It’s a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger

International Journal of Health Geographics

Alan M MacEachren¹  Wei Luo¹  Supriya Kumar²  Justine I Blanford¹ 

[1] GeoVISTA Center, Department of Geography, The Pennsylvania State University, University Park, PA, USA;Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

关键词: Seasonal variation;    Vaccination;    Crisis management;    Geographic information system;    Meningitis;    Measles;    Infectious disease;    Niger;    Health facilities;    Accessibility;   

Others  :  811276
DOI  :  10.1186/1476-072X-11-24

 received in 2012-03-29, accepted in 2012-06-21,  发布年份 2012

【 摘 要 】

Background

Ease of access to health care is of great importance in any country but particularly in countries such as Niger where restricted access can put people at risk of mortality from diseases such as measles, meningitis, polio, pneumonia and malaria. This paper analyzes the physical access of populations to health facilities within Niger with an emphasis on the effect of seasonal conditions and the implications of these conditions in terms of availability of adequate health services, provision of drugs and vaccinations. The majority of the transport within Niger is pedestrian, thus the paper emphasizes access by those walking to facilities for care. Further analysis compared the change in accessibility for vehicular travel since public health workers do travel by vehicle when carrying out vaccination campaigns and related proactive health care activities.

Results

The majority of the roads in Niger are non-paved (90%). Six districts, mainly in the region of Tahoua lack medical facilities. Patient to health facility ratios were best in Agadez with 7000 people served per health facility. During the dry season 39% of the population was within 1-hours walk to a health center, with the percentage decreasing to 24% during the wet season. Further analyses revealed that vaccination rates were strongly correlated with distance. Children living in clusters within 1-hour of a health center had 1.88 times higher odds of complete vaccination by age 1-year compared to children living in clusters further from a health center (p < 0.05). Three key geographic areas were highlighted where access to health centers took greater than 4 h walk during the wet and dry season. Access for more than 730,000 people can be improved in these areas with the addition of 17 health facilities to the current total of 504 during the dry season (260,000 during the wet season).

Conclusions

This study highlights critical areas in Niger where health services/facilities are lacking. A second finding is that population served by health facilities will be severely overestimated if assessments are solely conducted during the dry season. Mapped outputs can be used for future decision making processes and analysis.

【 授权许可】

   
2012 Blanford et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH: Poverty and access to health care in developing countries. Ann N Y Acad Sci 2008, 1136:161-171.
• [2]Al-Taiar A, Clark A, Longenecker JC, Whitty CJM: Physical accessibility and utilization of health services in Yemen. Int J Health Geogr 2010, 9:38. BioMed Central Full Text
• [3]Tanser F: Methodology for optimising location of new primary health care facilities in rural communities: a case study in KwaZulu-Natal, South Africa. J Epidemiol Community Health 2006, 60(10):846-850.
• [4]Noor AM, Amin AA, Gething PW, Atkinson PM, Hay SI, Snow RW: Modelling distances travelled to government health services in Kenya. Trop Med Int Health 2006, 11(2):188-196.
• [5]O'Meara WP, Noor A, Gatakaa H, Tsofa B, McKenzie FE, Marsh K: The impact of primary health care on malaria morbidity–defining access by disease burden. TM & IH 2009, 14(1):29-35.
• [6]Schoeps A, Gabrysch S, Niamba L, Sie A, Becher H: The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso. Am J Epidemiol 2011, 173(5):492-498.
• [7]Noor AM, Zurovac D, Hay SI, Ochola SA, Snow RW: Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya. Trop Med Int Health 2003, 8(10):917-926.
• [8]Feikin DR, Nguyen LM, Adazu K, Ombok M, Audi A, Slutsker L, Lindblade KA: The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Trop Med Int Health 2009, 14(1):54-61.
• [9]Muller I, Smith T, Mellor S, Rare L, Genton B: The effect of distance from home on attendance at a small rural health centre in Papua New Guinea. Int J Epidemiol 1998, 27(5):878-884.
• [10]Stock R: Distance and The Utilization of Health Facilities in Rural Nigeria. Soc Sci Med 1983, 17(9):563-570.
• [11]CIA – The world factbook – Niger. http://www.cia.gov/library/publications/the-world-factbook/geos/ng.html webcite
• [12]WHO: Global Health Indicators. Part II. Geneva: World Health Organization (WHO); 2005:135.
• [13]WHO: Country Health System Fact Sheet 2006. Niger. Geneva: World Health Organization (WHO); 2006:135.
• [14]SNIS: Annuaires Statistiques du Niger Annee 2002. Republique du Niger: Ministere de la Sante Publicque et de la Lutte Contre les Endemies Secretariat General Systeme national D’information Sanitaire; 2002.
• [15]SNIS: Annuaires Statistiques du Niger Annee 2003. Republique du Niger: Ministere de la Sante Publicque et de la Lutte Contre les Endemies Secretariat General Systeme national D’information Sanitaire; 2003.
• [16]SNIS: Annuaires Statistiques du Niger Annee 2004. Republique du Niger: Ministere de la Sante Publicque et de la Lutte Contre les Endemies Secretariat General Systeme national D’information Sanitaire; 2004.
• [17]SNIS: Annuaires Statistiques du Niger Annee 2005. Republique du Niger: Ministere de la Sante Publicque et de la Lutte Contre les Endemies Secretariat General Systeme national D’information Sanitaire; 2005.
• [18]SNIS: Annuaires Statistiques du Niger Annee 2006. Republique du Niger: Ministere de la Sante Publicque et de la Lutte Contre les Endemies Secretariat General Systeme national D’information Sanitaire; 2006.
• [19]SNIS: Annuaires Statistiques du Niger Annee 2009. Republique du Niger: Ministere de la Sante Publicque et de la Lutte Contre les Endemies Secretariat General Systeme national D’information Sanitaire; 2009.
• [20]SNIS: Direction des statistiques, de la surveillance et de la riposte aux epidemies. Annuaire des Statistiques Sanitaires du Niger. Republique du Niger: Ministere de la Sante Publique; 2006.
• [21]Lim SS, Stein DB, Charrow A, Murray CJ: Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. Lancet 2008, 372(9655):2031-2046.
• [22]Measure DHS: Final Report. DHS, Niger; 2006.
• [23]Tarhule A: Damaging rainfall and flooding: The other sahel hazards. Clim Chang 2005, 72(3):355-377.
• [24]At a glance: Niger. Floods devastate Agadez region of Niger. http://www.unicef.org/emerg/niger_51221.html webcite
• [25]Disaster relief emergency fund. Niger: Floods. http://www.ifrc.org/docs/appeals/11/MDRNE008.pdf webcite
• [26]UNWFP_ODAP: Niger Flood-Affected Areas. World Food Programme(WFP) Emergency Preparedness and Response Branch 2006.
• [27]Loewenberg S: Niger welcomes largest bednet distribution in history. Lancet 2006, 367(9521):1473.
• [28]Ousmane I, Issifi S, Lama M, Roy J, Hoyer S, Haskew J, Hawley W, Wolkon A, Watkins M, et al.: Distribution of Insecticide-Treated Bednets During a Polio Immunization Campaign --- Niger, 2005. MMWR 2006, 55(33):913-916.
• [29]Fighting polio across Niger’s Sahara desert. http://www.unicef.org/infobycountry/niger_25017.html webcite
• [30]BBC: Meningitis. Season 5 Episode 12. TV series – Kill or Cure? 2007.
• [31]BBC: Malaria Field Medicine. Season 4 Episode 9. TV Series – Kill or Cure? 2006.
• [32]Elliott J: Battling to keep children alive. London: BBC News; 2005.
• [33]Defourny I, Minetti A, Harczi G, Doyon S, Shepherd S, Tectonidis M, Bradol JH, Golden M: A large-scale distribution of milk-based fortified spreads: evidence for a new approach in regions with high burden of acute malnutrition. PLoS One 2009, 4(5):e5455.
• [34]In the midst of Niger’s vaccination campaign, treatment is essential for those who contract meningitis. http://www.msf.org/msfinternational/invoke.cfm?objectid=AE2CB404-15C5-F00A-25E72D258AAB7F12&component=toolkit.article&method=full_html webcite
• [35]Poku-Boansi M, Ekekpe E, Bonney AA: Combating maternal mortality in the Gushegu district of Ghana: The role of rural transportation. J Sustainable Dev Afr 2010, 12(5):274-283.
• [36]Safe Motherhood in Niger (EOC Survey). http://niger.unfpa.org/docs/Emergency%20Obstetric%20Care%20(Survey).pdf webcite
• [37]Niger. http://www.travellerspoint.com/guide/Niger/ webcite
• [38]Oppong JR: Accommodating the rainy season in third world location-allocation applications. Socioecon Plann Sci 1996, 30(2):121-137.
• [39]Ewing VL, Lalloo DG, Phiri KS, Roca-Feltrer A, Mangham LJ, SanJoaquin MA: Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi. Malar J 2011, 10:32. BioMed Central Full Text
• [40]Gele AA, Sagbakken M, Abebe F, Bjune GA: Barriers to tuberculosis care: a qualitative study among Somali pastoralists in Ethiopia. BMC research notes 2010, 3:86. BioMed Central Full Text
• [41]Nankabirwa V, Nankabirwa V, Tylleskar T, Tumwine JK, Sommerfelt H: Maternal education is associated with vaccination status of infants less than 6 months in Eastern Uganda: a cohort study. BMC Pediatr 2010, 10:92. BioMed Central Full Text
• [42]Cockcroft A, Andersson N, Omer K, Ansari NM, Khan A, Chaudhry UU, Ansari U: One size does not fit all: local determinants of measles vaccination in four districts of Pakistan. BMC Int Health Hum Rights 2009, 9(Suppl 1):S4. BioMed Central Full Text
• [43]Parashar S: Moving beyond the mother-child dyad: women's education, child immunization, and the importance of context in rural India. Soc Sci Med 2005, 61(5):989-1000.
• [44]Cassell JA, Leach M, Fairhead JR, Small M, Mercer CH: The social shaping of childhood vaccination practice in rural and urban Gambia. Health Policy Plan 2006, 21(5):373-391.
• [45]Mutua MK, Kimani-Murage E, Ettarh RR: Childhood vaccination in informal urban settlements in Nairobi, Kenya: who gets vaccinated? BMC Publ Health 2011, 11(1):6. BioMed Central Full Text
• [46]Mitchell S, Andersson N, Ansari NM, Omer K, Soberanis JL, Cockcroft A: Equity and vaccine uptake: a cross-sectional study of measles vaccination in Lasbela District, Pakistan. BMC Int Health Hum Rights 2009, 9(Suppl 1):S7. BioMed Central Full Text
• [47]Kumar D, Aggarwal A, Gomber S: Immunization status of children admitted to a tertiary-care hospital of north India: reasons for partial immunization or non-immunization. J Health Popul Nutr 2010, 28(3):300-304.
• [48]Sullivan MC, Tegegn A, Tessema F, Galea S, Hadley C: Minding the immunization gap: family characteristics associated with completion rates in rural Ethiopia. J Community Health 2010, 35(1):53-59.
• [49]Waters HR, Dougherty L, Tegang SP, Tran N, Wiysonge CS, Long K, Wolfe ND, Burke DS: Coverage and costs of childhood immunizations in Cameroon. Bull World Health Organ 2004, 82(9):668-675.
• [50]Danis K, Georgakopoulou T, Stavrou T, Laggas D, Panagiotopoulos T: Socioeconomic factors play a more important role in childhood vaccination coverage than parental perceptions: a cross-sectional study in Greece. Vaccine 2010, 28(7):1861-1869.
• [51]Babalola S, Lawan U: Factors predicting BCG immunization status in northern Nigeria: a behavioral-ecological perspective. J Child Health Care 2009, 13(1):46-62.
• [52]Sia D, Fournier P, Kobiane JF, Sondo BK: Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998–2003). BMC Publ Health 2009, 9:416. BioMed Central Full Text
• [53]Babalola S: Determinants of the uptake of the full dose of diphtheria-pertussis-tetanus vaccines (DPT3) in Northern Nigeria: a multilevel analysis. Matern Child Health J 2009, 13(4):550-558.
• [54]Tanser F, Hosegood V, Benzler J, Solarsh G: New approaches to spatially analyse primary health care usage patterns in rural South Africa. TM & IH 2001, 6(10):826-838.
• [55]Brabyn L, Skelly C: Modeling population access to New Zealand public hospitals. Int J Health Geogr 2002, 1:3. BioMed Central Full Text
• [56]Ridde V, Diarra A: A process evaluation of user fees abolitioin for pregnant women and children under five years in two districts in Niger (West Africa). BMC Health Serv Res 2009, 9:89. BioMed Central Full Text
• [57]Sociéte Nigerienne de Transports de Voyageurs. http://en.wikipedia.org/wiki/SNTV_%28Niger%29 webcite
• [58]Mampasu C: Niger: How many children like Haoua will die?. Diffa: Save the Children; 2010.
• [59]Bestow A: Bilma Salt and Camels. In The S Files: Travellers reports from the Sahara Edited by Scott C. 2006.
• [60]Bonobo2005: Travel Tips in Niger. Virtualtourist 2005.
• [61]Joris A, Joris E: Tenere crossing. Amsterdam: Joris & Joris in Afrika Van Kaapstad naar Amerdam; 2005.
• [62]Nelson A: Accessibility, transport and travel time information. In CIAT Hillsides Project Report. International Center for Tropical Agriculture (CIAT), Cali; 2000.
• [63]Nelson A, Leclerc G: A spatial model of accessibility: Linking population and infrastructure to land use patterns in the Honduran Hillsides. Alburquerque: University of New Mexico Press; 2007.
• [64]Pozzi F, Robinson T: Accessibility Mapping in the Horn of Africa: Applications for Livestock Policy. In Working Paper No 11–08. IGAD LPI; 2008:35.
• [65]Tanser F, Gijsbertsen B, Herbst K: Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system. Soc Sci Med 2006, 63(3):691-705.
• [66]Getting around Niger. http://www.worldtravelguide.net/country/199/internal_travel/Africa/Niger.html webcite
• [67]Juliao RP: Measuring accessibility using GIS. In GeoComputation '99: 25–28 July 1999. Mary Washington College, Fredericksburg; 1999.
• [68]Oppong JR, Hodgson MJ: SPATIAL ACCESSIBILITY TO HEALTH-CARE FACILITIES IN SUHUM DISTRICT, GHANA. Prof Geogr 1994, 46(2):199-209.
• [69]Schuurman N, Berube M, Crooks VA: Measuring potential spatial access to primary health care physicians using a modified gravity model. Canadian Geographer-Geographe Canadien 2010, 54(1):29-45.
• [70]ESRI: Spatial Analyst: Cost Distance algorithm. In ArcGIS 93 Desktop Help Documentation. Environmental Systems Research Institute, Redlands; 2009.
• [71]Ray N, Ebener S: AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients. Int J Health Geogr 2008, 7:63. BioMed Central Full Text
• [72]Nelson A: Estimated travel time to the nearest city of 50,000 or more people in year 2000. Ispra, Italy: Global Environment Monitoring Unit - Joint Research Centre of the European Commission; 2008.
• [73]Niger River floods destroying homes and crops. http://www.bbc.co.uk/news/world-africa-10929144 webcite
• [74]In pictures: Niger’s flood disaster. http://www.bbc.co.uk/news/world-africa-11063255 webcite
• [75]U.N: Niger flooding displaces nearly 200,000. http://articles.cnn.com/2010-08-29/world/niger.floods_1_heavy-rains-sahel-world-food-program?_s=PM:WORLD webcite
• [76]NIGER: Desert flooding wipes out electricity, homes, livestock. http://www.irinnews.org/report.aspx?reportid=85996 webcite
• [77]World_Bank: African Development Indicators. Washington: World Bank; 2001:366.
• [78]Lee BY, Assi TM, Rajgopal J, Norman BA, Chen SI, Brown ST, Slayton RB, Kone S, Kenea H, Welling JS, et al.: Impact of introducing the pneumococcal and rotavirus vaccines into the routine immunization program in Niger. Am J Public Health 2012, 102(2):269-276.
• [79]WHO: Financial Sustainability Plan of the EPI-Niger. Geneva: WHO; 2011:35.
• [80]MeasureDHS: Frequently Asked Questions. Calverton: MEASURE DHS; 2012.
• [81]Measure DHS: Incorporating geographic information into MEASURE surveys. Calverton: MEASURE DHS; 2004.
• [82]Langsten R, Hill K: The accuracy of mothers' reports of child vaccination: evidence from rural Egypt. Soc Sci Med 1998, 46(9):1205-1212.
• [83]Immunization Profile - Niger. http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=ner webcite
• [84]Alkire S, Santos ME: Acute Multidimensional Poverty: A New Index for Developing Countries. Oxford Poverty & Human Development Initiative (OPHI); Working Paper Series, 38
• [85]WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation: Types of drinking-water sources and sanitation. http://www.wssinfo.org/definitions-methods/watsan-categories/ webcite
• [86]Scientific Software International, Inc: HLM for Windows Version 7.0. Skokie: Scientific Software International, Inc; 2011.
• [87]shitijmehta: Create Hexagons - Case Study. ArcGIS Resource Center - Geoprocessing Model and Script Tool Gallery 2010.
• [88]Capus G, Bourrelier P, Souley M: Uranium Mining in Niger; Status and Perspectives of a Top Five Producing Country. London: World Nuclear Association Annual Symposium; 2004.
• [89]Bryce J, Requejo JH: Tracking Progress in Maternal, Newborn and Child Survival: The 2008 Report. New York: UNICEF; 2008.
• [90]Zhou FJ, Santoli J, Messonnier ML, Yusuf HR, Shefer A, Chu SY, Rodewald L, Harpaz R: Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001. Arch Pediat Adol Med 2005, 159(12):1136-1144.
• [91]Acharya A, Diaz-Ortega JL, Tambini G, Quadros C, Arita I: Cost-effectiveness of measles elimination in Latin America and the Caribbean: a prospective analysis. Vaccine 2002, 20(27–28):3332-3341.
• [92]Dayan GH, Cairns L, Sangrujee N, Mtonga A, Nguyen V, Strebel P: Cost-effectiveness of three different vaccination strategies against measles in Zambian children. Vaccine 2004, 22(3–4):475-484.
• [93]Tomaszewski B, Blanford J, Ross K, Pezanowski S, MacEachren AM: Supporting geographically-aware web document foraging and sensemaking. Comput Environ Urban Syst 2011, 35:192-207.
• [94]Proposal for health systems strengthening support from GAVI. http://www.gavialliance.org/resources/14a._FINAL_NIGER_REQUETE_RSS_GAVI_22_04_2010_en.doc webcite
• [95]Niger: Surveys. http://www.measuredhs.com/what-we-do/survey/survey-display-277.cfm webcite
• [96]Paireau J, Girond F, Collard JM, Mainassara HB, Jusot JF: Analysing spatio-temporal clustering of meningococcal meningitis outbreaks in niger reveals opportunities for improved disease control. PLoS Negl Trop Dis 2012, 6(3):e1577.
• [97]Bengtsson L, Lu X, Thorson A, Garfield R, von Schreeb J: Improved Response to Disasters and Outbreaks by Tracking Population Movements with Mobile Phone Network Data: A Post-Earthquake Geospatial Study in Haiti. PLoS Med 2011, 8(8):e1001083.
• [98]Kahabuka C, Kvale G, Moland KM, Hinderaker SG: Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania. BMC Health Serv Res 2011, 11(1):315. BioMed Central Full Text
• [99]Chuma J, Okungu V, Molyneux C: Barriers to prompt and effective malaria treatment among the poorest population in Kenya. Malar J 2010, 9:144. BioMed Central Full Text
• [100]Russell S: Treatment-seeking behaviour in urban Sri Lanka: trusting the state, trusting private providers. Soc Sci Med 2005, 61(7):1396-1407.
• [101]Ensor T, Cooper S: Overcoming barriers to health service access: influencing the demand side. Health Policy Plan 2004, 19:69-79.
• [102]Ndirangu J, Barnighausen T, Tanser F, Tint K, Newell ML: Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu-Natal, South Africa*. TM & IH 2009, 14(11):1383-1393.
• [103]Hundt GL, Alzaroo S, Hasna F, Alsmeiran M: The provision of accessible, acceptable health care in rural remote areas and the right to health: Bedouin in the North East region of Jordan. Soc Sci Med 2012, 74:36-43.