The winding road to health: A systematic scoping review on the effect of geographical accessibility to health care on infectious diseases in low- and middle-income countries.

Fleur Hierink,Antoine Flahault,Nicolas Ray,Emelda A Okiro,Claudia Marotta

doi:10.1371/journal.pone.0244921

Fleur Hierink, Antoine Flahault + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0244921

Copy DOI

Abstract

BackgroundGeographical accessibility to healthcare is an important component of infectious disease dynamics. Timely access to health facilities can prevent disease progression and enables disease notification through surveillance systems. The importance of accounting for physical accessibility in response to infectious diseases is increasingly recognized. Yet, there is no comprehensive review of the literature available on infectious diseases in relation to geographical accessibility to care. Therefore, we aimed at evaluating the current state of knowledge on the effect of geographical accessibility to health care on infectious diseases in low- and middle-income countries.Methods and findingsA search strategy was developed and conducted on Web of Science and PubMed on 4 March 2019. New publications were checked until May 28, 2020. All publication dates were eligible. Data was charted into a tabular format and descriptive data analyses were carried out to identify geographical regions, infectious diseases, and measures of physical accessibility among other factors. Search queries in PubMed and Web of Science yielded 560 unique publications. After title and abstract screening 99 articles were read in full detail, from which 64 articles were selected, including 10 manually. Results of the included publications could be broadly categorized into three groups: (1) decreased spatial accessibility to health care was associated with a higher infectious disease burden, (2) decreased accessibility was associated to lower disease reporting, minimizing true understanding of disease distribution, and (3) the occurrence of an infectious disease outbreak negatively impacted health care accessibility in affected regions. In the majority of studies, poor geographical accessibility to health care was associated with higher disease incidence, more severe health outcomes, higher mortality, and lower disease reporting. No difference was seen between countries or infectious diseases.ConclusionsCurrently, policy-makers and scientists rely on data collected through passive surveillance systems, introducing uncertainty on disease estimates for remote communities. Our results highlight the need for increasing integration of geographical accessibility measures in disease risk modelling, allowing more realistic disease estimates and enhancing our understanding of true disease burden. Additionally, disease risk estimates could be used in turn to optimize the allocation of health services in the prevention and detection of infectious diseases.

Highlights

Infectious diseases remain a major cause of global disease burden [1], especially in low resource settings where insufficient resources, inadequate infrastructures and poor access to health services impact disease outcomes [2, 3]
Results of the included publications could be broadly categorized into three groups: (1) decreased spatial accessibility to health care was associated with a higher infectious disease burden, (2) decreased accessibility was associated to lower disease reporting, minimizing true understanding of disease distribution, and (3) the occurrence of an infectious disease outbreak negatively impacted health care accessibility in affected regions
Policy-makers and scientists rely on data collected through passive surveillance systems, introducing uncertainty on disease estimates for remote communities

Summary

Introduction

Infectious diseases remain a major cause of global disease burden [1], especially in low resource settings where insufficient resources, inadequate infrastructures and poor access to health services impact disease outcomes [2, 3]. Access to health facilities can prevent further disease progression and as a result improves individual and public health outcomes [4]. Large disparities in geographical (i.e. physical or spatial) accessibility persist because facilities are present at finite fixed locations while health needs vary across space and time, which potentially poses higher risks to remote communities [5, 6]. Poor physical accessibility to health facilities is a important spatial aspect of disease control, as it delays or limits case detection through passive surveillance systems [4, 7, 8]. When distance to health care hinders accessibility, mild infections might develop into severe disease stages, potentially leading to suboptimal care outside the health system or even mortality. Access to health facilities can prevent disease progression and enables disease notification through surveillance systems. We aimed at evaluating the current state of knowledge on the effect of geographical accessibility to health care on infectious diseases in lowand middle-income countries.

Methods

Results

Discussion

Conclusion