Journal of Preventive Medicine and Public Health

  • 제55권1호
  • /
  • Pages.49-59
  • /
  • 2022
  • /
  • 1975-8375(pISSN)
  • /
  • 2233-4521(eISSN)
대한예방의학회 (The Korean Society for Preventive Medicine)
권호 표지
DOI QR코드

DOI QR Code

A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran

  • 투고 : 2021.07.17
  • 심사 : 2021.10.31
  • 발행 : 2022.02.03
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objectives: Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran. Methods: First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties. Results: It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider. Conclusions: This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

키워드

참고문헌

  1. Rahbar M, Ahmadi M, Lornejad H, Habibelahi A, Sanaei-Shoar T, Mesdeaghinia A. Mortality causes in children 1-59 months in Iran. Iran J Public Health 2013;42(Supple1):93-97.
  2. World Health Organization. Country profile: health system profile, Islamic Republic of Iran; 2006 [cited 2021 Jul 1]. Available from: http://www.emro.who.int/human-resources-observatory/countries/country-profile.html.
  3. Campbell OM, Graham WJ; Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006;368(9543):1284-1299. https://doi.org/10.1016/S0140-6736(06)69381-1
  4. Hare TS, Barcus HR. Geographical accessibility and Kentucky's heart-related hospital services. Appl Geogr 2007;27(3-4):181-205. https://doi.org/10.1016/j.apgeog.2007.07.004
  5. Combier E, Charreire H, Le Vaillant M, Michaut F, Ferdynus C, Amat-Roze JM, et al. Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy. Health Place 2013;24:225-233. https://doi.org/10.1016/j.healthplace.2013.09.006
  6. Pilkington H, Blondel B, Papiernik E, Cuttini M, Charreire H, Maier RF, et al. Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe. Health Place 2010;16(3):531-538. https://doi.org/10.1016/j.healthplace.2009.12.011
  7. Blondel B, Drewniak N, Pilkington H, Zeitlin J. Out-of-hospital births and the supply of maternity units in France. Health Place 2011;17(5):1170-1173. https://doi.org/10.1016/j.healthplace.2011.06.002
  8. Vali Y, Rashidian A, Jalili M, Omidvari AH, Jeddian A. Effectiveness of regionalization of trauma care services: a systematic review. Public Health 2017;146:92-107. https://doi.org/10.1016/j.puhe.2016.12.006
  9. Okwaraji YB, Mulholland K, Schellenberg JR, Andarge G, Admassu M, Edmond KM. The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia. A community based cross sectional study. BMC Public Health 2012;12:476. https://doi.org/10.1186/1471-2458-12-476
  10. Kedziora DJ, Stuart RM, Pearson J, Latypov A, Dierst-Davies R, Duda M, et al. Optimal allocation of HIV resources among geographical regions. BMC Public Health 2019;19(1):1509. https://doi.org/10.1186/s12889-019-7681-5
  11. Breckenkamp J, Mielck A, Razum O. Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health 2007;7:132. https://doi.org/10.1186/1471-2458-7-132
  12. Berns SD, Kott A, DeGroat N, Paap K, Signorile K, Umemoto A. Toward improving the outcome of pregnancy III: enhancing perinatal health through quality, safety and performance initiatives; 2010 [cited 2021 Jul 1]. Available from: https://www.marchofdimes.org/toward-improving-the-outcome-of-pregnancy-iii.pdf.
  13. Nguyen YL, Kahn JM, Angus DC. Reorganizing adult critical care delivery: the role of regionalization, telemedicine, and community outreach. Am J Respir Crit Care Med 2010;181(11):1164-1169. https://doi.org/10.1164/rccm.200909-1441CP
  14. Siegel E, Gillings D, Campbell S, Guild P. A controlled evaluation of rural regional perinatal care: impact on mortality and morbidity. Am J Public Health 1985;75(3):246-253. https://doi.org/10.2105/AJPH.75.3.246
  15. Gortmaker S, Sobol A, Clark C, Walker DK, Geronimus A. The survival of very low-birth weight infants by level of hospital of birth: a population study of perinatal systems in four states. Am J Obstet Gynecol 1985;152(5):517-524. https://doi.org/10.1016/0002-9378(85)90618-0
  16. McCormick MC, Shapiro S, Starfield BH. The regionalization of perinatal services. Summary of the evaluation of a national demonstration program. JAMA 1985;253(6):799-804. https://doi.org/10.1001/jama.1985.03350300087026
  17. Paneth N, Kiely JL, Wallenstein S, Marcus M, Pakter J, Susser M. Newborn intensive care and neonatal mortality in low-birthweight infants: a population study. N Engl J Med 1982;307(3):149-155. https://doi.org/10.1056/NEJM198207153070303
  18. Rashidian A, Omidvari AH, Vali Y, Mortaz S, Yousefi-Nooraie R, Jafari M, et al. The effectiveness of regionalization of perinatal care services-a systematic review. Public Health 2014;128(10):872-885. https://doi.org/10.1016/j.puhe.2014.08.005
  19. Brown SA, Richards ME, Elwell EC, Rayburn WF. Geographical information systems for mapping maternal ground transport to level III care neonatal centers. Am J Perinatol 2014;31(4):287-292. https://doi.org/10.1055/s-0033-1348029
  20. Baray J, Cliquet G. Optimizing locations through a maximum covering/p-median hierarchical model: maternity hospitals in France. J Bus Res 2013;66(1):127-132. https://doi.org/10.1016/j.jbusres.2012.09.003
  21. Tao Z, Cheng Y, Liu J. Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China. Int J Equity Health 2020;19(1):164. https://doi.org/10.1186/s12939-020-01280-7
  22. Marandi SA, Farrokhzad N, Moradi R, Rezaeizadeh G, Shariat M, Nayeri FS. Review of the Iranian newborns' health, survival, and care and future challenges. Arch Iran Med 2019;22(7):403-409.
  23. Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So near, so far: four decades of health policy reforms in Iran, achievements and challenges. Arch Iran Med 2019;22(10):592-605.
  24. Asadi-Lari M, Sayyari AA, Akbari ME, Gray D. Public health improvement in Iran--lessons from the last 20 years. Public Health 2004;118(6):395-402. https://doi.org/10.1016/j.puhe.2004.05.011
  25. IndexMundi. Iran - mortality rate [cited 2021 Jul 1]. Available from: https://www.indexmundi.com/facts/iran/mortalityrate#SH.DYN.NMRT.
  26. Khajavi A, Pishgar F, Dehghani M, Naderimagham S. Socioeconomic inequalities in neonatal and postneonatal mortality: evidence from rural Iran, 1998-2013. Int J Equity Health 2017;16(1):83. https://doi.org/10.1186/s12939-017-0570-6
  27. Mohammadi Daniali Z, Sepehri MM, Movahedi Sobhani F, Heidarzadeh M. Equitable distribution of neonatal intensive care unit: a healthcare planning case study. Int J Hosp Res 2020;9(2):1-17.
  28. Khalili N, Moradi-Lakeh M, Heidarzadeh M. Low birth weight in Iran based on Iranian Maternal and Neonatal Network (IMaN). Med J Islam Repub Iran 2019;33:30.
  29. Rashidian A, Yousefi NR, Azemikhah A, Heydarzadeh M, Changizi N, Mahta BF, et al. Perinatal care regionalization and geographical distribution model in the Islamic Republic of Iran. Hakim Res J 2008;11(2):1-11 (Persian).
  30. Saaty TL. A scaling method for priorities in hierarchical structures. J Math Psychol 1977;15(3):234-281. https://doi.org/10.1016/0022-2496(77)90033-5
  31. Liberatore MJ, Nydick RL. The analytic hierarchy process in medical and health care decision making: a literature review. Eur J Oper Res 2008;189(1):194-207. https://doi.org/10.1016/j.ejor.2007.05.001
  32. Church R, ReVelle C. The maximal covering location problem. Pap Reg Sci Assoc 1974;32(1):101-118. https://doi.org/10.1007/BF01942293
  33. Dell'Olmo P, Ricciardi N, Sgalambro A. A multiperiod maximal covering location model for the optimal location of intersection safety cameras on an urban traffic network. Procedia Soc Behav Sci 2014;108:106-117. https://doi.org/10.1016/j.sbspro.2013.12.824
  34. Smith HK, Harper PR, Potts CN. Bicriteria efficiency/equity hierarchical location models for public service application. J Oper Res Soc 2013;64(4):500-512. https://doi.org/10.1057/jors.2012.68