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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018
8
AFRICA
based on the typical traffic trends for each area. These data are
presented descriptively. Medians and interquartile ranges are
reported as the data showed heterogeneity between provinces.
Using the drive-time polygons and the ‘Select by Location’
feature of ArcGIS 10, it was possible to extract those wards
whose centres fell within the 60- and 120-minute drive-time
polygons.
17
Integrity of the data was ensured by performing
a series of manual verifications. We extracted the specific
wards and their populations that fell within these polygons to
determine the population who live within these referral areas.
Ethical approval was obtained from the Human Research
Ethics Committee of the University of Stellenbosch (HREC Ref
Nr: M14/07/027).
Results
PCI facilities are concentrated around major cities and along
the coastal areas of South Africa. Wards within the 60- and
120-minute drive-time polygons to PCI facilities are presented
in Fig. 1.
Table 1 displays the driving distances to PCI facilities in South
Africa. The median driving distance to the closest PCI facility
nationally is 123.6 km (IQR: 157.6 km). The Northern Cape
has the longest driving distance to a PCI facility, of 940.8 km,
while the shortest distance is 0.3 km in the Eastern Cape and the
Free State provinces, jointly. The median driving distance to the
closest public PCI facility (Table 2) is 100 km (IQR: 157.6 km),
while the shortest median driving distances are in the Free State
and the Gauteng provinces, jointly (0.9 km), and the furthest is
in the Northern Cape (1 085 km).
Table 3 displays the driving times to the PCI facilities in South
Africa. The longest drive to PCI is in the Northern Cape at 751
minutes while the shortest drive is in the Free State province
(0.7 minutes). Nationally, the median driving time to PCI is 100
minutes (IQR: 120.4). The closest public PCI facility (Table 4)
is a median of 123.7 minutes (IQR 164.1) away. The shortest
time to the closest public PCI facility is in KwaZulu-Natal (1.5
minutes away) while the furthest is in the Northern Cape (900.1
minutes away).
Just over half of the population (53.8%) of South Africa live
within 60 minutes of a PCI facility while 71.53% of the country’s
population can reach a PCI facility within two hours (Table 5).
Practically all inhabitants of the Gauteng province live within 60
minutes of PCI while 2.5% of the Northern Cape’s inhabitants
are within two hours of the closest PCI facility, whether public
or privately owned. When only considering public PCI facilities
(Table 6), only 47.8 and 63% of the population can access these
facilities within 60 and 120 minutes, respectively.
Discussion
Approximately 53.8 and 71.5% of the South African population
live within 60 and 120 minutes of a PCI facility, respectively. The
median distance from a PCI facility nationally is 123.6 km while
the median driving time to a PCI facility is 100 minutes.
In the United States, 79% of the adult population live within
one hour of a PCI facility. For those living further away, 74%
would be able to access a PCI facility with an additional drive of
less than 30 minutes,
18
well within the recommendations.
4
There
is currently one PCI facility for every 887 096 people in South
Africa,
15
which would be sufficient if every patient could access
this facility within 120 minutes of first medical contact.
19
This
is however only achievable for 71.53% of the population. More
PCI facilities are therefore needed.
Table 1. Driving distances to a PCI facility (public or private) in South Africa
Province
Minimum drive
distance (km)
Median drive distance
(km) (IQR)
Maximum drive
distance (km)
Gauteng
0.5
15.1 (15.9)
71.5
Western Cape
0.8
52.9 (110.3)
363
Northern Cape
155.5
406.9 (305.4)
940.8
Eastern Cape
0.3
206.9 (157.2)
395
North West
1.1
144 (162.6)
573.3
KwaZulu-Natal
1.6
137.5 (166.6)
413.8
Free State
0.3
140.1 (118.1)
278
Mpumalanga
2.0
109.7 (51.7)
313.1
Limpopo
2.3
132 (73.9)
342.9
South Africa
0.3
123.6 (157.6)
940.8
Table 2. Driving distances to a public PCI facility in South Africa
Province
Minimum drive
distance (km)
Median drive distance
(km) (IQR)
Maximum drive
distance (km)
Gauteng
0.9
28.7 (28.5)
90.6
Western Cape
1.4
93 (227.8)
495.6
Northern Cape
155.5
406.8 (311.6)
1085.8
Eastern Cape
2.4
302.3 (140.4)
551.7
North West
7.0
172.3 (173.9)
653.7
KwaZulu-Natal
2.4
146.3 (173.8)
434.8
Free State
0.9
158.3 (107.8)
301.8
Mpumalanga
7.4
125.5 (52.5)
320.4
Limpopo
77.0
289.2 (158.1)
607.8
South Africa
0.9
170.7 (22.35)
1085.8
Table 3. Driving times to a PCI facility (public or private) in South Africa
Province
Minimum drive
time (min)
Median drive time
(min) (IQR)
Maximum drive
time (min)
Gauteng
0.8
18.3 (13.8)
59.6
Western Cape
1.6
43.8 (79.3)
277.9
Northern Cape
111.7
300.4 (640.1)
751.8
Eastern Cape
0.8
164 (137.5)
318.6
North West
3.1
115.4 (117.3)
453.6
KwaZulu-Natal
3.0
109.8 (133.6)
345.1
Free State
0.7
103.1 (79.9)
227.0
Mpumalanga
4.2
94.4 (54.6)
249.2
Limpopo
3.5
114.1 (63.2)
344.3
South Africa
0.7
100 (120.4)
751.8
Table 4. Driving times to a public PCI facility in South Africa
Province
Minimum drive
time (min)
Median drive time
(min) (IQR)
Maximum drive
time (min)
Gauteng
1.7
29.1 (20.6)
68.3
Western Cape
3.0
77.8 (160.4)
328.7
Northern Cape
105.4
298.1 (210.9)
900.1
Eastern Cape
4.3
238.6 (127.2)
432.6
North West
10.5
134.2 (125.8)
486.7
KwaZulu-Natal
1.5
90.9 (108)
270.2
Free State
1.7
112.5 (79.1)
242.9
Mpumalanga
12.6
102.6 (53.4)
257.8
Limpopo
80.8
230 (88.3)
515.2
South Africa
1.5
123.7 (164.1)
900.1