The ‘golden hour’: a geospatial analysis of travel time to public emergency departments in Kenya

Abstract

IntroductionIn Kenya and many other low- and middle-income countries, prehospital care systems are underdeveloped or entirely non-existent, leaving emergency departments (EDs) as the primary point of care for medical emergencies. The aim of this cross-sectional observational study was to use a geographic information system (GIS) to comprehensively analyse access to public EDs in Kenya within 1-hour and 2-hour travel times.MethodsUsing open-source GIS software, population, land cover, elevation and road network data were analysed to create maps of 1-hour and 2-hour travel time catchment areas around public EDs in Kenya. Travel time analysis was calculated using AccessMod with a combined walking and motorised transport model.ResultsApproximately 93.7% of Kenya’s population has access to a public ED within 1 hour, and 98.2% within 2 hours. Of the 6.3% of the population lacking access to a public ED within 1 hour, many reside in rural areas with suboptimal road conditions. There was a significant difference in the proportions within 1-hour and 2-hour travel times across all counties (p<0.001). There was a weak association between the number of facilities in each county and the population proportion within 1 hour (ρ=0.237, p=0.109) and 2 hours (ρ=0.230, p=0.119).ConclusionsBy mapping population distribution in Kenya against the availability of public EDs, geospatial analysis provides crucial insights into emergency care access gaps, guiding policymakers in identifying areas that require infrastructure investments or prehospital service enhancements.