|Year : 2022 | Volume
| Issue : 1 | Page : 33-40
Georeferencing of current dental service locations in the Jazan Region, Saudi Arabia: A geographical information system-based approach
Mosa A Shubayr1, Estie Kruger2, Marc Tennant2
1 International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia; Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
2 International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia
|Date of Submission||03-Mar-2022|
|Date of Acceptance||01-May-2022|
|Date of Web Publication||27-Jul-2022|
Dr. Mosa A Shubayr
International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia; Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: This study focused on the Jazan region, Kingdom of Saudi Arabia. To date, there has not been any documented evidence about geographical distribution of dental health-care services in the region. The study aimed to assess the geographical accessibility of dental health-care services in Jazan. Materials and Methods: Most recent, openly accessible, nonidentifiable data and information were used in this study. The location of health facilities was obtained from the Ministry of Health (MOH) Statistical Yearbook 2020 and interactive map of the MOH, which was converted to longitude and latitude, using Google Maps with 90% of the level building. The study data to be analyzed were imported from the integrated database in Quantum Geographic Information Systems into Microsoft Excel software, where the ratios of health-care facilities to the study population were computed. Results: There were 145 primary health cares (PHCs) and 19 hospitals with a dental component in the Jazan region of 17 governorates with a total of 1,726,739 residents. The overall PHC-, hospital-, and dentist-to-population ratios were 1 PHC to 114,365 residents, 1 hospital to 90,881 residents, and 1 dentist to 9136 residents. Only 14.5% of PHCs and 5.6% of the hospitals served 70% of the population who are living within 20 km from the governorate's center. Conclusion: This study shows that irregular distribution of health services has led to decreased access to services in the region. Further research is needed focusing in mapping MOH, private and other health facilities, and the burden of oral disease in the region.
Keywords: Dental health-care services, dental workforce, Geographical Information System, Jazan, Saudi Arabia
|How to cite this article:|
Shubayr MA, Kruger E, Tennant M. Georeferencing of current dental service locations in the Jazan Region, Saudi Arabia: A geographical information system-based approach. King Khalid Univ J Health Sci 2022;7:33-40
|How to cite this URL:|
Shubayr MA, Kruger E, Tennant M. Georeferencing of current dental service locations in the Jazan Region, Saudi Arabia: A geographical information system-based approach. King Khalid Univ J Health Sci [serial online] 2022 [cited 2022 Nov 28];7:33-40. Available from: https://www.kkujhs.org/text.asp?2022/7/1/33/352518
| Introduction|| |
One of the most critical quality of life measures is the accessibility to health-care service. Everyone should have the same access to such services. However, due to many constraints such as economic and geographical challenges, achieving such equity is difficult. Millman defines access to health care as the “timely use of personal health services to achieve the best possible health outcomes.” Millman further explained the term “access” as the extent to which an individual or group can receive the much-needed health services. In most cases, access is used interchangeably with terms such as utilization or coverage. According to Al Agili and Farsi, accessibility to oral health services emphasizes both the availability and use of care.
According to Penchansky and Thomas, access means “the degree of fit between the system and the patient.” Access to health care has various dimensions, which help provide an overview of it. The first dimension is availability, which refers to the relationship between the quantity and type of existing services such as health providers and facilities and the quantity and types of patient needs. The relationship between the location of health service and the location of a patient is a referee to accessibility. Accommodation is determined by the relationship between how supply resources are organized to accommodate clients, such as appointment systems and hours of operation. Another dimension mentioned by Penchansky and Thomas is affordability, which is defined as the relationship between a patient's ability to pay through their income or insurance and the prices of treatments. Acceptability is defined as the relationship between patients' attitudes toward personal and practice characteristics of providers and the actual features of current providers, as well as provider attitudes toward acceptable personal characteristics.
Several studies have employed different methods of examining access to health-care services, such as Geographical Information System (GIS). According to Alsharif, GIS uses different scales to estimate and measure various associations between spatial and temporal trends of health-care-related variables, population, and risk factors related to the population and environment.
Alonge and Peters indicated that understanding health-care service distribution is a vital factor in addressing health-care inequality and access to health-care services. In the Jazan region, several factors hinder the growth and development of dental health-care services. The most notable among these is the distribution of dental service providers and practitioners, which partly explains the Jazan region's lower accessibility and quality of dental treatment compared to other parts of the country. In addition, the insufficient number of dental service practitioners further explains the limited dental disease preventive activities in this region.
There is a lack of studies about the geographical access or distribution factors (such as travel distance and time) of dental health-care services within regions of Saudi Arabia. Studies,,, using GIS to measure accessibility to primary and private health-care services in the region of Jeddah revealed that some areas of the region, such as the northern and central districts, had limited or poor accessibility to the available health-care facilities. In addition, a study by Alsharif, which examined a sample of primary and private dental practice in Al Madina, Saudi Arabia, found that there were more dental services in the city center but few in the peripheral areas in the city.
To the best of the researcher's knowledge, there are no similar published studies of spatial health-care characteristics in the same region (Jazan). Therefore, this study examines the distribution of dental health-care centers and services offered by the Ministry of Health (MOH) facilities in the Jazan region. In addition, this study provides vital recommendations which can be used to enhance future dental health-care services in the region. The current study aimed to fill a gap in the currently available literature on the dental health-care system in Jazan. Furthermore, the study examined the spatial distribution of health-care services and the health-care facility-to-population ratios in the region.
| Materials and Methods|| |
Data for the current study were collected between July 1, 2021, and October 31, 2021. The researcher used openly accessible, nonidentifiable data and information. Therefore, ethics approval was not required.
Dental clinic locations
The location of health facilities was obtained from the MOH Statistical Yearbook 2020 and an interactive Map of the MOH. Data on university dental schools, mobile clinics, private clinics, and duplicated addresses were identified and excluded. Only MOH primary health cares (PHCs) and hospitals were included in this study. Each health facility location was converted to longitude and latitude, using Google Maps with 90% of the level building.
All population data were obtained from the most recently available data at the General Authority website and the World Population website. Administrative governorates were chosen as the geographical region, as this is the only available data source in the file format that matched the population data files.
For this study, the researcher used Quantum Geographic Information Systems (QGIS) (version 3.20, Essen, Germany) to carry out geographical mapping. To coordinate referencing, this study used World Geodetic System 1984 (WGS 84), and all the generated data (geographical data and linked population data) were imported and analyzed in Microsoft Excel (version 14.0; Microsoft, Redmond, WA, USA).
The researcher used random points in the QGIS to display the area of coverage for the identified health facilities (PHCs and hospitals) in relation to the target Jazan population. Population dots and locations of PHCs and hospitals were placed on the study map using QGIS. Using four levels (radius), the study examined different accessibility levels of 145 PHCs and 19 hospitals. The most significant factor distinguishing these levels (radius) of accessibility was their distance from the governorate's center. The various buffer zones (5, 10, 15, and 20 km) from the governorate's center were identified and investigated. The ratios of health centers and dentists to population were determined using the available census data.
The data for this study were analyzed both descriptively (such as the number of dentists in each district) and by calculation. The data were analyzed using Microsoft Excel (2016 version 14.0). The study data to be analyzed were imported from the integrated database in QGIS into Microsoft Excel software, where the ratios of health-care facilities to the study population were computed.
| Results|| |
The Jazan region (also spelled Jizan, Gizan, or Gazan) consisted of 17 governorates (mohafadat in Arabic) with a total of 1,726,739 residents as of 2020 [Figure 1]. Most of the region's residents lived in the major cities of Sabya, Abu Arish, and Jazan with 290,244, 248,654, and 172,269 residents, respectively. One hundred and forty-five PHCs and 18 general hospitals were geocoded by QGIS [Figure 2] and [Figure 3].
|Figure 2: A high-resolution image showing the distribution of population per governorate and primary health-care centers based on accessibility areas in the Jazan region, KSA|
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|Figure 3: A high-resolution image showing the distribution of population per governorate and hospitals based on accessibility areas in the Jazan region, KSA|
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Sabya had the highest number of PHC clinics (14.5%) and about 5.3% of dental clinics in the general hospitals. However, with a population of about 36,068 people, Harub only had 4.1% of the PHCs without dental clinics in the general hospital that served the governorate population. General hospitals were more evenly distributed throughout the region, with the percentage ranging from 5.3% to 10.5% [Table 1].
|Table 1: Primary health-care center-, hospital-, and dentist-to-population ratios in the Jazan Region, Kingdom of Saudi Arabia|
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The region showed an overall practice–population ratio of 1 PHC to 114,365 residents and 1 hospital to 90,881 residents. Sabya, Abu Arish, and Jazan governorates had the highest PHC-to-population ratio (1:13,000) and were the most-populated governorates. On the other hand, the mountain areas such as Al Harth and Al Rayth had the lowest PHC-to-population ratios with 1:5768 and 1:5885, respectively. The general hospital-to-population ratio was the highest in Sabya (1:290,244) and the lowest in Farasan with 1:22,556 [Table 1].
The result showed that the dentist-to-population ratio in the Jazan region was 1:9136. Out of the 37 (17.7%) dentists who worked in Jazan city, most worked in the government dental center. These providers served 172,269 people, which represents 1 provider per 4655 people. Abu Arish had 26 (12.4%) dentists serving 248,654 people (representing 1 provider per 9563 individuals), followed by Sabya with 24 (11.5%) dentists serving 290,244, which represents 1 provider per almost 12,093 people [Table 1].
The majority of the PHCs (39.3%) in the Jazan region were located 15 km from the center of each governorate and 26.9% were located within 10 km. The results also showed that only 17.7% and 9.4% of the population had access to health-care services at a distance of 15 km and 10 km, respectively. Only 14.5% of the primary dental practices, which served approximately 70% of the population, were located more than 20 km away. Regarding the general hospitals, 36.8% were within 15 km, followed by 31.6% of the hospitals being within 5 km [Table 2].
|Table 2: Population distribution based on buffer zone in the Jazan region|
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The result found that Sabya, Abu Arish, Jazan, and Samtah had the highest number of health facilities and the most-populated governorates. Only 5% and 12.3% of the Sabya and Abu Arish populations had access to more than half of the PHCs within 15 km. More than half (53.8%) of the PHCs were located within 5 km from the Jazan governorate center, which provides dental services to only 7% of the population. Two-thirds (33.3%) of the PHCs in Samtah were located with 10 km for 20% of the population. The result also explained that 72.4% of Al Harth population lived within 15 km serviced by only one PHCs and almost 99% of the population in Al Ryath who lived in the area located more than 20 km from the center had no access to PHCs. Only a single general hospital in each governorate served a population located within 5 km from the governorate center compared to Jazan, Abu Arish, and Al At Tuwal, which had 2 hospitals each and no general hospital in Harub governorate [Table 2].
| Discussion|| |
This study examined the PHC centers and hospitals which included dental clinics in the Jazan region of Saudi Arabia using GIS-based methods. This study helps interested researchers and policymakers to explore dental service and geographical accessibility issues in the region. This study's findings are consistent with the hypothesis that dentists and population distribution is positively related. This was not the case with the health facilities distribution in the study region, which had uneven distribution. These observations were similar to those of Bohari et al. More than a third of the region's residents live in the major governorates such as Sabya, Jazan, and Abu Arish, where most of them live in less accessible areas and align with the result in this study – PHC-, hospital-, and dentist-to-population ratio in the region being 1:11,435, 1:90,881, and 1:9,136, respectively. These results are consistent with the observation from the study carried out by Alsharif.
The shortage of dental health-care services indicates that many people in the region might not receive preventive, basic, or advanced dental treatments, which would affect their oral health status. Moreover, this study found that governorates in the Jazan region, such as Al Harth, Fayfa, and Atwal, have a low percentage of dental providers and facilities. This could lead the residents to travel to the closest area and overload some of the MOH facilities, thus causing low quality of service. These findings suggest that these areas should be given attention for future health-care facilities' expansion.
Approximately 70% of the population who are living 20 km from the governorate's center had less access to health facilities than in the other areas. This result is similar to the result of the study conducted in Riyadh, which found that people who live far from the governorate's center have less access to public health facilities. These findings show that the outlying areas will be crowded more than the other area, which could cause other consequences such as long waiting times. This will decrease the patients' satisfaction and will eventually impact their oral health and increase the burden of oral-related diseases.,,
Over time, the traditional dental health-care system has proven to be insufficient and ineffective. The solution to the old system's shortcoming is a shift in dental policy toward a modern dental health-care system. To achieve this and make significant improvements in the dental health-care system, there needs to be a direct consultation between the major stakeholders (dentists and patients), plus improved data collection, storing, and sharing, especially for the population in remote areas.
Improvements in technology have enhanced the development of health-care services. In the case of dentistry, the development and use of applications such as teledentistry that enables a dental service provider to remotely interact with a patient for diagnosis, treatments, and recommendation have proven very effective., Such technological advancement eliminates geographical barriers, especially for the remote population. In Saudi Arabia, several studies have been carried out to assess the country's readiness to embrace teledentistry to improve dental health-care services in remote areas., For the continued progress and development of dental health-care services, policymakers and other stakeholders should embrace the use of technology. In addition, increasing the number of medical referral from the health providers, compulsory internship programs for graduated dental students in rural or underserved area in the region and support for rural area residents to be treated in closest private dental clinics should be considered to improve the access to dental health-care services.
To the researcher's knowledge, the current study was the first to make an effort to describe public dental health-care service distribution in the Jazan region of Saudi Arabia (using QGIS). However, the study faced several limitations that should be considered before using its results. At the time of the study, there was an absence of data regarding oral health services and oral health providers in the Jazan region regarding type of service offered, accessibility to dental services, and characteristics of dental providers such as gender and type of specialty as well as oral health providers (dentists, dental hygienists, and assistants, per population at district level). Due to the rapid advancement of the dental health system and general health-care system, previously collected data used in this study might not reflect recent developments.
| Conclusion|| |
This study sought to analyze variations in access to MOH PHCs and hospitals using the spatial distribution in relation to the population density in the Jazan region of Saudi Arabia. The study shows that there is a shortage in dental health-care services due to an irregular distribution of the health facilities, which leads to a decrease in the quality of service in the region. Many of the region's residents might not receive preventive, basic, or advanced dental treatments, which would negatively affect their oral health status. To combat the effects of poor dental service distribution, it is vital to consider the type of health-care facilities (PHCs or hospitals) since different facilities have different functions within the health-care service system. More efforts are needed in mapping MOH, private and other health facilities, and the burden of oral disease in the region to validate the findings.
The authors would like to acknowledge Jazan University, which has supported this study at the University of Western Australia. This support is highly acknowledged and appreciated. The authors would also like to extend their sincere gratitude to the school authorities at the University of Western Australia for their continuous support throughout the paper.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]