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Mapping access to basic hygiene services in low- and middle-income countries: A cross-sectional case study of geospatial disparities
Applied Geography ( IF 4.732 ) Pub Date : 2021-09-06 , DOI: 10.1016/j.apgeog.2021.102549
Weiyu Yu 1, 2 , Robert E.S. Bain 3 , Jie Yu 4 , Victor Alegana 1, 5 , Winfred Dotse-Gborgbortsi 1 , Yi Lin 2, 6 , Jim A. Wright 1
Affiliation  

Handwashing with water and soap is among the most a cost-effective interventions to improve public health. Yet billions of people globally lacking handwashing facilities with water and soap on premises, with gaps particularly found in low- and middle-income countries. Targeted efforts to expand access to basic hygiene services require data at geospatially explicit scales. Drawing on country-specific cross-sectional Demographic and Health Surveys with georeferenced hygiene data, we developed an ensemble machine learning model to predict the prevalence of basic hygiene facilities in Malawi, Nepal, Nigeria, Pakistan and Uganda. The ensemble model was based on a multiple-level stacking structure, where four predictive modelling algorithms were used to produce sub-models, and a random forest model was used to generalise the final predictions. An inverse distance weighted interpolation was incorporated in the random forest model to account for spatial autocorrelation. Local coverage and a local dissimilarity index were calculated to examine the geographic disparities in access. Our methodology produced robust outputs, as evidenced by performance evaluations (all R2 were above 0.8). Among the five study countries, Pakistan had the highest overall coverage, whilst Malawi had the poorest coverage. Apparent disparities in basic hygiene services measured by local coverage were found across geographic locations and between urban and rural settings. Nigeria had the highest level of inequalities in basic hygiene services measured by a dissimilarity index, whilst Malawi showed the least segregation between populations with and without basic hygiene services. Both educational attainment and wealth were important predictors of the geospatial distribution of basic hygiene services. By producing geospatially explicit estimates of the prevalence of handwashing facilities with water and soap, this study provides a means of identifying geographical disparities in basic hygiene services. The method and outputs can be useful tools to identify areas of low coverage and to support efficient and precise targeting of efforts to scale up access to handwashing facilities and shift social and cultural norms on handwashing.



中文翻译:

绘制中低收入国家基本卫生服务的可及性:地理空间差异的横断面案例研究

用水和肥皂洗手是改善公共卫生的最具成本效益的干预措施之一。然而,全球仍有数十亿人缺乏带水和肥皂的洗手设施,尤其是在低收入和中等收入国家。扩大获得基本卫生服务的有针对性的努力需要地理空间明确尺度的数据。利用具有地理参考卫生数据的特定国家的横截面人口和健康调查,我们开发了一个集成机器学习模型来预测马拉维、尼泊尔、尼日利亚、巴基斯坦和乌干达的基本卫生设施的流行情况。集成模型基于多级堆叠结构,其中使用四种预测建模算法来生成子模型,并使用随机森林模型来概括最终预测。随机森林模型中加入了逆距离加权插值以解决空间自相关问题。计算本地覆盖率和本地差异指数以检查访问的地理差异。我们的方法产生了强大的输出,正如绩效评估所证明的那样(所有 R2高于 0.8)。在五个研究国家中,巴基斯坦的总体覆盖率最高,而马拉维的覆盖率最低。在不同的地理位置以及城市和农村环境之间发现了以当地覆盖率衡量的基本卫生服务的明显差异。根据差异指数衡量,尼日利亚在基本卫生服务方面的不平等程度最高,而马拉维在有和没有基本卫生服务的人群之间的隔离程度最低。教育程度和财富都是基本卫生服务地理空间分布的重要预测因素。通过对使用水和肥皂的洗手设施的流行率进行地理空间明确的估计,本研究提供了一种确定基本卫生服务地理差异的方法。

更新日期:2021-09-07
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