility is a critical indicator of the burden of distance to health facility and can therefore better inform health services planning for people residing in rural and remote locations in Senegal.
在资源有限的环境中，到医疗机构的距离负担是孕产妇发病和死亡的一个因素。在塞内加尔，对于距离或出行时间作为前往医疗机构的障碍了解甚少。本研究的目的是评估距离作为塞内加尔妇女前往医疗机构的障碍及其促成因素。
本研究使用了2023年塞内加尔人口与健康调查（SDHS）的数据。分析了16,583名年龄在15至49岁之间的女性的总样本。使用Kaplan-Meier图来估计到达医疗机构的中位时间。此外，使用多变量Cox回归检查距离作为前往医疗机构障碍的因素，并报告为调整后的风险比（aHR）及其95%置信区间（CI）。统计学显著性以p < 0.05确定。
总体而言，35.8%的女性报告距离是前往医疗机构的障碍。到达医疗机构的中位时间为13分钟。大约三分之二的女性报告步行前往最近的医疗机构（66.4%），而其他人分别使用畜力车（12.5%）、摩托车/小型摩托车（9.3%）和汽车/卡车（7.8%）。与沃洛夫族女性相比，普拉尔族、塞雷尔族和曼丁格族女性报告距离是前往医疗机构障碍的风险分别降低了10%（aHR = 0.90；95% CI：0.84 - 0.98）、19%（aHR = 0.81；95% CI：0.74 - 0.90）和14%（aHR = 0.86；95% CI：0.76 - 0.97）。此外，与来自迪乌尔贝地区的女性相比，来自达喀尔、济金绍尔、圣路易、坦巴昆达、考拉克、捷斯、卢加、法蒂克、科尔达、马塔姆、卡菲林、凯杜古和塞久的女性报告距离是前往医疗机构障碍的风险更高。与城市女性相比，农村女性报告距离是前往医疗机构障碍的风险高36%（aHR = 1.36；95% CI：1.27 - 1.44）。
基于本研究的结果，农村和偏远地区的女性因距离而难以前往医疗机构。前往医疗机构的出行时间是距离医疗机构负担的关键指标，因此可以更好地为塞内加尔农村和偏远地区居民的卫生服务规划提供信息。
