Geospatial mapping to estimate timely access to surgical care in nine low-income and middle-income countries

Raykar, Nakul; Bowder, Alexis N.; Liu, Charles; Vega, Martha; Kim, Jong H.; Boye, Gloria N.; Greenberg, Sarah L M; Riesel, Johanna N; Gillies, Robyn M.; Meara, John G.; Roy, Nobhojit

doi:10.1016/s0140-6736(15)60811-x

Cited by 32 publications

(41 citation statements)

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“…Since our model applies the upper bound of the interval, it ascribes timely access to half of the rural population even though the scarcity of rural surgical providers means most of these patients live hours away from the nearest surgeon, which would preclude timely access even in the presence of excellent prehospital transportation. 19 …”

Section: Discussionmentioning

confidence: 99%

“…In 2013, for example, rural Sierra Leone had a surgeon-to-population ratio almost four times lower than that of the urban areas. 19 Therefore, low surgical rates are a specific but insensitive indicator of access; if surgery is not being done, it follows that surgical care is not being delivered; however, high surgical rates cannot speak to the distribution of surgical access.…”

Section: Discussionmentioning

confidence: 99%

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Global access to surgical care: a modelling study

Alkire

Raykar

Shrime

et al. 2015

The Lancet Global Health

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504

395

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Summary Background More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission’s vision. Methods We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. Findings At least 4·8 billion people (95% posterior credible interval 4·6–5·0 [67%, 64–70]) of the world’s population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Interpretation Most of the world’s population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. Funding None.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Global access to surgical care: a modelling study

Alkire

Raykar

Shrime

et al. 2015

The Lancet Global Health

Self Cite

504

395

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“… 31 , 32 Only 17% of Somalilanders live within 2 hours of a surgeon. 33 Somaliland includes the following 6 regions: Awdal, Maroodi Jeex, Sahil, Sanaag, Sool, and Togdheer. Of the total population of 4 million people, approximately 50% are children younger than 16 years.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Pediatric Surgical Conditions Across Somaliland

et al. 2019

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Key Points Question What is the prevalence of pediatric surgical conditions in Somaliland? Findings In this cross-sectional study that included 1503 children in Somaliland, the prevalence of pediatric surgical conditions was 12.2%. Only 23.7% of surgical conditions had been corrected at the time of this study. Meaning A scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in low- and middle-income countries is warranted.

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“…We note that studies in many other fields of medicine have used driving distance as a measure of access to care. 2,3 As noted in our paper, driving distance estimated by network road analysis is superior to straight line and centroids of polygons. 4 From a policy perspective, commercial insurance providers such as Blue Cross Blue Shield and the US Veteran's Administration Choice Program use driving distance to health care providers for defining their access to care standards.…”

Section: Diane Gibson Phdmentioning

confidence: 55%

“…2 Additionally, Lee et al 1 presented no empirical evidence to support the statement that provider density measures grossly underestimate availability. Their critique that county-level provider density measures do not consider the proximity of ophthalmologists and optometrists in neighboring counties is well-taken and is also mentioned as a caveat by Gibson,2 but the validity of this point does not necessarily mean that countylevel provider density measures grossly underestimate availability.…”

mentioning

confidence: 99%