Population demand, healthcare resourcing, and transportation linkage are considered as major determinants of spatial access to health care. Temporal changes of the 3 determinants would result in gain or loss of spatial access to health care. As a remarkable milestone achieved by Targeted Poverty Reduction Project launched in China, the significant improvements in spatial access to health care served as an ideal context for investigating the relative contributions of these 3 determinants to the changes in spatial access to health care in a rural county. A national level poverty-stricken county, Chishui county from Guizhou province, China, was chosen as our study area. The enhanced two-step floating catchment area model and the chain substitution method were employed for analysis. The relative contributions of the 3 determinants demonstrated variations with villages. The relative contributions of healthcare resourcing were positive in all villages as indicated by sharp increases in healthcare resources. Population changes and transportation infrastructure expansion had both negative and positive effects on spatial access to health care for different villages. Decisionmakers should take into account the duration of travel time spent between where people live, where transport hubs are located, and where healthcare services are delivered in the process of formulating policies toward rural healthcare planning. For villages with poorly-established infrastructure, the optimization of population distribution and healthcare resourcing should be considered as the priority. A stronger marginal effect would be induced by transportation infrastructure expansion with increased spatial accessibility. This study provides empirical evidences to inform healthcare planning in low- and middle-income countries.

https://journals.sagepub.com/doi/pdf/10.1177/00469580221146041

The Contributions of Population Distribution, Healthcare Resourcing, and Transportation Infrastructure to Spatial Accessibility of Health Care

During the last quarter century the developing world has been experiencing rapid urban growth. These rapidly changing urban landscapes can create many new opportunities for economic growth but the same processes can also generate spatial inequalities within urban boundaries. Using recent and comprehensive geospatial data we describe, map and examine one dimension of urban spatial inequality, our results suggest that accessiblity to urban facilities and services. Our case study is Tehran; one of the most rapidly growing cities in the Middle East and he developing world. Geospatial data, Geographic Information Systems and spatial analytical tools were combined for mapping accessibility to thirty different urban facilities and services in Tehran. Descriptive maps identify areas of under and over services. Also we use the Herfindahl–Hirschman Index (HHI), commonly used in economics, to calculate the geographical distribution of urban facilities. Our results suggest that accessibility to urban facilities and services is widely varying within Tehran; with better accessibility found in some northern, central, and southern districts as well as in those districts lying along a north–south axis. Differences in HHI values reveal spatial inequality in geographical distribution of many facilities and services, particularly those of potential interest to demographers and health researchers (e.g., Red Crescent centers). The use of recent geospatial data to map and derive measures of accessibility can help both urban and public health planners to take the best courses of action to tackle the (spatial) inequality in access to urban facilities and infrastructure mainly public health facilities. Similarly, these data can be used to generate contextual variables for neighborhoods, districts and other subunits in the city that can be combined with health studies to examine the role of place characteristics in health disparities.

Measuring Spatial Accessibility to Urban Facilities and Services in Tehran

Population and development have a mutual relationship, and more to the point, lack of sufficient knowledge on population development and fertility can lead to the presentation of inappropriate population plans in such a way that they may turn out to be useless and ineffective even in the event of implementation. So, the present study aimed to delve into the feasibility of implementing the new governmental policies on increasing birth rate with an emphasis on the socioeconomic status in Kermanshah Metropolis, Iran. To evaluate poverty and fertility in Kermanshah Metropolis, the present cross-sectional study used the latest statistics obtained from the Statistical Center of Iran (2011), and as for the data analysis, such tests in Arc/GIS and SPSS 20 software. The results of the present study showed that the spatial patterns of poverty and fertility were formed in clusters across the city, and the results of variance analysis of the relationship between the variables of fertility and poverty demonstrated that there was a significant difference between the selected neighborhoods in terms of the variables of poverty and total fertility (P < 0.001). Furthermore, the spatial autocorrelations of fertility and poverty in Kermanshah were positive and showed that the spatial means and standard distances of poverty and fertility were overlapping. Not all districts and urban neighborhoods were equal in the total fertility rate. So, given the societal classes’ different socioeconomic and cultural status across different neighborhoods, the government’s new approaches to increasing birthrate cannot be applied to all classes throughout Kermanshah Metropolis.

A Feasibility Study of Implementing the Policies on Increasing Birth Rate with an Emphasis on Socio-economic Status: A Case Study of Kermanshah Metropolis, Western Iran

Aim The present study aimed to investigate the distribution pattern of HIV using the spatial statistics (Mean Center and Standard Distance) and spatial clustering tests (Average Nearest Neighbor, Moran's I index and Getis-Ord generalG) in Kermanshah Metropolis, western Iran. Background It is believed that the application of GIS towards studying the distribution of HIV, could supply the health care policy makers with insights into this disease in Iran. Materials and methods In this analytical study the population of research was the whole of HIV-stricken patients of Kermanshah, Iran. To identify and determine the spatial patterns of HIV in the metropolis of Kermanshah, the statistical models of basic graphics and interpolation (Moran's I index and Getis-Ord generalG) in the environment of GIS were used. Results The standard deviation oval of HIV occurrence in the city of Kermanshah over 1996–2002 explains the fact that HIV prevalence is highly dispersed in different parts of Kermanshah. The results indicate that HIV prevalence is expanding across the metropolis of Kermanshah. In addition, the concentration of the disease is so dominant in east, southeast and west of Kermanshah that has formed a HIV corridor. Conclusion The results of study relating to HIV across the city of Kermanshah demonstrated that HIV prevalence was clustered (not accidental) and followed a regular basis over the period under study.

Identifying HIV distribution pattern based on clustering test using GIS software, Kermanshah, Iran

Background Surveillance of health care-associated infections (HCAIs) is an integral part of infection control programmes, especially in intensive care units (ICUs) Device-associated infections (DAIs) are a major threat to patient safety Aim To measure DAI rates in ICUs Methods Central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter- associated urinary tract infection (CAUTI) were assessed in the ICUs of 4 tertiary-care teaching hospitals in Tehran, Islamic Republic of Iran Results The incidence rate of CLABSI, VAP and CAUTI was 1020, 2108 and 742 per 1000 device-days, respectively The utilization ratio for central lines, ventilators and urinary catheters was 062, 047, and 084, respectively The most common organisms were Acinetobacter (335 %) and Klebsiella (190 %) Sixty to eighty percent of Enterobacteriaceae were extended- spectrum beta-lactamase producing About half of Pseudomonas aeruginosa isolates were resistant to piperacillin/ tazobactam and carbapenem Acinetobacter resistance rate to ampicillin/sulbactam and carbapenem was 70-80 % The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus was 846 % and 833 %, respectively Conclusions This study showed high incidence rates of DAIs and resistant organisms, and appropriate interventions are necessary to reduce these rates

/pdf/assessment-of-device-associated-infection-rates-in-teaching-26wdyffmaj.pdf

Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran.

Geographic information systems (GIS) analysis has not been widely used in underdeveloped countries to ensure that vulnerable populations have accessibility to primary health-care services. This study applied GIS methods to analyse the spatial accessibility to urban primary-care centres of the population in Kermanshah city, Islamic Republic of Iran, by age and sex groups. In a descriptive-analytical study over 3 time periods, network analysis, mean centre and standard distance methods were applied using ArcGIS 9.3. The analysis was based on a standard radius of 750 m distance from health centres, walking speed of 1 m/s and desired access time to health centres of 12.5 mins. The proportion of the population with inadequate geographical access to health centres rose from 47.3% in 1997 to 58.4% in 2012. The mean centre and standard distance mapping showed that the spatial distribution of health centres in Kermanshah needed to be adjusted to changes in population distribution.

/pdf/spatial-accessibility-of-the-population-to-urban-health-54at3vpk5z.pdf

Spatial accessibility of the population to urban health centres in Kermanshah, Islamic Republic of Iran: a geographic information systems analysis.

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Spatial accessibility of the population to urban health centres in Kermanshah, Islamic Republic of Iran: a geographic information systems analysis.