ArticleBMJ global health2019
Referral transit time between sending and first-line receiving health facilities: a geographical analysis in Tanzania.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review.Journal of global health · 2022Pooled it
- Inter-facility travel time and referral for emergency obstetric care in the 15 most populated cities of Nigeria: a spatial analysis.BMC global and public health · 2026Article
- Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda.International journal for equity in health · 2025Article
- The National Ambulance Service of Ghana: Changes in capacity and utilization over 20 years.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Using digital technology as a platform to strengthen the continuum of care at community level for maternal, child and adolescent health in Tanzania: introducing the Afya-Tek program.BMC health services research · 2024Article
- Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis.BMJ open · 2024Article
- Hospital readiness for the provision of care to critically ill patients in Tanzania- an in-depth cross-sectional study.BMC health services research · 2024Article
- Participants' experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting.Global mental health (Cambridge, England) · 2024Article
- Advancing primary care: Establishing family medicine specialty in Tanzania.African journal of primary health care & family medicine · 2023Article
- A geospatial analysis of accessibility and availability to implement the primary healthcare roadmap in Ethiopia.Communications medicine · 2023Article
- Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia.International journal of health geographics · 2023Article
- Editorial: Policy issues and perspectives in referrals and access to quality health care services.Frontiers in health services · 2023Article
- Article
- Travel scenario workshops for geographical accessibility modeling of health services: A transdisciplinary evaluation study.Frontiers in public health · 2022Article
- Patterns of referral for refugees in western Tanzania: a retrospective review.The Pan African medical journal · 2022Article
- Evaluating urban-rural access to pathology and laboratory medicine services in Tanzania.Health policy and planning · 2021Article
- Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia.BMC health services research · 2021Article
- A network analysis of patient referrals in two district health systems in Tanzania.Health policy and planning · 2021Article
- Article
- "In cities, it's not far, but it takes long": comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria.BMJ global health · 2021Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTimely, high-quality obstetric services are vital to reduce maternal and perinatal mortality. We spatially modelled referral pathways between sending and receiving health facilities in Kigoma Region, Tanzania, identifying communication and transportation delays to timely care and inefficient links within the referral system.
methodsWe linked sending and receiving facilities to form facility pairs, based on information from a 2016 Health Facility Assessment. We used an AccessMod cost-friction surface model, incorporating road classifications and speed limits, to estimate direct travel time between facilities in each pair. We adjusted for transportation and communications delays to create a total travel time, simulating the effects of documented barriers in this referral system.
resultsMore than half of the facility pairs (57.8%) did not refer patients to facilities with higher levels of emergency obstetric care. The median direct travel time was 25.9 min (range: 4.4-356.6), while the median total time was 106.7 min (22.9-371.6) at the moderate adjustment level. Total travel times for 30.7% of facility pairs exceeded 2 hours. All facility pairs required some adjustments for transportation and communication delays, with 94.0% of facility pairs' total times increasing.
conclusionHalf of all referral pairs in Kigoma Region have travel time delays nearly exceeding 1 hour, and facility pairs referring to facilities providing higher levels of care also have large travel time delays. Combining cost-friction surface modelling estimates with documented transportation and communications barriers provides a more realistic assessment of the effects of inter-facility delays on referral networks, and can inform decision-making and potential solutions in referral systems within resource-constrained settings.
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