Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria
Abstract Background Women in low- and middle-income countries (LMIC) remain at high risk of developing cervical cancer and have limited access to screening programs. The limits include geographical barriers related to road network characteristics and travel behaviors but these have neither been well...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-07-01
|
Series: | International Journal of Health Geographics |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12942-020-00222-4 |
id |
doaj-6904f2f350874d9592da72cf5f774e82 |
---|---|
record_format |
Article |
spelling |
doaj-6904f2f350874d9592da72cf5f774e822020-11-25T03:02:15ZengBMCInternational Journal of Health Geographics1476-072X2020-07-0119111410.1186/s12942-020-00222-4Modeling spatial access to cervical cancer screening services in Ondo State, NigeriaKathleen Stewart0Moying Li1Zhiyue Xia2Stephen Ayodele Adewole3Olusegun Adeyemo4Clement Adebamowo5Department of Geographical Sciences, Center for Geospatial Information Science, University of MarylandDepartment of Geographical Sciences, Center for Geospatial Information Science, University of MarylandDepartment of Geographical Sciences, Center for Geospatial Information Science, University of MarylandDepartment of Obstetrics and Gynaecology, University of Medicine Teaching HospitalCenter for Bioethics and ResearchDepartment of Epidemiology and Public Health and Greenebaum Comprehensive Cancer Center, Institute of Human Virology, University of Maryland School of MedicineAbstract Background Women in low- and middle-income countries (LMIC) remain at high risk of developing cervical cancer and have limited access to screening programs. The limits include geographical barriers related to road network characteristics and travel behaviors but these have neither been well studied in LMIC nor have methods to overcome them been incorporated into cervical cancer screening delivery programs. Methods To identify and evaluate spatial barriers to cervical cancer prevention services in Ondo State, Nigeria, we applied a Multi-Mode Enhanced Two-Step Floating Catchment Area model to create a spatial access index for cervical cancer screening services in Ondo City and the surrounding region. The model used inputs that included the distance between service locations and population centers, local population density, quantity of healthcare infrastructures, modes of transportation, and the travel time budgets of clients. Two different travel modes, taxi and mini bus, represented common modes of transit. Geocoded client residential locations were compared to spatial access results to identify patterns of spatial access and estimate where gaps in access existed. Results Ondo City was estimated to have the highest access in the region, while the largest city, Akure, was estimated to be in only the middle tier of access. While 73.5% of clients of the hospital in Ondo City resided in the two highest access zones, 21.5% of clients were from locations estimated to be in the lowest access catchment, and a further 2.25% resided outside these limits. Some areas that were relatively close to cervical cancer screening centers had lower access values due to poor road network coverage and fewer options for public transportation. Conclusions Variations in spatial access were revealed based on client residential patterns, travel time differences, distance decay assumptions, and travel mode choices. Assessing access to cervical cancer screening better identifies potentially underserved locations in rural Nigeria that can inform plans for cervical cancer screening including new or improved infrastructure, effective resource allocation, introduction of service options for areas with lower access, and design of public transportation networks.http://link.springer.com/article/10.1186/s12942-020-00222-4Spatial accessibilityCancer screening servicesHealth care planningNigeriaLow-and middle-income countries |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kathleen Stewart Moying Li Zhiyue Xia Stephen Ayodele Adewole Olusegun Adeyemo Clement Adebamowo |
spellingShingle |
Kathleen Stewart Moying Li Zhiyue Xia Stephen Ayodele Adewole Olusegun Adeyemo Clement Adebamowo Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria International Journal of Health Geographics Spatial accessibility Cancer screening services Health care planning Nigeria Low-and middle-income countries |
author_facet |
Kathleen Stewart Moying Li Zhiyue Xia Stephen Ayodele Adewole Olusegun Adeyemo Clement Adebamowo |
author_sort |
Kathleen Stewart |
title |
Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria |
title_short |
Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria |
title_full |
Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria |
title_fullStr |
Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria |
title_full_unstemmed |
Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria |
title_sort |
modeling spatial access to cervical cancer screening services in ondo state, nigeria |
publisher |
BMC |
series |
International Journal of Health Geographics |
issn |
1476-072X |
publishDate |
2020-07-01 |
description |
Abstract Background Women in low- and middle-income countries (LMIC) remain at high risk of developing cervical cancer and have limited access to screening programs. The limits include geographical barriers related to road network characteristics and travel behaviors but these have neither been well studied in LMIC nor have methods to overcome them been incorporated into cervical cancer screening delivery programs. Methods To identify and evaluate spatial barriers to cervical cancer prevention services in Ondo State, Nigeria, we applied a Multi-Mode Enhanced Two-Step Floating Catchment Area model to create a spatial access index for cervical cancer screening services in Ondo City and the surrounding region. The model used inputs that included the distance between service locations and population centers, local population density, quantity of healthcare infrastructures, modes of transportation, and the travel time budgets of clients. Two different travel modes, taxi and mini bus, represented common modes of transit. Geocoded client residential locations were compared to spatial access results to identify patterns of spatial access and estimate where gaps in access existed. Results Ondo City was estimated to have the highest access in the region, while the largest city, Akure, was estimated to be in only the middle tier of access. While 73.5% of clients of the hospital in Ondo City resided in the two highest access zones, 21.5% of clients were from locations estimated to be in the lowest access catchment, and a further 2.25% resided outside these limits. Some areas that were relatively close to cervical cancer screening centers had lower access values due to poor road network coverage and fewer options for public transportation. Conclusions Variations in spatial access were revealed based on client residential patterns, travel time differences, distance decay assumptions, and travel mode choices. Assessing access to cervical cancer screening better identifies potentially underserved locations in rural Nigeria that can inform plans for cervical cancer screening including new or improved infrastructure, effective resource allocation, introduction of service options for areas with lower access, and design of public transportation networks. |
topic |
Spatial accessibility Cancer screening services Health care planning Nigeria Low-and middle-income countries |
url |
http://link.springer.com/article/10.1186/s12942-020-00222-4 |
work_keys_str_mv |
AT kathleenstewart modelingspatialaccesstocervicalcancerscreeningservicesinondostatenigeria AT moyingli modelingspatialaccesstocervicalcancerscreeningservicesinondostatenigeria AT zhiyuexia modelingspatialaccesstocervicalcancerscreeningservicesinondostatenigeria AT stephenayodeleadewole modelingspatialaccesstocervicalcancerscreeningservicesinondostatenigeria AT olusegunadeyemo modelingspatialaccesstocervicalcancerscreeningservicesinondostatenigeria AT clementadebamowo modelingspatialaccesstocervicalcancerscreeningservicesinondostatenigeria |
_version_ |
1724690623360925696 |