ArticlePLOS global public health2022
Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar.
Article in PLOS global public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Delay in malaria care-seeking for children under five in Africa: a systematic review.Malaria journal · 2026Pooled it
- Epidemiology of surgical site infections post-cesarean section in Africa: a comprehensive systematic review and meta-analysis.BMC pregnancy and childbirth · 2025Pooled it
- Economic Burden of Human Immunodeficiency Virus and Hypertension Care Among MOPHADHIV Trial Participants: Patient Costs and Determinants of Out-of-Pocket Expenditure in South Africa.International journal of environmental research and public health · 2025Trial
- Bringing malaria diagnosis and treatment closer to the people: economic rationale for expanding malaria community case management to all ages in a rural district in Madagascar.Malaria journal · 2025Trial
- Evaluating tuberculosis service accessibility in Pakistan by analyzing population movement patterns from telecom mobility and survey data.BMC global and public health · 2026Article
- Reimagining Data for Equity: Reaching the Unreached Map Explorer for Localized Public Health Intelligence in the Western Pacific Region.JMIR public health and surveillance · 2026Article
- Informal and out-of-pocket payments for public-sector contraceptive care in remote Madagascar.Contraception · 2026Article
- Community use of oral rehydration solution and antibiotics for diarrhea in the Far North and Littoral regions of Cameroon: distribution and determinants.Scientific reports · 2026Article
- Community health volunteers improve access to malaria case management in Siaya County, Kenya.Malaria journal · 2026Article
- Housing distance, salt intake and cardiovascular risk in rural Aceh Tamiang: Insights utilizing the WHO 10-year non-laboratory assessment.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index.BMC health services research · 2026Article
- Circulating genotypes of human papillomavirus in adult women of reproductive age from the Boeny region of Madagascar: a cross-sectional study to explore needs and opportunities for HPV vaccination in the country.BMC infectious diseases · 2026Article
- Evaluation of Midwife-Led Colposcopy for Female Genital Schistosomiasis Screening at Primary Level of Care in Rural Madagascar: A Cross-Sectional Study.Tropical medicine & international health : TM & IH · 2026Article
- A consensus-based evaluation framework for telehealth in resource-constrained settings: evidence from a community Delphi study in Colombia.Frontiers in digital health · 2026Article
- Health Equity Barriers to Accessing Vaccination and Screening Services in Low- and Middle-Income Countries: A Narrative Review.Risk management and healthcare policy · 2026Review
- Role of telemedicine in bridging the healthcare gap: application of the hub and spokes model in the Hohoe Municipality, Ghana.Frontiers in digital health · 2026Article
- Analytical validation of Smilo.ai: evaluating an AI-driven platform for automated oral health screening and global diagnostic accessibility.Frontiers in oral health · 2026Article
- A questionnaire survey of healthcare access and dietary habits in a rural Japanese community: implications for potential community pharmacy roles.Journal of pharmaceutical health care and sciences · 2025Article
- Two-leaves and many bites: Profiling dog-bites and adherence to rabies prophylaxis in tea-estate communities of Udalguri District, Assam, India.PLoS neglected tropical diseases · 2025Article
- Disparities in spatial access to healthcare facilities for pregnant women: a case study of a hilly region in India.BMC pregnancy and childbirth · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Geographic distance is a critical barrier to healthcare access, particularly for rural communities with poor transportation infrastructure who rely on non-motorized transportation. There is broad consensus on the importance of community health workers (CHWs) to reduce the effects of geographic isolation on healthcare access. Due to a lack of fine-scale spatial data and individual patient records, little is known about the precise effects of CHWs on removing geographic barriers at this level of the healthcare system. Relying on a high-quality, crowd-sourced dataset that includes all paths and buildings in the area, we explored the impact of geographic distance from CHWs on the use of CHW services for children under 5 years in the rural district of Ifanadiana, southeastern Madagascar from 2018-2021. We then used this analysis to determine key features of an optimal geographic design of the CHW system, specifically optimizing a single CHW location or installing additional CHW sites. We found that consultation rates by CHWs decreased with increasing distance patients travel to the CHW by approximately 28.1% per km. The optimization exercise revealed that the majority of CHW sites (50/80) were already in an optimal location or shared an optimal location with a primary health clinic. Relocating the remaining CHW sites based on a geographic optimum was predicted to increase consultation rates by only 7.4%. On the other hand, adding a second CHW site was predicted to increase consultation rates by 31.5%, with a larger effect in more geographically dispersed catchments. Geographic distance remains a barrier at the level of the CHW, but optimizing CHW site location based on geography alone will not result in large gains in consultation rates. Rather, alternative strategies, such as the creation of additional CHW sites or the implementation of proactive care, should be considered.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.