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Geospatial analysis of pediatric surgical need and geographical access to care in Somaliland: a cross-sectional study
Cesia F Cotache-Condor1, Katelyn Moody1, Tessa Concepcion2
1Department of Public Health, Baylor University, Waco, Texas, USA.
Insights
Children in Somaliland face significant delays in accessing surgical care, with less than 10% receiving timely treatment. Geospatial analysis reveals critical disparities in paediatric surgical access, especially in rural areas.
Area of Science:
- Global Health
- Surgical Care Access
- Geospatial Analysis
Background:
- Paediatric surgical disease presents a substantial global health burden, disproportionately impacting low- and middle-income countries (LMICs).
- Geospatial analysis provides critical tools for quantifying and visualizing disparities in surgical care delivery within LMICs.
Purpose of the Study:
- To analyze the geographical distribution of paediatric surgical conditions in Somaliland.
- To evaluate geographical access to essential surgical care for children in Somaliland.
Main Methods:
- Utilized Surgeons OverSeas Assessment of Surgical Need, WHO Surgical Assessment Tool, and Global Initiative for Children's Surgery surveys.
- Collected data from 1503 children and 15 hospitals across Somaliland.
- Employed geospatial tools including hotspot analysis, service area analysis, Voronoi diagrams, and Inverse Distance Weighted interpolation.
Main Results:
- Less than 10% of children in Somaliland have timely access to surgical care.
- Travel times to surgical care can exceed 12 hours by public transport and 2 days by foot.
- Significant geographical disparities in paediatric surgical conditions and care access were identified, with Sahil and Sool regions showing the greatest need and poorest coverage.
Conclusions:
- Wide disparities exist in paediatric surgical disease distribution and access to care across Somaliland.
- Geospatial analysis is crucial for identifying underserved areas and guiding resource allocation for scaling up paediatric surgical services.
Background:
The global burden of disease in children is large and disproportionally affects low-income and middle-income countries (LMICs). Geospatial analysis offers powerful tools to quantify and visualise disparities in surgical care in LMICs. Our study aims to analyse the geographical distribution of paediatric surgical conditions and to evaluate the geographical access to surgical care in Somaliland.
Methods:
Using the Surgeons OverSeas Assessment of Surgical Need survey and a combined survey from the WHO's (WHO) Surgical Assessment Tool-Hospital Walkthrough and the Global Initiative for Children's Surgery Global Assessment in Paediatric Surgery, we collected data on surgical burden and access from 1503 children and 15 hospitals across Somaliland. We used several geospatial tools, including hotspot analysis, service area analysis, Voronoi diagrams, and Inverse Distance Weighted interpolation to estimate the geographical distribution of paediatric surgical conditions and access to care across Somaliland.
Results:
Our analysis suggests less than 10% of children have timely access to care across Somaliland. Patients could travel up to 12 hours by public transportation and more than 2 days by foot to reach surgical care. There are wide geographical disparities in the prevalence of paediatric surgical conditions and access to surgical care across regions. Disparities are greater among children travelling by foot and living in rural areas, where the delay to receive surgery often exceeds 3 years. Overall, Sahil and Sool were the regions that combined the highest need and the poorest surgical care coverage.
Conclusion:
Our study demonstrated wide disparities in the distribution of surgical disease and access to surgical care for children across Somaliland. Geospatial analysis offers powerful tools to identify critical areas and strategically allocate resources and interventions to efficiently scale-up surgical care for children in Somaliland.
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