Geospatial analysis of first, second, and third level hospitals in a surgical network in the low and middle income countries

Introduction Distance from a healthcare facility is a barrier in access to surgery. Methodologies to evaluate the population covered by a hospital are time consuming and costly. The aim of this study was to analyse the population density around hospitals to pragmatically evaluate their access while comparing differences between hospital types. Methods This analysis was conducted in the hospitals that participated in an international cohort study on inguinal hernia patients (HIPPO study). Hospitals located in low and middle income countries were eligible for inclusion and were classified as first-referral, secondary, tertiary level hospitals. For each hospital, location and GPS coordinates were reported in maps. The population density within a 5km, 40km and 80km radius was calculated. The medians and interquartile range of the population densities were calculated in two stages: considering each hospital and considering the number of patients recruited. Results This analysis included 326 hospitals: 38 first-referral, 84 secondary and 204 tertiary level hospitals. For the 5km distance, the population density increased from first referral to tertiary hospitals (median of population density 1776, 3439 and 6979, respectively). In 40km and 80km radius, the same trend was observed (351, 300 and 888 for 40km and 294, 197 and 462 for 80km). When adjusting and weighting the patients recruited for the study, the differences became more evident. Discussion This analysis showed that in less densely populated areas first-referral hospitals predominate. The methods described can be used in other studies to evaluate the population that can be covered by different healthcare facilities.