Geospatial mapping of surgical systems for earthquake emergency planning in Guerrero, Mexico: an ecological study

Letícia Nunes Campos; Mayte Bryce-Alberti; Sarah K Hill; Diana D Del Valle; Mehreen Zaigham; Alberto de la Rosa Rábago; Tanujit Dey; Sabrina Juran; Tarsicio Uribe-Leitz

doi:10.1016/j.lana.2023.100586

Geospatial mapping of surgical systems for earthquake emergency planning in Guerrero, Mexico: an ecological study

Lancet Reg Health Am. 2023 Sep 7:26:100586. doi: 10.1016/j.lana.2023.100586. eCollection 2023 Oct.

Authors

Letícia Nunes Campos^{1

2}, Mayte Bryce-Alberti^{1

3}, Sarah K Hill¹, Diana D Del Valle^{1

4}, Mehreen Zaigham^{1

5}, Alberto de la Rosa Rábago⁶, Tanujit Dey⁷, Sabrina Juran¹, Tarsicio Uribe-Leitz^{1

8

9}

Affiliations

¹ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
² Faculty of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil.
³ Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁴ Department of Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico City, Mexico.
⁵ Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
⁶ Comisión Nacional para la Mejora Continua de la Educación (MEJOREDU), Unidad de Apoyo y Seguimiento a la Mejora Continua e Inonovación Educativa, Ciudad de México, Mexico.
⁷ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Department of Plastic Surgery, Boston Children's Hospital, Boston, MA, USA.
⁹ Department of Sport and Health Sciences, Technical University Munich, Epidemiology, Munich, Germany.

Abstract

Background: Accessibility to surgical services can impact earthquake preparedness and response. We aimed to estimate the population with timely access to surgical care in Guerrero, a Mexican state with high tectonic activity, and identify populations at risk in the event of an earthquake.

Methods: We conducted an ecological study using open government data. We extracted data from Guerrero municipalities regarding their earthquake risk, social vulnerability, social inequality, marginalisation, and resilience indices. The latest combines municipalities' resistance to unexpected events and capacity to maintain optimal functionality without immediate federal or international support. Geographical coordinates of active public and private surgical facilities in Guerrero were combined with ancillary spatial data on roads and municipalities' population density to estimate population coverage within 30-min and 1-h driving time to surgical facilities in Redivis. We built an ordered beta regression model for each driving time estimate.

Findings: We identified 25 public and 16 private facilities capable of providing surgical care in Guerrero. The population with access to facilities with surgical capacity within 30 min and 1-h driving times were 48.4% and 69.1%, respectively. We found that municipalities with very high levels of earthquake risk, social vulnerability, social inequality, and marginalisation, and very low levels of resilience had decreased coverage. In the multivariable analysis, the resilience index was statistically significant only for the 30-min model, with an effect size of 0.524 (95% CI 0.082, 1.089).

Interpretation: Access to surgical care remains unequally distributed in Guerrero municipalities at the highest risk for earthquakes. Municipalities' resilience was the most significant predictor of higher surgical care coverage in 30-min driving time. Our study provides insights on how surgical system strengthening can enhance earthquake emergency disaster planning.

Funding: No funding.

Keywords: Disaster planning; Emergency service; Geographic mapping; Global health; Health policy; Hospital; Natural disasters.