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      Physical accessibility and utilization of health services in Yemen

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          Abstract

          Background

          Assessment of physical access to health services is extremely important for planning. Complex methods that incorporate data inputs from road networks and transport systems are used to assess physical access to healthcare in industrialised countries. However, such data inputs hardly exist in many developing countries. Straight-line distances between the service provider and resident population are easily obtained but their relationship with driving distance and travel time is unclear. This study aimed to investigate the relationship between different measures of physical access, including straight-line distances, road distances and travel time and the impact of these measures on the vaccination of children in Yemen.

          Methods

          Coordinates of houses and health facilities were determined by GPS machine in Urban and rural areas in Taiz province, Yemen. Road distances were measured by an odometer of a vehicle driven from participants' houses to the nearest health centre. Driving time was measured using a stop-watch. Data on children's vaccination were collected by personal interview and verified by inspecting vaccination cards.

          Results

          There was a strong correlation between straight-line distances, driving distances and driving time (straight line distances vs. driving distance r = 0.92, p < 0.001, straight line distances vs. driving time r = 0.75; p < 0.001, driving distance vs. driving time r = 0.83, p < 0.001). Each measure of physical accessibility showed strong association with vaccination of children after adjusting for socio-economic status.

          Conclusion

          Straight-line distances, driving distances and driving time are strongly linked and associated with vaccination uptake. Straight-line distances can be used to assess physical access to health services where data inputs on road networks and transport are lacking. Impact of physical access is clear in Yemen, highlighting the need for efforts to target vaccination and other preventive healthcare measures to children who live away from health facilities.

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          Most cited references30

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          Spatial accessibility of primary care: concepts, methods and challenges

          Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S. For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care – travel impedance to nearest provider and supply level within bordered areas – lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas. This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.
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            Equity of access to health care services: theory and evidence from the UK.

            The pursuit of equity of access to health care is a central objective of many health care systems. This paper first sets out a general theoretical framework within which equity of access can be examined. It then applies the framework by examining the extent to which research evidence has been able to detect systematic inequities of access in UK, where equity of access has been a central focus in the National Health Service since its inception in 1948. Inequity between socio-economic groups is used as an illustrative example, and the extent of inequity of access experienced is explored in each of five service areas: general practitioner consultations; acute hospital care; mental health services; preventative medicine and health promotion; and long-term health care. The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.
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              Comparing alternative approaches to measuring the geographical accessibility of urban health services: Distance types and aggregation-error issues

              Background Over the past two decades, geographical accessibility of urban resources for population living in residential areas has received an increased focus in urban health studies. Operationalising and computing geographical accessibility measures depend on a set of four parameters, namely definition of residential areas, a method of aggregation, a measure of accessibility, and a type of distance. Yet, the choice of these parameters may potentially generate different results leading to significant measurement errors. The aim of this paper is to compare discrepancies in results for geographical accessibility of selected health care services for residential areas (i.e. census tracts) computed using different distance types and aggregation methods. Results First, the comparison of distance types demonstrates that Cartesian distances (Euclidean and Manhattan distances) are strongly correlated with more accurate network distances (shortest network and shortest network time distances) across the metropolitan area (Pearson correlation greater than 0.95). However, important local variations in correlation between Cartesian and network distances were observed notably in suburban areas where Cartesian distances were less precise. Second, the choice of the aggregation method is also important: in comparison to the most accurate aggregation method (population-weighted mean of the accessibility measure for census blocks within census tracts), accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 5% to 10% of census tracts. Conclusion Although errors associated to the choice of distance types and aggregation method are only important for about 10% of census tracts located mainly in suburban areas, we should not avoid using the best estimation method possible for evaluating geographical accessibility. This is especially so if these measures are to be included as a dimension of the built environment in studies investigating residential area effects on health. If these measures are not sufficiently precise, this could lead to errors or lack of precision in the estimation of residential area effects on health.
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                Author and article information

                Journal
                Int J Health Geogr
                International Journal of Health Geographics
                BioMed Central
                1476-072X
                2010
                21 July 2010
                : 9
                : 38
                Affiliations
                [1 ]Faculty of Medicine, Kuwait University, Box: 24923 Safat, 13110 Kuwait
                [2 ]School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK
                [3 ]London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 6NL, UK
                [4 ]Dept. Community Medicine and Behavioural Science, Faculty of Medicine, Kuwait University, Box: 24923 Safat, 13110 Kuwait
                Article
                1476-072X-9-38
                10.1186/1476-072X-9-38
                2914054
                20663146
                09edc52b-89a7-47b9-8fb3-d0be117afd8d
                Copyright ©2010 Al-Taiar et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 June 2010
                : 21 July 2010
                Categories
                Research

                Public health
                Public health

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