{"id":"https://openalex.org/W4414320953","doi":"https://doi.org/10.1016/j.joclim.2026.100672","title":"Health system resilience: quantifying the dynamic impact of environmental shocks on health service utilization using an interrupted time series and time-series forecasting approach in Western Province, Zambia","display_name":"Health system resilience: quantifying the dynamic impact of environmental shocks on health service utilization using an interrupted time series and time-series forecasting approach in Western Province, Zambia","publication_year":2026,"publication_date":"2026-03-01","ids":{"openalex":"https://openalex.org/W4414320953","doi":"https://doi.org/10.1016/j.joclim.2026.100672","pmid":"https://pubmed.ncbi.nlm.nih.gov/42011358","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13092025"},"language":"en","primary_location":{"id":"doi:10.1016/j.joclim.2026.100672","doi":"https://doi.org/10.1016/j.joclim.2026.100672","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.joclim.2026.100672","pdf_url":null,"source":{"id":"https://openalex.org/S4210213993","display_name":"The Journal of Climate Change and Health","issn_l":"2667-2782","issn":["2667-2782"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of Climate Change and Health","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1016/j.joclim.2026.100672","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5009449099","display_name":"Cameron B. Chiarot","orcid":"https://orcid.org/0000-0001-7026-902X","observed_orcids":["https://orcid.org/0000-0001-7026-902X"]},"institutions":[{"id":"https://openalex.org/I151746483","display_name":"University of Waterloo","ror":"https://ror.org/01aff2v68","country_code":"CA","type":"education","lineage":["https://openalex.org/I151746483"]}],"countries":["CA"],"is_corresponding":false,"raw_author_name":"Cameron B. Chiarot","raw_affiliation_strings":["School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada"],"raw_orcid":"https://orcid.org/0000-0001-7026-902X","affiliations":[{"raw_affiliation_string":"School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada","institution_ids":["https://openalex.org/I151746483"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5004735699","display_name":"Craig R. Janes","orcid":"https://orcid.org/0000-0002-2652-1117","observed_orcids":["https://orcid.org/0000-0002-2652-1117"]},"institutions":[{"id":"https://openalex.org/I151746483","display_name":"University of Waterloo","ror":"https://ror.org/01aff2v68","country_code":"CA","type":"education","lineage":["https://openalex.org/I151746483"]}],"countries":["CA"],"is_corresponding":false,"raw_author_name":"Craig R. Janes","raw_affiliation_strings":["School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada","institution_ids":["https://openalex.org/I151746483"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5003020167","display_name":"Fastone Mathew Goma","orcid":"https://orcid.org/0000-0002-9159-1621","observed_orcids":["https://orcid.org/0000-0002-9159-1621"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Fastone Goma","raw_affiliation_strings":["Centre for Primary Care Research, Kasama Road, Lusaka, Zambia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Centre for Primary Care Research, Kasama Road, Lusaka, Zambia","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5075886691","display_name":"Karen A. Gr\u00e9pin","orcid":"https://orcid.org/0000-0003-4368-0045","observed_orcids":["https://orcid.org/0000-0003-4368-0045"]},"institutions":[{"id":"https://openalex.org/I889458895","display_name":"University of Hong Kong","ror":"https://ror.org/02zhqgq86","country_code":"HK","type":"education","lineage":["https://openalex.org/I889458895"]}],"countries":["HK"],"is_corresponding":false,"raw_author_name":"Karen A. Gr\u00e9pin","raw_affiliation_strings":["Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China"],"raw_orcid":"https://orcid.org/0000-0003-4368-0045","affiliations":[{"raw_affiliation_string":"Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China","institution_ids":["https://openalex.org/I889458895"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5036082323","display_name":"Abel Torres Espin","orcid":"https://orcid.org/0000-0002-9787-8738","observed_orcids":["https://orcid.org/0000-0002-9787-8738"]},"institutions":[{"id":"https://openalex.org/I180670191","display_name":"University of California, San Francisco","ror":"https://ror.org/043mz5j54","country_code":"US","type":"education","lineage":["https://openalex.org/I180670191"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Abel Torres-Espin","raw_affiliation_strings":["Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA","institution_ids":["https://openalex.org/I180670191"]}]},{"author_position":"middle","author":{"id":null,"display_name":"Elizabeth J. Mroz","orcid":"https://orcid.org/0000-0002-5204-1811","observed_orcids":["https://orcid.org/0000-0002-5204-1811"]},"institutions":[{"id":"https://openalex.org/I130828816","display_name":"University of Leeds","ror":"https://ror.org/024mrxd33","country_code":"GB","type":"education","lineage":["https://openalex.org/I130828816"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Elizabeth J. Mroz","raw_affiliation_strings":["School of Geography and Water@Leeds, University of Leeds, Leeds, United Kingdom"],"raw_orcid":"https://orcid.org/0000-0002-5204-1811","affiliations":[{"raw_affiliation_string":"School of Geography and Water@Leeds, University of Leeds, Leeds, United Kingdom","institution_ids":["https://openalex.org/I130828816"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5073371477","display_name":"Mark W. Smith","orcid":"https://orcid.org/0000-0003-4361-9527","observed_orcids":["https://orcid.org/0000-0003-4361-9527"]},"institutions":[{"id":"https://openalex.org/I130828816","display_name":"University of Leeds","ror":"https://ror.org/024mrxd33","country_code":"GB","type":"education","lineage":["https://openalex.org/I130828816"]}],"countries":["GB"],"is_corresponding":false,"raw_author_name":"Mark W. Smith","raw_affiliation_strings":["School of Geography and Water@Leeds, University of Leeds, Leeds, United Kingdom"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Geography and Water@Leeds, University of Leeds, Leeds, United Kingdom","institution_ids":["https://openalex.org/I130828816"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5013553497","display_name":"Zahid A Butt","orcid":"https://orcid.org/0000-0002-2486-4781","observed_orcids":["https://orcid.org/0000-0002-2486-4781"]},"institutions":[{"id":"https://openalex.org/I151746483","display_name":"University of Waterloo","ror":"https://ror.org/01aff2v68","country_code":"CA","type":"education","lineage":["https://openalex.org/I151746483"]}],"countries":["CA"],"is_corresponding":true,"raw_author_name":"Zahid A. Butt","raw_affiliation_strings":["School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada","institution_ids":["https://openalex.org/I151746483"]}]}],"institutions":[],"countries_distinct_count":4,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5013553497"],"corresponding_institution_ids":["https://openalex.org/I151746483"],"apc_list":{"value":2200,"currency":"USD","value_usd":2200},"apc_paid":{"value":2200,"currency":"USD","value_usd":2200},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.00244789,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"28","issue":null,"first_page":"100672","last_page":"100672"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11244","display_name":"Climate Change and Health Impacts","score":0.2563000023365021,"subfield":{"id":"https://openalex.org/subfields/2307","display_name":"Health, Toxicology and Mutagenesis"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T11244","display_name":"Climate Change and Health Impacts","score":0.2563000023365021,"subfield":{"id":"https://openalex.org/subfields/2307","display_name":"Health, Toxicology and Mutagenesis"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T14090","display_name":"Health and Conflict Studies","score":0.14550000429153442,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.09430000185966492,"subfield":{"id":"https://openalex.org/subfields/2003","display_name":"Finance"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/health-system-resilience","display_name":"health system resilience","score":0.9980000257492065},{"id":"https://openalex.org/keywords/health-care-utilization","display_name":"health care utilization","score":0.8970000147819519},{"id":"https://openalex.org/keywords/environmental-shocks","display_name":"environmental shocks","score":0.996999979019165},{"id":"https://openalex.org/keywords/drought","display_name":"drought","score":0.9039999842643738},{"id":"https://openalex.org/keywords/covid-19","display_name":"COVID-19 pandemic","score":0.9769999980926514},{"id":"https://openalex.org/keywords/floods","display_name":"floods","score":0.8539999723434448},{"id":"https://openalex.org/keywords/universal-health-coverage","display_name":"universal health coverage","score":0.8500000238418579},{"id":"https://openalex.org/keywords/time-series-forecasting","display_name":"time series forecasting","score":0.6489999890327454},{"id":"https://openalex.org/keywords/prophet-model","display_name":"Prophet model","score":0.8690000176429749},{"id":"https://openalex.org/keywords/hierarchical-time-series","display_name":"hierarchical time series","score":0.8009999990463257},{"id":"https://openalex.org/keywords/early-warning","display_name":"early warning","score":0.5239999890327454},{"id":"https://openalex.org/keywords/western-province-zambia","display_name":"Western Province, Zambia","score":0.9599999785423279}],"concepts":[{"id":"https://openalex.org/C2909024267","wikidata":"https://www.wikidata.org/wiki/Q39046682","display_name":"Interrupted Time Series Analysis","level":2,"score":0.5324000120162964},{"id":"https://openalex.org/C151406439","wikidata":"https://www.wikidata.org/wiki/Q186588","display_name":"Time series","level":2,"score":0.5178999900817871},{"id":"https://openalex.org/C2780089965","wikidata":"https://www.wikidata.org/wiki/Q39046682","display_name":"Interrupted time series","level":3,"score":0.46560001373291016},{"id":"https://openalex.org/C2986740045","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health services","level":3,"score":0.4318999946117401},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.387800008058548},{"id":"https://openalex.org/C2780378061","wikidata":"https://www.wikidata.org/wiki/Q25351891","display_name":"Service (business)","level":2,"score":0.3614000082015991},{"id":"https://openalex.org/C143724316","wikidata":"https://www.wikidata.org/wiki/Q312468","display_name":"Series (stratigraphy)","level":2,"score":0.3433000147342682},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.31839999556541443},{"id":"https://openalex.org/C107826830","wikidata":"https://www.wikidata.org/wiki/Q929380","display_name":"Environmental resource management","level":1,"score":0.3174000084400177},{"id":"https://openalex.org/C91375879","wikidata":"https://www.wikidata.org/wiki/Q15473274","display_name":"Environmental planning","level":1,"score":0.302700012922287},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.28049999475479126},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.26759999990463257},{"id":"https://openalex.org/C149782125","wikidata":"https://www.wikidata.org/wiki/Q160039","display_name":"Econometrics","level":1,"score":0.26499998569488525},{"id":"https://openalex.org/C77405623","wikidata":"https://www.wikidata.org/wiki/Q598451","display_name":"System dynamics","level":2,"score":0.2542000114917755},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.2500999867916107}],"mesh":[],"locations_count":7,"locations":[{"id":"doi:10.1016/j.joclim.2026.100672","doi":"https://doi.org/10.1016/j.joclim.2026.100672","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.joclim.2026.100672","pdf_url":null,"source":{"id":"https://openalex.org/S4210213993","display_name":"The Journal of Climate Change and Health","issn_l":"2667-2782","issn":["2667-2782"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of Climate Change and Health","raw_type":"journal-article"},{"id":"doi:10.2139/ssrn.5444498","doi":"https://doi.org/10.2139/ssrn.5444498","is_oa":true,"landing_page_url":"https://doi.org/10.2139/ssrn.5444498","pdf_url":null,"source":{"id":"https://openalex.org/S4210172589","display_name":"SSRN Electronic Journal","issn_l":"1556-5068","issn":["1556-5068"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1318003438","host_organization_name":"RELX Group (Netherlands)","host_organization_lineage":["https://openalex.org/I1318003438"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},{"id":"pmid:42011358","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42011358","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The journal of climate change and health","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13092025","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13092025/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"J Clim Chang Health","raw_type":"Text"},{"id":"pmh:oai:eprints.whiterose.ac.uk:241917","doi":null,"is_oa":true,"landing_page_url":"https://eprints.whiterose.ac.uk/id/eprint/241917/1/1-s2.0-S2667278226000271-main.pdf","pdf_url":"https://eprints.whiterose.ac.uk/id/eprint/241917/1/1-s2.0-S2667278226000271-main.pdf","source":{"id":"https://openalex.org/S4306400854","display_name":"White Rose Research Online (University of Leeds, The University of Sheffield, University of York)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I2800616092","host_organization_name":"White Rose University Consortium","host_organization_lineage":["https://openalex.org/I2800616092"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":null,"raw_type":"Article"},{"id":"pmh:oai:eprints.whiterose.ac.uk:243681","doi":null,"is_oa":true,"landing_page_url":"https://eprints.whiterose.ac.uk/id/eprint/243681/1/1-s2.0-S2667278226000271-main.pdf","pdf_url":"https://eprints.whiterose.ac.uk/id/eprint/243681/1/1-s2.0-S2667278226000271-main.pdf","source":{"id":"https://openalex.org/S4306400854","display_name":"White Rose Research Online (University of Leeds, The University of Sheffield, University of York)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I2800616092","host_organization_name":"White Rose University Consortium","host_organization_lineage":["https://openalex.org/I2800616092"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":null,"raw_type":"Article"},{"id":"pmh:oai:doaj.org/article:68bd176320d24603bb71cc2467a06b93","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/68bd176320d24603bb71cc2467a06b93","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"The Journal of Climate Change and Health, Vol 28, Iss , Pp 100672- (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1016/j.joclim.2026.100672","doi":"https://doi.org/10.1016/j.joclim.2026.100672","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.joclim.2026.100672","pdf_url":null,"source":{"id":"https://openalex.org/S4210213993","display_name":"The Journal of Climate Change and Health","issn_l":"2667-2782","issn":["2667-2782"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","jufo-1","ki-jl-1","norway-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of Climate Change and Health","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9074000120162964,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[{"id":"https://openalex.org/F4320334506","display_name":"Canadian Institutes of Health Research","ror":"https://ror.org/01gavpb45"}],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":30,"referenced_works":["https://openalex.org/W1533079942","https://openalex.org/W1964656088","https://openalex.org/W1998643818","https://openalex.org/W2060004321","https://openalex.org/W2064454189","https://openalex.org/W2081498408","https://openalex.org/W2139726867","https://openalex.org/W2155588712","https://openalex.org/W2255146410","https://openalex.org/W2741458641","https://openalex.org/W2747599906","https://openalex.org/W2780517933","https://openalex.org/W2784037328","https://openalex.org/W2786358356","https://openalex.org/W2968399180","https://openalex.org/W3006536974","https://openalex.org/W3094497334","https://openalex.org/W3157805359","https://openalex.org/W3180013492","https://openalex.org/W3203489526","https://openalex.org/W3216027625","https://openalex.org/W4229063736","https://openalex.org/W4296035373","https://openalex.org/W4309191768","https://openalex.org/W4312018364","https://openalex.org/W4386346988","https://openalex.org/W4394824811","https://openalex.org/W4401895860","https://openalex.org/W4405804386","https://openalex.org/W4412470824"],"related_works":["https://openalex.org/W4312018364","https://openalex.org/W4387097219","https://openalex.org/W4221030612","https://openalex.org/W7167808243","https://openalex.org/W7131423907","https://openalex.org/W7134983628","https://openalex.org/W4295879743","https://openalex.org/W7134946528","https://openalex.org/W7134952205","https://openalex.org/W7134985565"],"abstract_inverted_index":{"Background:":[0],"In":[1],"low-":[2],"and":[3,25,70,116,165,280,303],"lower-middle-income":[4],"nations,":[5],"advancements":[6],"toward":[7],"Universal":[8],"Health":[9],"Coverage":[10],"(UHC)":[11],"are":[12,39],"progressively":[13],"jeopardized":[14],"by":[15,220,239],"the":[16,33,47,72,121,150,160,179,275,292],"combined":[17],"effects":[18,35],"of":[19,36,50,74,91,110,152,191,294],"acute":[20],"shocks,":[21],"such":[22],"as":[23,178],"floods":[24],"pandemics,":[26],"alongside":[27],"chronic":[28],"health":[29,67,93,202,281,286,311],"system":[30,282,312],"stressors.":[31],"Although":[32],"disruptive":[34],"individual":[37],"conditions":[38],"well":[40],"understood,":[41],"a":[42,84,107,127,156,166,185,210,221,240,259],"significant":[43,211,260],"gap":[44],"exists":[45],"in":[46,77,158,163,171,214,231],"empirical":[48,271],"quantification":[49],"their":[51],"synergistic":[52],"interactions":[53],"over":[54],"time.":[55],"This":[56,267],"study":[57,87,268],"employs":[58],"an":[59,140,232],"innovative":[60,270],"multi-model":[61,296],"time-series":[62,112],"methodology":[63],"to":[64,103,119,135,148,299,304,309],"dynamically":[65,284],"forecast":[66],"service":[68,203,287],"utilization":[69,215],"assess":[71],"impacts":[73,151],"major":[75],"shocks":[76,279],"Western":[78],"Province":[79],"(WP),":[80],"Zambia.Methods:":[81],"We":[82],"conducted":[83],"longitudinal":[85],"ecological":[86],"utilizing":[88],"73":[89],"months":[90],"routine":[92],"data":[94],"collected":[95],"from":[96],"62":[97],"healthcare":[98],"facilities,":[99],"spanning":[100],"October":[101],"2017":[102],"September":[104],"2023.":[105],"Initially,":[106],"comparative":[108],"analysis":[109,145,195],"four":[111],"models\u2014ARIMA,":[113],"SARIMA,":[114],"ETS,":[115],"Prophet\u2014was":[117],"performed":[118],"determine":[120],"most":[122,180],"accurate":[123,181],"forecasting":[124,182],"approach.":[125],"Subsequently,":[126],"Hierarchical":[128],"Time":[129,142],"Series":[130,143],"(HTS)":[131],"model":[132,175],"was":[133,146,176,207,256],"employed":[134],"generate":[136],"reconciled":[137],"forecasts.":[138],"Finally,":[139],"Interrupted":[141],"(ITS)":[144],"implemented":[147],"quantify":[149],"three":[153],"distinct":[154],"shocks:":[155],"drought":[157,206],"2019,":[159],"COVID-19":[161,228],"pandemic":[162,229],"2021,":[164],"complex":[167],"double-peak":[168],"flood":[169,249],"event":[170,250],"2023.Findings:":[172],"The":[173,193,205,227,247,289],"Prophet":[174],"identified":[177],"tool,":[183],"achieving":[184],"mean":[186],"absolute":[187],"percentage":[188],"error":[189],"(MAPE)":[190],"7\u00b722%.":[192],"ITS":[194],"demonstrated":[196],"that":[197,274],"each":[198],"shock":[199],"distinctly":[200],"affected":[201],"utilization.":[204,288],"associated":[208,257],"with":[209,258],"immediate":[212,233,253],"decline":[213],"(level":[216,235],"change=-0\u00b7105,":[217],"p<0\u00b7001),":[218],"followed":[219,238],"recovery":[222],"trend":[223,242,262],"(trend":[224,244,264],"change=0\u00b7019,":[225,265],"p<0\u00b7001).":[226,246],"resulted":[230],"increase":[234],"change=0\u00b7069,":[236],"p<0\u00b7001)":[237],"negative":[241],"change":[243,263],"change=-0\u00b7005,":[245],"2023":[248],"showed":[251],"no":[252],"impact":[254],"but":[255],"positive":[261],"p<0\u00b7001).Interpretation:":[266],"provides":[269],"evidence":[272],"demonstrating":[273],"interaction":[276],"between":[277],"environmental":[278],"stressors":[283],"affects":[285],"findings":[290],"underscore":[291],"significance":[293],"adopting":[295],"predictive":[297],"strategies":[298],"produce":[300],"early":[301],"warnings":[302],"inform":[305],"targeted,":[306],"data-driven":[307],"interventions":[308],"strengthen":[310],"resilience.":[313]},"counts_by_year":[],"updated_date":"2026-10-30T12:39:25.321706","created_date":"2025-10-10T00:00:00"}