Impact of traffic, poverty and facility ownership on travel time to emergency care in Nairobi, Kenya.
Emergency care
Kenya
Poverty
Traffic
Journal
African journal of emergency medicine : Revue africaine de la medecine d'urgence
ISSN: 2211-4203
Titre abrégé: Afr J Emerg Med
Pays: Netherlands
ID NLM: 101572277
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
10
09
2019
revised:
09
12
2019
accepted:
19
12
2019
entrez:
13
3
2020
pubmed:
13
3
2020
medline:
13
3
2020
Statut:
ppublish
Résumé
In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world. We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between travel time and socioeconomic status. We estimate the average minimum travel time during uncongested traffic conditions to any level 4 health facility (primary hospitals) or above in Nairobi to be 4.5 min (IQR 2.5-6.1). Traffic added an average of 9.0 min (a 200% increase). In uncongested conditions, we estimate an average travel time of 7.9 min (IQR 5.1-10.4) to level 5 facilities (secondary hospitals) and 11.6 min (IQR 8.5-14.2) to Kenyatta National Hospital, the only level 6 facility (tertiary hospital) in the country. Traffic congestion added an average of 13.1 and 16.0 min (166% and 138% increase) to travel times to level 5 and level 6 facilities, respectively. For individuals living below the poverty line, we estimate that preferential use of public or faith-based facilities could increase travel time by as much as 65%. Average travel times to health facilities capable of providing emergency care in Nairobi are quite low, but traffic congestion double or triple estimated travel times. Furthermore, we estimate significant disparities in timely access to care for those individuals living under the poverty line who preferentially seek care in public or faith-based facilities.
Sections du résumé
BACKGROUND
BACKGROUND
In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world.
METHODS
METHODS
We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between travel time and socioeconomic status.
RESULTS
RESULTS
We estimate the average minimum travel time during uncongested traffic conditions to any level 4 health facility (primary hospitals) or above in Nairobi to be 4.5 min (IQR 2.5-6.1). Traffic added an average of 9.0 min (a 200% increase). In uncongested conditions, we estimate an average travel time of 7.9 min (IQR 5.1-10.4) to level 5 facilities (secondary hospitals) and 11.6 min (IQR 8.5-14.2) to Kenyatta National Hospital, the only level 6 facility (tertiary hospital) in the country. Traffic congestion added an average of 13.1 and 16.0 min (166% and 138% increase) to travel times to level 5 and level 6 facilities, respectively. For individuals living below the poverty line, we estimate that preferential use of public or faith-based facilities could increase travel time by as much as 65%.
CONCLUSION
CONCLUSIONS
Average travel times to health facilities capable of providing emergency care in Nairobi are quite low, but traffic congestion double or triple estimated travel times. Furthermore, we estimate significant disparities in timely access to care for those individuals living under the poverty line who preferentially seek care in public or faith-based facilities.
Identifiants
pubmed: 32161711
doi: 10.1016/j.afjem.2019.12.003
pii: S2211-419X(19)30163-6
pmc: PMC7058857
doi:
Types de publication
Journal Article
Langues
eng
Pagination
40-45Subventions
Organisme : NEI NIH HHS
ID : K23 EY029246
Pays : United States
Informations de copyright
© 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.
Déclaration de conflit d'intérêts
The authors declared no conflicts of interest. Dr Benjamin Wachira is an editor of the African Journal of Emergency Medicine. Dr Wachira was not involved in the editorial workflow for this manuscript.
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