16 research outputs found
The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria.
No full textAccess to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother's area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria
“It Feels Like Somebody Cut my Legs off”: Public Transportation and the Politics of Health in Saskatchewan
No full textBackground: In May 2017, the Government of Saskatchewan closed the Saskatchewan Transportation Company (STC), a 70-year-old bus company in Saskatchewan, Canada, through an austerity budget that saw many cuts to programs and services. The government justified its decision on budgetary grounds ignoring opponents who cited the possibility of negative impacts of the decision on population health. Little research evidence exists to interrogate the closure and its implications for the health system, population health, health equity and the politics of health.
Methodology: A qualitative case study was conducted to explore the politics, health and health equity implications of the closure of STC. The study drew on 47 days of Parliamentary Hansards, 751 newspaper articles, archival material, six focus group discussions (with activists, Indigenous, health system and social services stakeholders) and 100 interviews (with former STC users). A discourse analysis was conducted on two focus groups, newspaper articles and Parliamentary Hansards. The rest of the data were subjected to a thematic analysis. The study maintained rigour through crystallisation and member checking.
Findings: The closure of STC was facilitated by a neoliberal economic policy paradigm that ignored counter-discourses of resistance from activists and advocates who argued that the bus should be maintained on human rights, climate change and other grounds. The closure of STC has had deleterious impacts on health and this is best understood through a web of
dispossession whereby the closure affects individual former bus users through missed hospital appointments and other psychosocial impacts, their family members through financial burdens and strained relationships, communities through reduced access to the commons, and the whole of society through inefficiencies in the health system and stress on health and other workers. The closure has had inequitable impacts and has exacerbated the vulnerability of women, low-income populations, Indigenous populations, seniors, newcomers, young adults, people with disabilities and rural and northern populations.
Conclusion: Austerity is bad for health. This transportation case study reveals how it affects health in the Saskatchewan context. New approaches to public policy that prioritise health in all policies (HiAP) are needed to pay attention to the negative impacts of austerity on health and health equity globally and in Saskatchewan
The tramadol sex street.
No full textCartoon by Ghanian artist Tilapia da Cartoonist, April 2018. Reproduced with permission from Tilapia da Cartoonist.</p
Public transport investments as generators of economic and social activity
No full textBackground:
High-quality public transport systems increase accessibility, which is linked to wider economic and social benefits that improve the health of the populations served. This paper reviews evidence on the existence and magnitude of these wider benefits.
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Methods:
We searched for academic studies that evaluated the effects of specific public transport investments or disinvestments on levels of economic and social activity.
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Results:
Public transport improvements increase economic activity, both at an aggregate level (higher gross domestic product) and household level (higher income), although the effect can be geographically imbalanced. Better public transport boosts employment but tends to increase house prices, leading to gentrification, although suitable policies can prevent this effect. Public transport improves social connections, especially for older people in isolated rural areas. In urban areas, it can reduce connections due to barriers to pedestrians. Disinvestment in public transport, such as closure of bus services, has multiple economic and social costs, although the evidence is still scarce.
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Conclusions:
Public transport has potentially wide but possibly unequal economic and social benefits
