Access to care following injury in Northern Malawi, a comparison of travel time estimates between Geographic Information System and community household reports

作者：John Whitaker, Giulia Brunelli, Thomas P. Van Boeckel, Albert Lazarous Nkhata Dube, Abena Serwaa Amoah, Rory F Rickard, Andrew J M Leather, Justine Ina Davies · 发表于：Injury · 年份：2022 · DOI：10.1016/j.injury.2022.02.010 · 被引用次数：20 · 研究领域：Trauma and Emergency Care Studies、Injury Epidemiology and Prevention、Global Health and Surgery

INTRODUCTION: Injuries disproportionately impact low- and middle-income countries like Malawi. The Lancet Commission on Global Surgery's indicators include the population proportion accessing laparotomy and open fracture care, key trauma interventions, within two hours. The "Golden Hour" for receiving facility-based resuscitation also guides injury care system strengthening. Firstly, we estimated the proportion of the local population able to reach primary, secondary and tertiary facility care within two and one hours using Geographic Information System (GIS) analysis. Secondly, we compared community household-reported with GIS-estimated travel time. METHODS: Using information from a Health and Demographic Surveillance Site (Karonga, Malawi) on road network, facility location, and local staff-estimated travel speeds, we used a GIS-generated friction surface to calculate the shortest travel time from all households to each facility serving the population. We surveyed community households who reported travel time to their preferred, closest, government secondary and tertiary facilities. For recently injured community members, time to reach facility care was recorded. To assess the relationship between community household-reported travel time and GIS-estimated travel time, we used linear regression to generate a proportionality constant. To assess associations and agreement between injured patient-reported and GIS-estimated travel time, we used Kendall rank and Cohen's kappa tes...