THE EFFECT OF GEOGRAPHY AND DEMOGRAPHY ON OUTCOMES OF UGANDAN EMERGENCY DEPARTMENT PATIENTS Open Access

Abstract

Background: In Sub-Saharan Africa (SSA) geography represents a significant challenge to accessing health services. Patients' ability to negotiate these challenges is strongly influenced by poverty, urban versus rural household location (urbanicity), and transportation options. Numerous studies have demonstrated the influence of these factors on healthcare access, but their influence on health outcomes has not been well understood. Geographic barriers to healthcare access and outcomes in the clinical context of emergency care in SSA have not been studied. Understanding the influence of these factors on emergency care access and outcomes can inform future emergency care development and resource allocation among central hospital-based care and pre-hospital care and transportation.

Methods: An emergency department in Rukungiri district, Uganda has collected patient demographic, geographic and outcome data since 2009. We used geographic imaging systems to measure and categorized patient distance-to-hospital into <5km, 5 to <10km, and 10km+ tertiles. Urbanicity and poverty data was available at the subcounty level. We used logistic regression modeling to evaluate if patients' distance-to-hospital is associated with 3-day mortality, controlling for urbanicity, poverty prevalence, age, gender and dry versus rainy season.

Results: 3767 Rukungiri residents with sufficient geographic information were treated in the emergency department from November 2010 to November 2012, with an observed 3-day mortality of 2.0%. Distance-to-hospital was found to be positively associated to 3-day mortality after controlling for poverty, urbanicity, age and malnutrition. Compared to patients living <5km from the hospital, patients living 5km to <10km from the hospital had 1.7 times the odds of 3-day death (95% CI: 0.8-3.7, p=0.155), and patients living 10km+ from the hospital had 2.2 times the odds of 3-day death (95% CI: 1.0-5.0; p=0.048).

Conclusion: Distance-to-hospital is an independent risk factor for 3-day mortality of emergency department patients after controlling for other demographic risk factors. This may have implications for the future development of emergency care in Uganda and SSA.

Table of Contents

Table of Contents

1. Introduction........................... 1

2. Background ............................ 2

3. Methods .................................. 6

4. Results ................................... 12

5. Discussion ............................. 14

6. References ............................. 18

7. Tables .................................... 26

8. Figures .................................. 29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Rural Urban Healthcare outcomes Sub-Saharan Africa Emergency Medicine Poverty Geography Demography Transportation Uganda Healthcare access
Committee Chair / Thesis Advisor	Ward, Kevin C., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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