Modeling Geographical Accessibility and Inequalities to Childbirth Services in the Grand Nokoué Metropolitan Area, Benin.

IF 4.1 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Yiséché S C Hounménou, Elias Martinien Avahoundjè, Aline Semaan, Christian Mahugnon Agossou, Christelle Boyi Hounsou, Mena K Agbodjavou, Giulia Scarpa, Ange D Dossou, Thierry O Lawale, Romuald Bothon, Justin Lewis Denakpo, Lenka Beňová, Jean-Paul Dossou, Peter M Macharia
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Abstract

Timely access to comprehensive , high-quality emergency obstetric and neonatal care can prevent maternal and neonatal mortality but remains challenging in Benin. We examine geographic accessibility to childbirth care (CBC) in Grand Nokoué, the largest conurbation in Benin. We gathered data on boundaries, health facilities, road network, elevation, land cover, relative wealth, urbanicity, and geo-traced travel speeds over 45 days during the rainy season. We modelled travel times (TT) to health facility offering CBC (stratified by level and sector) using the least-cost path algorithm, based on slowest, average, and fastest travel speeds. We estimated the percentage of women of childbearing age (WoCBA) within 30, 60, and 120 min of the nearest facility by subnational areas. We explored inequalities in TT by wealth quintile and urbanicity gradient. TT to nearest facility at average speed was 8 min and 24 min at slowest speed. For hospitals, this was 31 and 106 min, respectively. TT ranged from 2 to 38 min across arrondissements at average speeds. At average speeds, all WoCBA lived within 30 min of a health facility and 71.6% of a hospital. At slowest speed, this decreased to 84.7% and 22.9%, respectively, with substantial variations across arrondissements. TT to hospitals at average speed was five-fold longer among women from the poorest (50 min) compared to the richest quintile, while TT was shorter in the core urban (27 min) relative to peri-urban (46 min). TT to CBC varied by wealth and urbanicity gradient and was longer at the slowest speeds. Targeting peri-urban areas and poorest WoCBA with longer TT will reduce inequities.

建模地理可及性和不平等的分娩服务在大nokou大都市区,贝宁。
及时获得全面、高质量的产科和新生儿紧急护理可以预防孕产妇和新生儿死亡,但在贝宁仍然具有挑战性。我们检查地理可及性分娩护理(CBC)在大诺库瓦尔,在贝宁最大的城市。在雨季的45天内,我们收集了有关边界、卫生设施、道路网络、海拔、土地覆盖、相对财富、城市化和地理追踪旅行速度的数据。我们使用基于最慢、平均和最快旅行速度的最小成本路径算法,对提供CBC的医疗机构的旅行时间(TT)进行建模(按级别和部门分层)。我们按次国家地区估计了距离最近的医疗机构30、60和120分钟内的育龄妇女(WoCBA)百分比。我们通过财富五分位数和城市化梯度探讨了TT的不平等。到最近设施的平均速度为8分钟,最慢速度为24分钟。对于医院来说,这分别是31分钟和106分钟。以平均速度跨区行驶时间从2到38分钟不等。按平均速度计算,所有WoCBA居住在距离医疗机构30分钟的范围内,71.6%居住在距离医院30分钟的范围内。在最慢的速度下,这一比例分别下降到84.7%和22.9%,各地区差异很大。以平均速度前往医院的时间,最贫困妇女(50分钟)比最富裕五分之一的妇女长五倍,而核心城市妇女(27分钟)比城市周边妇女(46分钟)短。TT到CBC随财富和城市化梯度而变化,在最慢的速度下更长。以城郊地区和最贫穷的WoCBA为目标,提供较长的TT将减少不平等现象。
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来源期刊
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Journal of Urban Health-Bulletin of the New York Academy of Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
9.10
自引率
3.00%
发文量
105
审稿时长
6-12 weeks
期刊介绍: The Journal of Urban Health is the premier and authoritative source of rigorous analyses to advance the health and well-being of people in cities. The Journal provides a platform for interdisciplinary exploration of the evidence base for the broader determinants of health and health inequities needed to strengthen policies, programs, and governance for urban health. The Journal publishes original data, case studies, commentaries, book reviews, executive summaries of selected reports, and proceedings from important global meetings. It welcomes submissions presenting new analytic methods, including systems science approaches to urban problem solving. Finally, the Journal provides a forum linking scholars, practitioners, civil society, and policy makers from the multiple sectors that can influence the health of urban populations.
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