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Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

Geospatial mapping of access to timely essential surgery in sub-Saharan Africa
Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

Introduction Despite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level. Methods Major district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level. results Overall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern. Conclusion The study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.

2059-7908
1-10
Broer, P. Niclas
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Klug, Stefanie J.
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Snow, Rachel C.
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Okiro, Emelda A.
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Ouma, Paul O.
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Snow, Robert W.
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Tatem, Andrew J.
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Meara, John G.
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Alegana, Victor A.
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Juran, Sabrina
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Broer, P. Niclas
92c67a36-c74d-43ec-b13e-58e5a1698974
Klug, Stefanie J.
3c8f1c95-e654-4064-ad61-59d9a95e075c
Snow, Rachel C.
18157d44-ec5e-4c4d-a49f-794ee53d5b21
Okiro, Emelda A.
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Ouma, Paul O.
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Snow, Robert W.
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Tatem, Andrew J.
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Meara, John G.
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Alegana, Victor A.
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Juran, Sabrina
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Broer, P. Niclas, Klug, Stefanie J., Snow, Rachel C., Okiro, Emelda A., Ouma, Paul O., Snow, Robert W., Tatem, Andrew J., Meara, John G., Alegana, Victor A. and Juran, Sabrina (2018) Geospatial mapping of access to timely essential surgery in sub-Saharan Africa. BMJ Global Health, 3 (4), 1-10. (doi:10.1136/bmjgh-2018-000875).

Record type: Article

Abstract

Introduction Despite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level. Methods Major district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level. results Overall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern. Conclusion The study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.

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Accepted/In Press date: 6 July 2018
e-pub ahead of print date: 18 August 2018

Identifiers

Local EPrints ID: 428666
URI: https://eprints.soton.ac.uk/id/eprint/428666
ISSN: 2059-7908
PURE UUID: 4bfb8828-37ee-4ca6-bc9b-803240e3a44b
ORCID for Andrew J. Tatem: ORCID iD orcid.org/0000-0002-7270-941X
ORCID for Victor A. Alegana: ORCID iD orcid.org/0000-0001-5177-9227

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Date deposited: 06 Mar 2019 17:30
Last modified: 10 Dec 2019 01:37

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Contributors

Author: P. Niclas Broer
Author: Stefanie J. Klug
Author: Rachel C. Snow
Author: Emelda A. Okiro
Author: Paul O. Ouma
Author: Robert W. Snow
Author: Andrew J. Tatem ORCID iD
Author: John G. Meara
Author: Sabrina Juran

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