Assessing the accuracy of health facility typology in representing the availability of health services: a case study in Mali.

INTRODUCTION: Using health facility types as a measure of service availability is a common approach in international standards for health system policy and planning. However, this proxy may not accurately reflect the actual availability of specific health services. OBJECTIVE: This study aims to evaluate the reliability of health facility typology as an indicator of specific health service availability and explore whether certain facility types consistently provide particular services. DESIGN: We analysed a comprehensive dataset containing information from 1725 health facilities in Mali. To uncover and visualise patterns within the dataset, we used two analytical techniques: Multiple Correspondence Analysis and Between-Class Analysis. These analyses allowed us to quantitatively measure the influence of health facility types on the variation in health service provisioning. Additionally, we developed and calculated a Consistency Index, which assesses the consistency of a health facility type in providing specific health services. By examining various health facilities and services, we sought to determine the accuracy of facility types as indicators of service availability. SETTING: The study focused on the health system in Mali as a case study. RESULTS: Our findings indicate that using health facility types as a proxy for service availability in Mali is not an accurate representation. We observed that most of the variation in service provision does not stem from differences between facility types but rather within facility types. This suggests that relying solely on health facility typology may lead to an incomplete understanding of health service availability. CONCLUSIONS: These results have significant implications for health policy and planning. The reliance on health facility types as indicators for health system policy and planning should be reconsidered. A more nuanced and evidence-based understanding of health service availability is crucial for effective health policy and planning, as well as for the assessment and monitoring of health systems.

Differences between gridded population data impact measures of geographic access to healthcare in sub-Saharan Africa.

Background: Access to healthcare is imperative to health equity and well-being. Geographic access to healthcare can be modeled using spatial datasets on local context, together with the distribution of existing health facilities and populations. Several population datasets are currently available, but their impact on accessibility analyses is unknown. In this study, we model the geographic accessibility of public health facilities at 100-meter resolution in sub-Saharan Africa and evaluate six of the most popular gridded population datasets for their impact on coverage statistics at different administrative levels. Methods: Travel time to nearest health facilities was calculated by overlaying health facility coordinates on top of a friction raster accounting for roads, landcover, and physical barriers. We then intersected six different gridded population datasets with our travel time estimates to determine accessibility coverages within various travel time thresholds (i.e., 30, 60, 90, 120, 150, and 180-min). Results: Here we show that differences in accessibility coverage can exceed 70% at the sub-national level, based on a one-hour travel time threshold. The differences are most notable in large and sparsely populated administrative units and dramatically shape patterns of healthcare accessibility at national and sub-national levels. Conclusions: The results of this study show how valuable and critical a comparative analysis between population datasets is for the derivation of coverage statistics that inform local policies and monitor global targets. Large differences exist between the datasets and the results underscore an essential source of uncertainty in accessibility analyses that should be systematically assessed.

Assessment of the stream invertebrate ß -diversity along an elevation gradient using a bidimensional null model analysis.

ß -Diversity, commonly defined as the compositional variation among localities that links local diversity (α-diversity) and regional diversity (γ-diversity), can arise from two different ecological phenomena, namely the spatial species turnover (i.e., species replacement) and the nestedness of assemblages (i.e., species loss). However, any assessment that does not account for stochasticity in community assembly could be biased and misinform conservation management. In this study, we aimed to provide a better understanding of the overall ecological phenomena underlying stream ß -diversity along elevation gradients and to contribute to the rich debate on null model approaches to identify nonrandom patterns in the distribution of taxa. Based on presence-absence data of 78 stream invertebrate families from 309 sites located in the Swiss Alpine region, we analyzed the effect size of nonrandom spatial distribution of stream invertebrates on the ß -diversity and its two components (i.e., turnover and nestedness). We used a modeling framework that allows exploring the complete range of existing algorithms used in null model analysis and assessing how distribution patterns vary according to an array of possible ecological assumptions. Overall, the turnover of stream invertebrates and the nestedness of assemblages were significantly lower and higher, respectively, than the ones expected by chance. This pattern increased with elevation, and the consistent trend observed along the altitudinal gradient, even in the most conservative analysis, strengthened our findings. Our study suggests that deterministic distribution of stream invertebrates in the Swiss Alpine region is significantly driven by differential dispersal capacity and environmental stress gradients. As long as the ecological assumptions for constructing the null models and their implications are acknowledged, we believe that they still represent useful tools to measure the effect size of nonrandom spatial distribution of taxa on ß -diversity.

Light-trapped caddisflies to decipher the role of species traits and habitats in Hg accumulation and transfer.

We present a novel meta-community approach to explore the influence of species traits, such as adult body size, larval feeding type and microhabitat, as well as larval macrohabitat (main river channel vs. floodplain water bodies) on the concentration of total Hg accumulated ([THg]) in assemblages of adult caddisflies. We analyzed [THg] in 157 light-trapped adult caddisflies in a floodplain sector of the French upper Rhône River and used a linear mixed effect model to decipher the role of species traits and habitats in Hg accumulation. Variation of [THg] between species was best explained by the larval feeding type, whereas the contributions of adult size and larval micro and macro-habitat were minor. Results showed that [THg] in species associated with floodplain macrohabitats in the larval stage was lower than in those associated with the main river channel. This difference could depend on complexation of Hg by DOM (in the floodplain) and MES (in the main channel). This research provides a first evidence of the potential of an entire caddisfly assemblage for the assessment of contamination in large alluvial rivers. The implications of the results are discussed in view of the possible role of caddisflies as vectors of Hg to riparian predators.

Impacts of climate change on aquatic insects in temperate alpine regions: Complementary modeling approaches applied to Swiss rivers.

Freshwater biodiversity loss is a major concern, and global warming is already playing a significant role in species extinctions. Our main goal was to predict climate change impacts on aquatic insect species distribution and richness in Swiss running waters according to two climate change scenarios (RCP2.6 and RCP8.5), using different modeling approaches, that is, species distribution models (SDMs), stacked-SDMs (S-SDMs) and a macroecological model (MEM). We analyzed 10,808 reaches, used as spatial units for model predictions, for a total river network length of 20,610 km. Results were assessed at both the countrywide and the biogeographic regional scales. We used incidence data of 41 species of Ephemeroptera, Plecoptera and Trichoptera (EPT) from 259 sites distributed across Switzerland. We integrated a coupled model for hydrology and glacier retreat to simulate monthly time-step discharge from which we derived hydrological variables. These, along with thermal, land-cover, topographic and spatially explicit data, served as predictors for our ecological models. Predictions of occurrence probabilities and EPT richness were compared among the different regions, periods and scenarios. A Shiny web application was developed to interactively explore all the models' details, to ensure transparency and promote the sharing of information. MEM and S-SDMs approaches consistently showed that overall, climate change is likely to reduce EPT richness. Decrease could be around 10% in the least conservative scenario, depending on the region. Global warming was shown to represent a threat to species from high elevation, but in terms of species richness, running waters from lowlands and medium elevation seemed more vulnerable. Finally, our results suggested that the effects of anthropogenic activities could overweight natural factors in shaping the future of river biodiversity.

The interplay of flow processes shapes aquatic invertebrate successions in floodplain channels - A modelling applied to restoration scenarios.

The high biotic diversity supported by floodplains is ruled by the interplay of geomorphic and hydrological processes at various time scales, from daily fluctuations to decennial successions. Because understanding such processes is a key question in river restoration, we attempted to model changes in taxonomic richness in an assemblage of 58 macroinvertebrate taxa (21 gastropoda and 37 ephemeroptera, plecoptera and trichoptera, EPT) along two successional sequences typical for former braided channels. Individual models relating the occurrence of taxa to overflow and backflow durations were developed from field measurements in 19 floodplain channels of the Rhône floodplain (France) monitored over 10 years. The models were combined to simulate diversity changes along a progressive alluviation and disconnection sequence after the reconnection with the main river of a previously isolated channel. Two scenarios were considered: (i) an upstream + downstream reconnection creating a lotic channel, (ii) a downstream reconnection creating a semi-lotic channel. Reconnection led to a direct increase in invertebrate richness (on average x2.5). However, taxonomical richness showed a constant decrease as isolation progressed and reached an average of 2 for EPT and 7 for gastropods at the end of the scenarios. With more than 80% of the taxonomic models with an AUC equal or higher than 0.7 and slopes of linear relations between observed and predicted richness of 0.75 (gastropods) and 1 (EPT), the Boosted Regression Trees (BRT) provided a good basis for prediction of species assemblages. These models can be used to quantify a priori the sustainability and ecological efficiency of restoration actions and help floodplain restoration planning and management.