Potential versus revealed access to care during a dengue fever outbreak

- Use of revealed travel time data of patients diagnosed with dengue fever.
- Greater travel times for patients who live in the periphery of the city.
- Males and patients from affluent neighborhoods travel longer to receive health care.
- Findings are important for policy related decisions.

Dengue fever is a vector-borne disease which spreads quickly under suitable conditions and puts certain segments of the population at higher risk, especially in developing countries. Prompt diagnosis of the disease is critical to (1) substantially reduce risks of morbidity and mortality and (2) prevent further expansion of an existing outbreak. Suitable geographic access to medical care and effective prevention campaigns can help achieve these two objectives. This paper examines patterns of health care use based on travel time during an outbreak of dengue fever in the city of Cali, Colombia. We map patterns of diagnosis by facility and identify associated travel disparities. Results indicate that travel times exhibited significant spatial autocorrelation, showing that patients living in the periphery of the city experienced substantially greater travel times compared with patients residing in the north-south corridor of the city, owing to the proximity of health care centers. Revealed travel times were nearly six times longer than estimated travel to the closest hospital, suggesting that the healthcare center where care was received rarely coincided with the closest option (only in 8% of cases). A multilevel model, accounting for both individual and neighborhood characteristics, was developed to explain variation in travel estimates. Results revealed that males and patients from affluent neighborhoods were more likely to travel longer and beyond their closest facility to receive care. These findings are important for policy related decisions such as (1) timely allocation and training of health personnel and (2) organizing informative campaigns aiming at increasing the awareness about the disease, especially for the population that is at high risk and/or most vulnerable.