title: The Correlation Between Poverty and Access to Essential Surgical Care in Ghana: A Geospatial Analysis.
abstract: Surgical disease burden falls disproportionately on individuals in low- and middle-income countries. These populations are also the least likely to have access to surgical care. Understanding the barriers to access in these populations is therefore necessary to meet the global surgical need.
  
  
  
  Using geospatial methods, this study explores the district-level variation of two access barriers in Ghana: poverty and spatial access to care. National survey data were used to estimate the average total household expenditure (THE) in each district. Estimates of the spatial access to essential surgical care were generated from a cost-distance model based on a recent surgical capacity assessment. Correlations were analyzed using regression and displayed cartographically.
  
  
  
  Both THE and spatial access to surgical care were found to have statistically significant regional variation in Ghana (p < 0.001). An inverse relationship was identified between THE and spatial access to essential surgical care (β -5.15 USD, p < 0.001). Poverty and poor spatial access to surgical care were found to co-localize in the northwest of the country.
  
  
  
  Multiple barriers to accessing surgical care can coexist within populations. A careful understanding of all access barriers is necessary to identify and target strategies to address unmet surgical need within a given population.
authors.affiliation: Department of Surgery, Dalhousie University, Room 8-821, 1276 South Park St, Halifax, NS, B3H2Y9, Canada. gtansley@dal.ca.|Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. gtansley@dal.ca.
authors.forename: Gavin
authors.initials: G
authors.lastname: Tansley
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.|School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.|Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Adam
authors.initials: A
authors.lastname: Gyedu
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Godfred
authors.initials: G
authors.lastname: Boakye
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lewis
authors.affiliation: Department of Surgery, Dalhousie University, Room 8-821, 1276 South Park St, Halifax, NS, B3H2Y9, Canada.
authors.forename: Marius
authors.initials: M
authors.lastname: Hoogerboord
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.|Harborview Injury Prevention & Research Centre, Seattle, WA, USA.|Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
mesh_terms: D003906:Developing Countries; D062305:Geographic Mapping; D005869:Ghana / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area; D011203:Poverty; D062206:Spatial Analysis; D013514:Surgical Procedures, Operative