Geographic accessibility and hospital competition for emergency blood transfusion services in Bungoma, Western Kenya.

BACKGROUND: Estimating accessibility gaps to essential health interventions helps to allocate and prioritize health resources. Access to blood transfusion represents an important emergency health requirement. Here, we develop geo-spatial models of accessibility and competition to blood transfusion services in Bungoma County, Western Kenya. METHODS: Hospitals providing blood transfusion services in Bungoma were identified from an up-dated geo-coded facility database. AccessMod was used to define care-seeker's travel times to the nearest blood transfusion service. A spatial accessibility index for each enumeration area (EA) was defined using modelled travel time, population demand, and supply available at the hospital, assuming a uniform risk of emergency occurrence in the county. To identify populations marginalized from transfusion services, the number of people outside 1-h travel time and those residing in EAs with low accessibility indexes were computed at the sub-county level. Competition between the transfusing hospitals was estimated using a spatial competition index which provided a measure of the level of attractiveness of each hospital. To understand whether highly competitive facilities had better capacity for blood transfusion services, a correlation test between the computed competition metric and the blood units received and transfused at the hospital was done. RESULTS: 15 hospitals in Bungoma county provide transfusion services, however these are unevenly distributed across the sub-counties. Average travel time to a blood transfusion centre in the county was 33 min and 5% of the population resided outside 1-h travel time. Based on the accessibility index, 38% of the EAs were classified to have low accessibility, representing 34% of the population, with one sub-county having the highest marginalized population. The computed competition index showed that hospitals in the urban areas had a spatial competitive advantage over those in rural areas. CONCLUSION: The modelled spatial accessibility has provided an improved understanding of health care gaps essential for health planning. Hospital competition has been illustrated to have some degree of influence in provision of health services hence should be considered as a significant external factor impacting the delivery, and re-design of available services.

Yield of Tuberculosis Contact Screening and Predictors of Contact Tuberculosis Diagnosis in Bungoma County Hospital, Kenya.

Tuberculosis (TB) contact screening though highly recommended is seldom practiced in low- and middle-income countries due to lack of evidence-based approaches best suited to the local setting. We assessed the yield of TB contact screening and predictors of TB diagnosis at a county referral hospital in Western Kenya. We identified clients with TB disease at Bungoma county referral hospital between January and December 2021, who completed a standard questionnaire and identified potential close contacts. We described the characteristics and yield of TB disease among contacts using means, standard deviation, counts and proportions. We used logistic regression to determine factors associated with TB diagnosis for contacts and reported odds ratios and 95% confidence intervals (95% CI). We identified 105 index TB cases who identified 358 contacts. The yield of TB disease among the contacts was 11% (39/353). The mean age of the TB contacts was 29.2 years (SD 19.3) and 87.8% (310/353) were household contacts. Body mass index of 18.5 kg/m2 and above was associated with 89% lower odds of TB disease among contacts (OR 0.11, 95% CI: 0.05-0.25). Contacts who had ever smoked were 3 times more likely to be diagnosed with TB disease (OR 3.10, 95% CI: 1.56-6.15). Contacts who used wood/kerosene for cooking had 3.5 times higher odds of TB disease (OR 3.5 95% CI: 1.05-11.72). Contact screening has a high yield of TB disease. Targeted approach directed towards contacts with malnutrition, smokers, and those using wood/kerosene for cooking may increase TB yield among contacts.