The well-being of a population and its health are influenced by a myriad of socioeconomic and environmental factors that interact across a wide range of scales, from the individual to the national and global levels. One of these factors is the provision of health services, which is regulated by both demand and supply. Although an adequate provision can significantly improve health outcomes of a population, lopsided flow of patients to specific health centers can result in serious disparities and potentially delay the timeliness of a diagnosis. In this paper, utilization patterns during an epidemic of dengue fever in the city of Cali, Colombia for the year 2010 are investigated. Specifically, the objectives are to (1) identify health facilities that exhibit patterns of over- and underutilization, (2) determine where patients who are being diagnosed at a particular facility originate from, and (3) whether patients are traveling to their closest facility and hence (4) estimate how far patients are willing to travel to be diagnosed and treated for dengue fever. Analysis is further decomposed by age group and by gender, in an attempt to test whether utilization patterns drastically change according to these variables. Answers to these questions can help health authorities plan for future epidemics, for instance, by providing guidelines as to which facilities require more resources and by improving the organization of health prevention campaigns to direct population seeking health assistance to use facilities that are underutilized.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Abadia, C. E., & Oviedo, D. G. (2009). Bureaucratic itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems. Social Science & Medicine, 68, 1153–1160.
Alegana, V. a., Wright, J. a., Pentrina, U., Noor, A. M., Snow, R. W., & Atkinson, P. M. (2012). Spatial modelling of healthcare utilisation for treatment of fever in Namibia. International Journal of Health Geographics, 11, 6.
Alliance, T. W. R. (2015). Healthy mothers make a healthy world. http://whiteribbonalliance.org/. April 8, 2015.
Al-Taiar, A., Clark, A., Longenecker, J. C., & Whitty, C. J. M. (2010). Physical accessibility and utilization of health services in Yemen. International Journal of Health Geographics, 9, 1–8.
Astell-Burt, T., Flowerdew, R., Boyle, P. J., & Dillon, J. F. (2011). Does geographic access to primary healthcare influence the detection of hepatitis C? Social Science & Medicine, 72, 1472–1481.
Bijl, R., de Graff, R., Hiripi, E., Kessler, R. C., Kohn, R., Offord, D. R., Ustun, T. B., Vicente, B., Vollebergh, W. A. M., Walters, E. E., & Wittchen, H.-U. (2003). The prevalence of treted and untereated mental disorders in five countries. Health Affairs, 22, 122–133.
Black, R., Cousens, S., Johnson, H. L., Lawn, J. e., Rudan, I., Bassani, d. g., Jha, P., Campbell, H., Walker, C. F., Cibulskis, R., Eisele, t., Liu, L., & Mathers, C. (2010). Global, regional and national causes of child mortality in 2008: a systematic analysis. Lancet, 375, 1969–1987.
Buor, D. (2003). Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana. International Journal of Health Planning and Management, 18, 293–311.
Cali, A. d. S. d. (2008). Cali en cifras. Cali: Alcaldia de Cali.
Cali, S. d. S. P. M. d. (2010). Historia del dengue en Cali. Endemia o una continua epidemia. Cali: Secretaria de Salud Publica Municipal de Cali.
Casas, I., Delmelle, E., & Varela, A. (2010). A space-time approach to diffusion of health service provision information. International Regional Science Review, 33(2), 134–156.
Casas, I., Delmelle, E., & Delmelle, E. C. (2017). Potential versus revealed access to care during a dengue fever outbreak. Journal of Transport & Health, 4, 18–29.
Delmelle, E., Casas, I., Rojas, J. H., & Varela, A. (2013a). Spatio-temporal patterns of dengue fever in Cali, Colombia. International Journal of Applied Geospatial Research, 4, 58–75.
Delmelle, E. M., Cassell, C. H., Dony, C., Radcliff, E., Tanner, J. P., Siffel, C., & Kirby, R. S. (2013b). Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems. Birth Defects Research Part A: Clinical and Molecular Teratology, 97, 673–684.
Delmelle, E., Jia, M., Dony, C., Casas, I., & Tang, W. (2014a). Space-time visualization of dengue fever outbreaks. In: Kanaroglou, Delmelle, & Paez (Eds), Spatial analysis in health geography. Ashgate.
Delmelle, E. M., Zhu, H., Tang, W., & Casas, I. (2014b). A web-based geospatial toolkit for the monitoring of dengue fever. Applied Geography, 52, 144–152.
Delmelle, E., Hagenlocher, M., Kienberger, S., & Casas, I. (2016). A spatial model of socioeconomic and environmental determinants of dengue fever in Cali, Colombia. Acta Tropica, 164, 169–176.
Desjardins, M. R., Whiteman, A., Casas, I., & Delmelle, E. (2018). Space-time clusters and co-occurrence of chikungunya and dengue fever in Colombia from 2015 to 2016. Acta Tropica, 185, 77–85.
Eastin, M. D., Delmelle, E., Casas, I., Wexler, J., & Self, C. (2014). Intra-and interseasonal autoregressive prediction of dengue outbreaks using local weather and regional climate for a tropical environment in Colombia. The American Journal of Tropical Medicine and Hygiene, 91(3), 598–610.
Ensor, T., & Cooper, S. (2004). Overcoming barriers to health service access: influencing the demand side. Health Policy and Planning, 19, 69–79.
Ensor, T., & San, P. B. (1996). Access and payment for health care: the poor of Northern Vietnam. International Journal of Health Planning and Management, 11, 69–83.
Gabrysch, S., & Campbell, O. M. R. (2009). Still too far to walk: literature review of the determinants of delivery service use. BMC Preganancy and Childbirth, 9, 1–18.
Gabrysch, S., Cousens, S., Cox, J., & Campbell, O. M. R. (2011). The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Medicine, 8, e1000394.
Ganathra, B. & Hirve, S. (1994. Male bias in health care utilization for under-fives in a rural community in western India. In Bulleting of the World Health Organization (pp. 101–104). W. H. Organization.
Garcia-Subirats, I., Vargas, I., Mogollon-Perez, A. S., De Paepe, P., da Silva, M. R., Unger, J. P., & Vazquez, M. L. (2014). Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of Central Colombia and north-eastern Brazil. Social Science & Medicine, 106, 204–213.
Gaviria, A., Medina, C., & Mejia, C. (2006). Evaluating the impact of health care reform in Colombia: from theory to practice. In CEDE (Ed.) U. d. l. Andes. Bogotá Colombia.
Gething, P. W., Noor, A. M., Zurovac, D., Atkinson, P. M., Hay, S. I., Nixon, M. S., & Snow, R. W. (2004). Empirical modelling of government health service use by children with fevers in Kenya. Acta Tropica, 91, 227–237.
Glassman, A. L., Escobar, M.-L., Giuffrida, A., & Giedion, U. (2009). From few to many: ten years of health insurance expansion in Colombia. In I.-A. D. B. T. B. Institution. New York: The Brookings Institution.
Hagenlocher, M., Delmelle, E., Casas, I., & Kienberger, S. (2013). Assessing socioeconomic vulnerability to dengue fever in Cali, Colombia: statistical vs expert-based modeling. International Journal of Health Geographics, 12(1), 36.
Hassan, A. R., Jiménez, J. C., & Montoya, R. C. (2013). The impact of subsidized health insurance on the poor in Colombia: evaluating the case of Medellín. Economía Aplicada, 17, 543–556.
Hine, J., & Kamruzzaman, M. (2012). Journeys to health services in Great Britain: an analysis of changing travel patterns 1985–2006. Health & Place, 18, 274–285.
Hohl, A., Zheng, M., Tang, W., Delmelle, E., & Casas, I. (2017). Spatiotemporal point pattern analysis using Ripley’s K function. Geospatial data science: techniques and applications. CRC Press, Boca Raton, FL.
Jia, P., & Xierali, I. M. (2015). Disparities in patterns of health care travel among inpatients diagnosed with congestive heart failure, Florida, 2011. Preventing Chronic Disease, 12, E150.
Khun, S., & Manderson, L. (2007). Health seeking and access to care for children with suspected dengue in Cambodia: an ethnographic study. BMC Public Health, 7, 262.
Khun, S., & Manderson, L. (2008). Poverty, user fees and ability to pay for health care for children with suspected dengue in rural Cambodia. International Journal for Equity in Health, 7, 10.
Kienberger, S., Hagenlocher, M., Delmelle, E., & Casas, I. (2013). A WebGIS tool for visualizing and exploring socioeconomic vulnerability to dengue fever in Cali, Colombia. Geospatial Health, 8(1), 313–316.
Kittayapong, P., Yoksan, S., Chansang, U., Chansang, C., & Bhumiratana, A. (2008). Suppression of dengue transmission by application of integrated vector control strategies at sero-positive GIS-based foci. The American Journal of Tropical Medicine and Hygiene, 78, 70–76.
Kwan, M.-P., Casas, I., & Schmitz, B. C. (2004). Protection of geoprivacy and accuracy of spatial information: how effective are geographical masks? Cartographica, 39, 15–28.
Lee, S. Y., Xue, Q.-l., Spira, A. P., & Lee, H. B. (2014). Racial and ethnic differences in depressive subtypes and access to mental health care in the United States. Journal of Affective Disorders, 155, 130–137.
Målqvist, M., Sohel, N., Do, T. T., Eriksson, L., & Persson, L.-Å. (2010). Distance decay in delivery care utilisation associated with neonatal mortality. A case referent study in northern Vietnam. BMC Public Health, 10, 1–9.
Masters, S. H., Burstein, R., Amofah, G., Abaogye, P., Kumar, S., & Hanlon, M. (2013). Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis. Social Science & Medicine, 93, 147–154.
Méndez, F., Barreto, M., Arias, J. F., Rengifo, G., Muñoz, J., Burbano, M. E., & Parra, B. (2006). Human and mosquito infections by dengue viruses during and after epidemics in a dengue-endemic region of Colombia. The American Journal of Tropical Medicine and Hygiene, 74, 678–683.
Noor, A. M., Zurovac, D., Hay, S. I., Ochola, S. A., & Snow, R. W. (2003). Defining equity in physical access to clinical services using geographical information systems as part of malaria planning and monitoring in Kenya. Tropical Medicine & International Health, 8, 917–926.
O’Donnell, O. (2007). Access to health care in developing countries: breaking down demand side barriers. Cadernos de Saúude Pública, 23.
Okanurak, K., Sornmani, S., & Indaratna, K. (1997). The cost of dengue hemorrhagic fever in Thailand. The Southeast Asian Journal of Tropical Medicine and Public Health, 28, 711–717.
Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Rahman, M. H. (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences, 1136, 161–171.
Ray, N., & Ebener, S. (2008). AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients. International Journal of Health Geographics, 7, 63.
Restrepo, L. D. E. (2006). El plan piloto de cali 1950. Revista Bitacora Urbano Territorial, 1, 222–223.
Rojas, J. (2013). Dengue 2013—Semanas epidemiológicas (pp. 1–17). Cali: Secretaría de Salud Municipal.
Romero-Vivas, C. M., Leake, C. J., & Falconar, a. K. (1998). Determination of dengue virus serotypes in individual Aedes aegypti mosquitoes in Colombia. Medical and Veterinary Entomology, 12, 284–288.
Schiefelbein, E. L., Olson, J. a., & Moxham, J. D. (2014). Patterns of health care utilization among vulnerable populations in Central Texas using data from a regional Health Information Exchange. Journal of Health Care for the Poor and Underserved, 25, 37–51.
Simmons, C., Farrar, J. J., van Vinh Chau, N., & Wills, B. (2012). Dengue. 366, 1423–1432.
Sipsma, H., Callands, T. A., Bradley, E., Harris, B., Johnson, B., & Hansen, N. B. (2013). Healthcare utilisation and empowerment among women in Liberia. Journal of Epidemiology and Community Health, 67, 953–959.
Staff (2013). Dos clínicas de Cali están en el ‘ranking’ de las mejores de Latinoamérica. El País September 18.
Staff (2017a). Historia: Club Noel. http://clubnoel.org/content/quienes-somos/sobre-el-club-noel/historia/. April 13, 2017.
Staff (2017b). Hospital Universitario del Valle. http://www.huv.gov.co/web/node/8. April 13, 2017.
Stephens, J. M., Brotherton, S., Dunning, S. C., Emerson, L. C., Gilbertson, D. T., Harrison, D. J., Kochevar, J. J., McClellan, A. C., McClellan, W. M., Wan, S., & Gitlin, M. (2013). Geographic disparities in patient travel for dialysis in the United States. The Journal of Rural Health, 29, 339–348.
Tanser, F., Gijsbertsen, B., & Herbst, K. (2006). Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system. Social Science & Medicine, 63, 691–705.
UNICEF. (2015). The state of the world’s children 2015. New York: UNICEF.
Vargas, I., Vázquez, M. L., Mogollón-Pérez, A. S., & Unger, J.-P. (2010). Barriers of access to care in a managed competition model: lessons from Colombia. BMC Health Services Research, 10, 297.
Yao, J., Murray, A. T., & Agadjanian, V. (2013). A geographical perspective on access to sexual and reproductive health care for women in rural Africa. Social Science & Medicine, 96, 60–68.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Geospatial Technology in Environmental Health Applications
About this article
Cite this article
Casas, I., Delmelle, E. Landscapes of healthcare utilization during a dengue fever outbreak in an urban environment of Colombia. Environ Monit Assess 191, 279 (2019) doi:10.1007/s10661-019-7415-2
- Dengue fever
- Geographic information systems (GIS)
- Healthcare utilization