Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response.
Identifieur interne : 000466 ( Main/Exploration ); précédent : 000465; suivant : 000467Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response.
Auteurs : Pascal Geldsetzer [États-Unis, Allemagne] ; Marcel Reinmuth [Allemagne] ; Paul O. Ouma [Kenya] ; Sven Lautenbach [Allemagne] ; Emelda A. Okiro [Kenya, Royaume-Uni] ; Till B Rnighausen [États-Unis, Afrique du Sud] ; Alexander Zipf [Allemagne]Source :
- medRxiv : the preprint server for health sciences ; 2020.
Abstract
Background
SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km × 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA.
Methods
We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km × 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km × 1km raster using a cost-distance algorithm.
Findings
9.6% (95% CI: 5.2% - 16.9%) of adults aged ≥60 years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged ≥60 years had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged ≥60 years with the longest travel times was 348 minutes (IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (IQR: 1065 - 2440 minutes) in Gabon.
Interpretation
Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.
Funding
Bill & Melinda Gates Foundation.
DOI: 10.1101/2020.07.17.20152389
PubMed: 32743597
PubMed Central: PMC7386521
Affiliations:
- Afrique du Sud, Allemagne, Kenya, Royaume-Uni, États-Unis
- Angleterre, Bade-Wurtemberg, Californie, District de Karlsruhe, Massachusetts, Oxfordshire
- Heidelberg, Oxford, Stanford (Californie)
- Université Stanford, Université d'Oxford
Links toward previous steps (curation, corpus...)
Le document en format XML
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Chan School of Public Health, Boston, MA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health and Population, Harvard T.H. 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Ouma</name><affiliation wicri:level="1"><nlm:affiliation>Population Health Unit, Kenya Medical Research Institute (MFL)-Wellcome Trust Research Programme, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>Population Health Unit, Kenya Medical Research Institute (MFL)-Wellcome Trust Research Programme, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Lautenbach, Sven" sort="Lautenbach, Sven" uniqKey="Lautenbach S" first="Sven" last="Lautenbach">Sven Lautenbach</name><affiliation wicri:level="3"><nlm:affiliation>HeiGIT at Heidelberg University, Heidelberg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>HeiGIT at Heidelberg University, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Okiro, Emelda A" sort="Okiro, Emelda A" uniqKey="Okiro E" first="Emelda A" last="Okiro">Emelda A. Okiro</name><affiliation wicri:level="1"><nlm:affiliation>Population Health Unit, Kenya Medical Research Institute (MFL)-Wellcome Trust Research Programme, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>Population Health Unit, Kenya Medical Research Institute (MFL)-Wellcome Trust Research Programme, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:affiliation>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="B Rnighausen, Till" sort="B Rnighausen, Till" uniqKey="B Rnighausen T" first="Till" last="B Rnighausen">Till B Rnighausen</name><affiliation wicri:level="4"><nlm:affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA</wicri:regionArea><placeName><region type="state">Californie</region><settlement type="city">Stanford (Californie)</settlement></placeName><orgName type="university">Université Stanford</orgName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="1"><nlm:affiliation>Africa Health Research Institute, Somkhele, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Africa Health Research Institute, Somkhele</wicri:regionArea><wicri:noRegion>Somkhele</wicri:noRegion></affiliation></author><author><name sortKey="Zipf, Alexander" sort="Zipf, Alexander" uniqKey="Zipf A" first="Alexander" last="Zipf">Alexander Zipf</name><affiliation wicri:level="3"><nlm:affiliation>Institute of Geography, Heidelberg University, Heidelberg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Geography, Heidelberg University, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>HeiGIT at Heidelberg University, Heidelberg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>HeiGIT at Heidelberg University, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></analytic><series><title level="j">medRxiv : the preprint server for health sciences</title><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km × 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA.</p></div><div type="abstract" xml:lang="en"><p><b>Methods</b></p><p>We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km × 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km × 1km raster using a cost-distance algorithm.</p></div><div type="abstract" xml:lang="en"><p><b>Findings</b></p><p>9.6% (95% CI: 5.2% - 16.9%) of adults aged ≥60 years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged ≥60 years had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged ≥60 years with the longest travel times was 348 minutes (IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (IQR: 1065 - 2440 minutes) in Gabon.</p></div><div type="abstract" xml:lang="en"><p><b>Interpretation</b></p><p>Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.</p></div><div type="abstract" xml:lang="en"><p><b>Funding</b></p><p>Bill & Melinda Gates Foundation.</p></div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32743597</PMID><DateRevised><Year>2021</Year><Month>01</Month><Day>10</Day></DateRevised><Article PubModel="Electronic"><Journal><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Jul</Month><Day>21</Day></PubDate></JournalIssue><Title>medRxiv : the preprint server for health sciences</Title><ISOAbbreviation>medRxiv</ISOAbbreviation></Journal><ArticleTitle>Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">2020.07.17.20152389</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1101/2020.07.17.20152389</ELocationID><Abstract><AbstractText Label="Background" NlmCategory="UNASSIGNED">SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km × 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA.</AbstractText><AbstractText Label="Methods" NlmCategory="UNASSIGNED">We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km × 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km × 1km raster using a cost-distance algorithm.</AbstractText><AbstractText Label="Findings" NlmCategory="UNASSIGNED">9.6% (95% CI: 5.2% - 16.9%) of adults aged ≥60 years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged ≥60 years had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged ≥60 years with the longest travel times was 348 minutes (IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (IQR: 1065 - 2440 minutes) in Gabon.</AbstractText><AbstractText Label="Interpretation" NlmCategory="UNASSIGNED">Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.</AbstractText><AbstractText Label="Funding" NlmCategory="UNASSIGNED">Bill & Melinda Gates Foundation.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Geldsetzer</LastName><ForeName>Pascal</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Reinmuth</LastName><ForeName>Marcel</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Institute of Geography, Heidelberg University, Heidelberg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>HeiGIT at Heidelberg University, Heidelberg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ouma</LastName><ForeName>Paul O</ForeName><Initials>PO</Initials><AffiliationInfo><Affiliation>Population Health Unit, Kenya Medical Research Institute (MFL)-Wellcome Trust Research Programme, Nairobi, Kenya.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lautenbach</LastName><ForeName>Sven</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>HeiGIT at Heidelberg University, Heidelberg, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Okiro</LastName><ForeName>Emelda A</ForeName><Initials>EA</Initials><AffiliationInfo><Affiliation>Population Health Unit, Kenya Medical Research Institute (MFL)-Wellcome Trust Research Programme, Nairobi, Kenya.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bärnighausen</LastName><ForeName>Till</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Africa Health Research Institute, Somkhele, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zipf</LastName><ForeName>Alexander</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Institute of Geography, Heidelberg University, Heidelberg, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>HeiGIT at Heidelberg University, Heidelberg, Germany.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><Acronym>WT_</Acronym><Agency>Wellcome Trust</Agency><Country>United Kingdom</Country></Grant><Grant><GrantID>EP-C-15-003</GrantID><Acronym>EPA</Acronym><Agency>EPA</Agency><Country>United States</Country></Grant><Grant><GrantID>KL2 TR003143</GrantID><Acronym>TR</Acronym><Agency>NCATS NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D000076942">Preprint</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>07</Month><Day>21</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>medRxiv</MedlineTA><NlmUniqueID>101767986</NlmUniqueID></MedlineJournalInfo><CoiStatement>Declaration of interests The authors declare no competing interests.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>8</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>8</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>8</Month><Day>4</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32743597</ArticleId><ArticleId IdType="doi">10.1101/2020.07.17.20152389</ArticleId><ArticleId IdType="pmc">PMC7386521</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Reprod Health. 2014 Sep 19;11(1):71</Citation><ArticleIdList><ArticleId IdType="pubmed">25238684</ArticleId></ArticleIdList></Reference><Reference><Citation>Nat Commun. 2018 Nov 26;9(1):4994</Citation><ArticleIdList><ArticleId IdType="pubmed">30478314</ArticleId></ArticleIdList></Reference><Reference><Citation>BMJ Glob Health. 2018 Aug 16;3(4):e000875</Citation><ArticleIdList><ArticleId IdType="pubmed">30147944</ArticleId></ArticleIdList></Reference><Reference><Citation>Sci Data. 2017 Jan 31;4:170004</Citation><ArticleIdList><ArticleId IdType="pubmed">28140397</ArticleId></ArticleIdList></Reference><Reference><Citation>BMC Health Serv Res. 2018 Apr 19;18(1):291</Citation><ArticleIdList><ArticleId IdType="pubmed">29673360</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2020 Jul 20;15(7):e0236308</Citation><ArticleIdList><ArticleId IdType="pubmed">32687538</ArticleId></ArticleIdList></Reference><Reference><Citation>Sci Data. 2019 Jul 25;6(1):134</Citation><ArticleIdList><ArticleId IdType="pubmed">31346183</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet Glob Health. 2018 Mar;6(3):e342-e350</Citation><ArticleIdList><ArticleId IdType="pubmed">29396220</ArticleId></ArticleIdList></Reference><Reference><Citation>Eur J Cancer Care (Engl). 2017 Jan;26(1):</Citation><ArticleIdList><ArticleId IdType="pubmed">26853214</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet Infect Dis. 2020 May;20(5):533-534</Citation><ArticleIdList><ArticleId IdType="pubmed">32087114</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 2016 Jan 9;387(10014):168-75</Citation><ArticleIdList><ArticleId IdType="pubmed">26603918</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet Glob Health. 2018 Nov;6(11):e1196-e1252</Citation><ArticleIdList><ArticleId IdType="pubmed">30196093</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 2015 Aug 8;386(9993):569-624</Citation><ArticleIdList><ArticleId IdType="pubmed">25924834</ArticleId></ArticleIdList></Reference><Reference><Citation>Syst Rev. 2017 Jun 6;6(1):110</Citation><ArticleIdList><ArticleId IdType="pubmed">28587676</ArticleId></ArticleIdList></Reference><Reference><Citation>AIDS Behav. 2014 Jul;18(7):1199-223</Citation><ArticleIdList><ArticleId IdType="pubmed">24563115</ArticleId></ArticleIdList></Reference><Reference><Citation>World J Surg. 2011 May;35(5):941-50</Citation><ArticleIdList><ArticleId IdType="pubmed">21360305</ArticleId></ArticleIdList></Reference><Reference><Citation>Nature. 2018 Jan 18;553(7688):333-336</Citation><ArticleIdList><ArticleId IdType="pubmed">29320477</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2015 Feb 17;10(2):e0107042</Citation><ArticleIdList><ArticleId IdType="pubmed">25689585</ArticleId></ArticleIdList></Reference><Reference><Citation>Crit Care. 2011;15(1):R10</Citation><ArticleIdList><ArticleId IdType="pubmed">21219619</ArticleId></ArticleIdList></Reference><Reference><Citation>BMC Med. 2019 Dec 30;17(1):232</Citation><ArticleIdList><ArticleId IdType="pubmed">31888667</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet Glob Health. 2016 Nov;4(11):e845-e855</Citation><ArticleIdList><ArticleId IdType="pubmed">27670090</ArticleId></ArticleIdList></Reference><Reference><Citation>Science. 2020 Jul 24;369(6502):413-422</Citation><ArticleIdList><ArticleId IdType="pubmed">32532802</ArticleId></ArticleIdList></Reference><Reference><Citation>Anesth Analg. 2020 Apr;130(4):845-853</Citation><ArticleIdList><ArticleId IdType="pubmed">31453870</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2018 Jan 3;13(1):e0189959</Citation><ArticleIdList><ArticleId IdType="pubmed">29298314</ArticleId></ArticleIdList></Reference><Reference><Citation>J Crit Care. 2020 Aug;58:96-97</Citation><ArticleIdList><ArticleId IdType="pubmed">32408107</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>Afrique du Sud</li><li>Allemagne</li><li>Kenya</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Bade-Wurtemberg</li><li>Californie</li><li>District de Karlsruhe</li><li>Massachusetts</li><li>Oxfordshire</li></region><settlement><li>Heidelberg</li><li>Oxford</li><li>Stanford (Californie)</li></settlement><orgName><li>Université Stanford</li><li>Université d'Oxford</li></orgName></list><tree><country name="États-Unis"><region name="Californie"><name sortKey="Geldsetzer, Pascal" sort="Geldsetzer, Pascal" uniqKey="Geldsetzer P" first="Pascal" last="Geldsetzer">Pascal Geldsetzer</name></region><name sortKey="B Rnighausen, Till" sort="B Rnighausen, Till" uniqKey="B Rnighausen T" first="Till" last="B Rnighausen">Till B Rnighausen</name><name sortKey="B Rnighausen, Till" sort="B Rnighausen, Till" uniqKey="B Rnighausen T" first="Till" last="B Rnighausen">Till B Rnighausen</name></country><country name="Allemagne"><region name="Bade-Wurtemberg"><name sortKey="Geldsetzer, Pascal" sort="Geldsetzer, Pascal" uniqKey="Geldsetzer P" first="Pascal" last="Geldsetzer">Pascal Geldsetzer</name></region><name sortKey="Lautenbach, Sven" sort="Lautenbach, Sven" uniqKey="Lautenbach S" first="Sven" last="Lautenbach">Sven Lautenbach</name><name sortKey="Reinmuth, Marcel" sort="Reinmuth, Marcel" uniqKey="Reinmuth M" first="Marcel" last="Reinmuth">Marcel Reinmuth</name><name sortKey="Reinmuth, Marcel" sort="Reinmuth, Marcel" uniqKey="Reinmuth M" first="Marcel" last="Reinmuth">Marcel Reinmuth</name><name sortKey="Zipf, Alexander" sort="Zipf, Alexander" uniqKey="Zipf A" first="Alexander" last="Zipf">Alexander Zipf</name><name sortKey="Zipf, Alexander" sort="Zipf, Alexander" uniqKey="Zipf A" first="Alexander" last="Zipf">Alexander Zipf</name></country><country name="Kenya"><noRegion><name sortKey="Ouma, Paul O" sort="Ouma, Paul O" uniqKey="Ouma P" first="Paul O" last="Ouma">Paul O. Ouma</name></noRegion><name sortKey="Okiro, Emelda A" sort="Okiro, Emelda A" uniqKey="Okiro E" first="Emelda A" last="Okiro">Emelda A. Okiro</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Okiro, Emelda A" sort="Okiro, Emelda A" uniqKey="Okiro E" first="Emelda A" last="Okiro">Emelda A. Okiro</name></region></country><country name="Afrique du Sud"><noRegion><name sortKey="B Rnighausen, Till" sort="B Rnighausen, Till" uniqKey="B Rnighausen T" first="Till" last="B Rnighausen">Till B Rnighausen</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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