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Geographic accessibility to childhood tuberculosis care in Pakistan
Aashifa Yaqoob1,2, Muhammad Rizwan Alvi3, Razia Fatima1
1Research Unit, Common Management Unit [TB, HIV/AIDS & Malaria], Islamabad, Pakistan.
Insights
Childhood tuberculosis (TB) diagnosis is challenging in Pakistan. While primary healthcare access is widespread, specialized TB services are geographically limited, requiring improved referral systems for effective child TB care.
Area of Science:
- Public Health
- Geospatial Analysis
- Pediatric Infectious Diseases
Background:
- Childhood tuberculosis (TB) diagnosis presents significant challenges, often requiring specialized pediatric expertise.
- Pakistan's healthcare system relies on referrals from primary to secondary/tertiary care for complex cases like childhood TB.
- Primary healthcare facilities in Pakistan often lack the capacity to diagnose childhood TB.
Purpose of the Study:
- To assess the geographical accessibility of child TB services within Pakistan.
- To evaluate the population's proximity to healthcare facilities capable of diagnosing childhood TB.
Main Methods:
- Geospatial analysis using qGIS was employed to determine distances from settlements to public health facilities.
- Calculated population distribution within the World Health Organization's (WHO) recommended 5-km radius for healthcare access.
- Assessed geographical access to both primary and specialized child TB diagnostic services.
Main Results:
- Only 14.1% of primary facilities report child TB cases, despite 74% of the population having access to general primary care within 5 km.
- Geographical access to secondary and tertiary care, crucial for TB diagnosis, is limited to 33.5% of the population within 5 km.
- The average distance to a specialized child TB diagnostic site was 26.3 km, with significant disparities noted in provinces like Balochistan.
Conclusions:
- Pakistan's healthcare system demonstrates broad primary care coverage but faces significant gaps in specialized childhood TB services.
- Effective management of childhood TB hinges on a robust referral system from communities to higher-level care.
- Improving geographical access to specialized pediatric TB diagnostic facilities is critical for timely and accurate diagnosis.
Background:
Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan.
Objective:
We aimed to determine the geographical access to child TB services in Pakistan.
Method:
We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization's (WHO) recommended 5-km distance.
Result:
At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services.
Conclusion:
With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.
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