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Macharia PM, Wong KLM, Beňová L, Wang J, Makanga PT, Ray N, Banke-Thomas A. Measuring geographic access to emergency obstetric care: a comparison of travel time estimates modelled using Google Maps Directions API and AccessMod in three Nigerian conurbations. GEOSPATIAL HEALTH 2024; 19. [PMID: 38801322 DOI: 10.4081/gh.2024.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
Google Maps Directions Application Programming Interface (the API) and AccessMod tools are increasingly being used to estimate travel time to healthcare. However, no formal comparison of estimates from the tools has been conducted. We modelled and compared median travel time (MTT) to comprehensive emergency obstetric care (CEmOC) using both tools in three Nigerian conurbations (Kano, Port-Harcourt, and Lagos). We compiled spatial layers of CEmOC healthcare facilities, road network, elevation, and land cover and used a least-cost path algorithm within AccessMod to estimate MTT to the nearest CEmOC facility. Comparable MTT estimates were extracted using the API for peak and non-peak travel scenarios. We investigated the relationship between MTT estimates generated by both tools at raster celllevel (0.6 km resolution). We also aggregated the raster cell estimates to generate administratively relevant ward-level MTT. We compared ward-level estimates and identified wards within the same conurbation falling into different 15-minute incremental categories (<15/15-30/30-45/45-60/+60). Of the 189, 101 and 375 wards, 72.0%, 72.3% and 90.1% were categorised in the same 15- minute category in Kano, Port-Harcourt, and Lagos, respectively. Concordance decreased in wards with longer MTT. AccessMod MTT were longer than the API's in areas with ≥45min. At the raster cell-level, MTT had a strong positive correlation (≥0.8) in all conurbations. Adjusted R2 from a linear model (0.624-0.723) was high, increasing marginally in a piecewise linear model (0.677-0.807). In conclusion, at <45-minutes, ward-level estimates from the API and AccessMod are marginally different, however, at longer travel times substantial differences exist, which are amenable to conversion factors.
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Affiliation(s)
- Peter M Macharia
- Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Public Health, Institute of Tropical Medicine, Antwerp.
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
| | - Jia Wang
- School of Computing and Mathematical Sciences, University of Greenwich, London.
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of the Built Environment, Gweru, Midlands, Zimbabwe; Climate, Environment and Health Department, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool.
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute for Environmental Sciences, University of Geneva, Geneva.
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Human Sciences, University of Greenwich, London, United Kingdom; Maternal and Reproductive Health Research Collective, Surulere, Lagos.
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Banke-Thomas A, Wong KLM, Olubodun T, Macharia PM, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Ogunyemi O, Gwacham-Anisiobi U, Wang J, Abejirinde IOO, Makanga PT, Azodoh N, Nzelu C, Afolabi BB, Stanton C, Beňová L. Geographical accessibility to functional emergency obstetric care facilities in urban Nigeria using closer-to-reality travel time estimates: a population-based spatial analysis. Lancet Glob Health 2024; 12:e848-e858. [PMID: 38614632 DOI: 10.1016/s2214-109x(24)00045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/17/2023] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Better accessibility for emergency obstetric care facilities can substantially reduce maternal and perinatal deaths. However, pregnant women and girls living in urban settings face additional complex challenges travelling to facilities. We aimed to assess the geographical accessibility of the three nearest functional public and private comprehensive emergency obstetric care facilities in the 15 largest Nigerian cities via a novel approach that uses closer-to-reality travel time estimates than traditional model-based approaches. METHODS In this population-based spatial analysis, we mapped city boundaries, verified and geocoded functional comprehensive emergency obstetric care facilities, and mapped the population distribution for girls and women aged 15-49 years (ie, of childbearing age). We used the Google Maps Platform's internal Directions Application Programming Interface to derive driving times to public and private facilities. Median travel time and the percentage of women aged 15-49 years able to reach care were summarised for eight traffic scenarios (peak and non-peak hours on weekdays and weekends) by city and within city under different travel time thresholds (≤15 min, ≤30 min, ≤60 min). FINDINGS As of 2022, there were 11·5 million girls and women aged 15-49 years living in the 15 studied cities, and we identified the location and functionality of 2020 comprehensive emergency obstetric care facilities. City-level median travel time to the nearest comprehensive emergency obstetric care facility ranged from 18 min in Maiduguri to 46 min in Kaduna. Median travel time varied by location within a city. The between-ward IQR of median travel time to the nearest public comprehensive emergency obstetric care varied from the narrowest in Maiduguri (10 min) to the widest in Benin City (41 min). Informal settlements and peripheral areas tended to be worse off compared to the inner city. The percentages of girls and women aged 15-49 years within 60 min of their nearest public comprehensive emergency obstetric care ranged from 83% in Aba to 100% in Maiduguri, while the percentage within 30 min ranged from 33% in Aba to over 95% in Ilorin and Maiduguri. During peak traffic times, the median number of public comprehensive emergency obstetric care facilities reachable by women aged 15-49 years under 30 min was zero in eight (53%) of 15 cities. INTERPRETATION Better access to comprehensive emergency obstetric care is needed in Nigerian cities and solutions need to be tailored to context. The innovative approach used in this study provides more context-specific, finer, and policy-relevant evidence to support targeted efforts aimed at improving comprehensive emergency obstetric care geographical accessibility in urban Africa. FUNDING Google.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; School of Human Sciences, University of Greenwich, London, UK; Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Zimbabwe; Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Zimbabwe
| | - Ngozi Azodoh
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Charles Nzelu
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria; Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Bluhm S, Schramm P, Spreen-Ledebur Y, Bluhm S, Münte TF, Eiersted MR, Wolfram F, van Hooff RJR, Wienecke T, Royl G. Potential effects of a mobile stroke unit on time to treatment and outcome in patients treated with thrombectomy or thrombolysis: A Danish-German cross-border analysis. Eur J Neurol 2024:e16298. [PMID: 38682808 DOI: 10.1111/ene.16298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND PURPOSE A mobile stroke unit (MSU) reduces delays in stroke treatment by allowing thrombolysis on board and avoiding secondary transports. Due to the beneficial effect in comparison to conventional emergency medical services, current guidelines recommend regional evaluation of MSU implementation. METHODS In a descriptive study, current pathways of patients requiring a secondary transport for mechanical thrombectomy were reconstructed from individual patient records within a Danish (n = 122) and an adjacent German region (n = 80). Relevant timestamps included arrival times (on site, primary hospital, thrombectomy centre) as well as the initiation of acute therapy. An optimal MSU location for each region was determined. The resulting time saving was translated into averted disability-adjusted life years (DALYs). RESULTS For each region, the optimal MSU location required a median driving time of 35 min to a stroke patient. Time savings in the German region (median [Q1; Q3]) were 7 min (-15; 31) for thrombolysis and 35 min (15; 61) for thrombectomy. In the Danish region, the corresponding time savings were 20 min (8; 30) and 43 min (25; 66). Assuming 28 thrombectomy cases and 52 thrombolysis cases this would translate to 9.4 averted DALYs per year justifying an annual net MSU budget of $0.8M purchasing power parity dollars (PPP-$) in the German region. In the Danish region, the MSU would avert 17.7 DALYs, justifying an annual net budget of PPP-$1.7M. CONCLUSION The effects of an MSU can be calculated from individual patient pathways and reflect differences in the hospital infrastructure between Denmark and Germany.
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Affiliation(s)
- Susanna Bluhm
- Department of Neurology, University of Lübeck, Lübeck, Germany
- St Vinzenz-Hospital, Köln, Germany
| | - Peter Schramm
- Department of Neuroradiology, University of Lübeck, Lübeck, Germany
- Neurovascular Center, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | | | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Neurovascular Center, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Frauke Wolfram
- Department of Radiology, Zealand University Hospital, Roskilde, Denmark
| | - Robbert-Jan Roderick van Hooff
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Troels Wienecke
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Georg Royl
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Neurovascular Center, University Hospital Schleswig-Holstein, Lübeck, Germany
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Wong KLM, Banke-Thomas A, Olubodun T, Macharia PM, Stanton C, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Ogunyemi O, Gwacham-Anisiobi U, Wang J, Abejirinde IOO, Makanga PT, Afolabi BB, Beňová L. Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria. COMMUNICATIONS MEDICINE 2024; 4:34. [PMID: 38418903 PMCID: PMC10902387 DOI: 10.1038/s43856-024-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Better geographical accessibility to comprehensive emergency obstetric care (CEmOC) facilities can significantly improve pregnancy outcomes. However, with other factors, such as affordability critical for care access, it is important to explore accessibility across groups. We assessed CEmOC geographical accessibility by wealth status in the 15 most-populated Nigerian cities. METHODS We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assembled population distribution for women of childbearing age and Meta's Relative Wealth Index (RWI). We used the Google Maps Platform's internal Directions Application Programming Interface to obtain driving times to public and private facilities. City-level median travel time (MTT) and number of CEmOC facilities reachable within 60 min were summarised for peak and non-peak hours per wealth quintile. The correlation between RWI and MTT to the nearest public CEmOC was calculated. RESULTS We show that MTT to the nearest public CEmOC facility is lowest in the wealthiest 20% in all cities, with the largest difference in MTT between the wealthiest 20% and least wealthy 20% seen in Onitsha (26 vs 81 min) and the smallest in Warri (20 vs 30 min). Similarly, the average number of public CEmOC facilities reachable within 60 min varies (11 among the wealthiest 20% and six among the least wealthy in Kano). In five cities, zero facilities are reachable under 60 min for the least wealthy 20%. Those who live in the suburbs particularly have poor accessibility to CEmOC facilities. CONCLUSIONS Our findings show that the least wealthy mostly have poor accessibility to care. Interventions addressing CEmOC geographical accessibility targeting poor people are needed to address inequities in urban settings.
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Affiliation(s)
- Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- School of Human Sciences, University of Greenwich, London, UK.
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
- Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 67:102386. [PMID: 38152414 PMCID: PMC10751841 DOI: 10.1016/j.eclinm.2023.102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA. Methods In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger's test. This study is registered with PROSPERO, CRD42021296623. Findings Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78-1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79-0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6). Interpretation Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA. Funding Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council.
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Macharia PM, Wong KLM, Olubodun T, Beňová L, Stanton C, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Gwacham-Anisiobi U, Ogunyemi O, Wang J, Abejirinde IOO, Makanga PT, Afolabi BB, Banke-Thomas A. A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations. Sci Data 2023; 10:736. [PMID: 37872185 PMCID: PMC10593805 DOI: 10.1038/s41597-023-02651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
Travel time estimation accounting for on-the-ground realities between the location where a need for emergency obstetric care (EmOC) arises and the health facility capable of providing EmOC is essential for improving pregnancy outcomes. Current understanding of travel time to care is inadequate in many urban areas of Africa, where short distances obscure long travel times and travel times can vary by time of day and road conditions. Here, we describe a database of travel times to comprehensive EmOC facilities in the 15 most populated extended urban areas of Nigeria. The travel times from cells of approximately 0.6 × 0.6 km to facilities were derived from Google Maps Platform's internal Directions Application Programming Interface, which incorporates traffic considerations to provide closer-to-reality travel time estimates. Computations were done to the first, second and third nearest public or private facilities. Travel time for eight traffic scenarios (including peak and non-peak periods) and number of facilities within specific time thresholds were estimated. The database offers a plethora of opportunities for research and planning towards improving EmOC accessibility.
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Affiliation(s)
- Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
- Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
- School of Human Sciences, University of Greenwich, London, UK.
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Dotse-Gborgbortsi W, Tatem AJ, Matthews Z, Alegana VA, Ofosu A, Wright JA. Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data. BMJ Open 2023; 13:e066792. [PMID: 36657766 PMCID: PMC9853258 DOI: 10.1136/bmjopen-2022-066792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana. DESIGN The study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data. SETTING 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana. PARTICIPANTS Women who gave birth in health facilities in the Eastern Region, Ghana in 2017. OUTCOME MEASURES The count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services. RESULTS As travel time from women's place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations. CONCLUSIONS To increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
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Affiliation(s)
| | - Andrew J Tatem
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Zoe Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Victor A Alegana
- Population Health Unit-Wellcome Trust Research Programme, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anthony Ofosu
- Headquarters, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Jim A Wright
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
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Anwar J, Torvaldsen S, Morrell S, Taylor R. Maternal Mortality in a Rural District of Pakistan and Contributing Factors. Matern Child Health J 2023; 27:902-915. [PMID: 36609798 DOI: 10.1007/s10995-022-03570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. MATERIAL AND METHODS A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. RESULTS The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. CONCLUSION The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.
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Affiliation(s)
- Jasim Anwar
- Department of Community Medicine, Women Medical and Dental College, Abbottabad, Pakistan.
- School of Population Health, UNSW Sydney, Sydney, Australia.
| | - Siranda Torvaldsen
- School of Population Health, UNSW Sydney, Sydney, Australia
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia
| | | | - Richard Taylor
- School of Population Health, UNSW Sydney, Sydney, Australia
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Banke-Thomas A. The potential utility of an augmented data collection approach in understanding the journey to care of pregnant women for maternal and perinatal death surveillance and response. F1000Res 2022; 11:739. [PMID: 36128551 PMCID: PMC9475203 DOI: 10.12688/f1000research.123210.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background: The Maternal and Perinatal Death Surveillance and Response (MPDSR) proposed by the World Health Organization recognises the importance for health systems to understand the reasons underpinning the death of a pregnant woman or her newborn as an essential first step in preventing future similar deaths. Data for the surveillance component of the MPDSR process are typically collected from health facility sources and post-mortem interviews with affected families, though it may be traumatising to them. This brief report aimed to assess the potential utility of an augmented data collection method for mapping journeys of maternal and perinatal deaths, which does not require sourcing additional information from grieving family members. Methods: A descriptive analysis of maternal and perinatal deaths that occurred across 24 public hospitals in Lagos State, Nigeria, between 1 st November 2018 and 30 th October 2019 was conducted. Data on their demographic, obstetric history and complication at presentation, travel to the hospital, and mode of birth were extracted from their hospital records. The extracted travel data was exported to Google Maps, where driving distance and travel time to the hospital for the period of the day of travel were also extracted. Results: Of the 182 maternal deaths, most presented during the week (80.8%), travelled 5-10 km (30.6%) and 10-29 minutes (46.9%), and travelled to the nearest hospital to their places of residence (70.9%). Of the 442 pregnant women who had perinatal deaths, most presented during the week (78.5%), travelled <5 km (26.9%) and 10-29 minutes (38.0%). For both, the least reported travel data was the mode of travel used to care (>90.0%) and the period of the day they travelled (approximately 30.0%). Conclusion: An augmented data collection approach that includes accurate and complete travel data and closer-to-reality estimates of travel time and distance can be beneficial for MPDSR purposes.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, SE10 9LS, UK,Maternal and Reproductive Health Research Collective, Lagos, Nigeria,
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Banke-Thomas A, Macharia PM, Makanga PT, Beňová L, Wong KLM, Gwacham-Anisiobi U, Wang J, Olubodun T, Ogunyemi O, Afolabi BB, Ebenso B, Omolade Abejirinde IO. Leveraging big data for improving the estimation of close to reality travel time to obstetric emergency services in urban low- and middle-income settings. Front Public Health 2022; 10:931401. [PMID: 35968464 PMCID: PMC9372297 DOI: 10.3389/fpubh.2022.931401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Maternal and perinatal mortality remain huge challenges globally, particularly in low- and middle-income countries (LMICs) where >98% of these deaths occur. Emergency obstetric care (EmOC) provided by skilled health personnel is an evidence-based package of interventions effective in reducing these deaths associated with pregnancy and childbirth. Until recently, pregnant women residing in urban areas have been considered to have good access to care, including EmOC. However, emerging evidence shows that due to rapid urbanization, this so called “urban advantage” is shrinking and in some LMIC settings, it is almost non-existent. This poses a complex challenge for structuring an effective health service delivery system, which tend to have poor spatial planning especially in LMIC settings. To optimize access to EmOC and ultimately reduce preventable maternal deaths within the context of urbanization, it is imperative to accurately locate areas and population groups that are geographically marginalized. Underpinning such assessments is accurately estimating travel time to health facilities that provide EmOC. In this perspective, we discuss strengths and weaknesses of approaches commonly used to estimate travel times to EmOC in LMICs, broadly grouped as reported and modeled approaches, while contextualizing our discussion in urban areas. We then introduce the novel OnTIME project, which seeks to address some of the key limitations in these commonly used approaches by leveraging big data. The perspective concludes with a discussion on anticipated outcomes and potential policy applications of the OnTIME project.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, United Kingdom
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- *Correspondence: Aduragbemi Banke-Thomas
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Faculty of Science and Technology, Midlands State University, Gweru, Zimbabwe
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kerry L. M. Wong
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Jia Wang
- School of Computing and Mathematical Sciences, University of Greenwich, London, United Kingdom
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Nigeria
| | | | - Bosede B. Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Ibukun-Oluwa Omolade Abejirinde
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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11
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Avoka CKO, Banke-Thomas A, Beňová L, Radovich E, Campbell OMR. Use of motorised transport and pathways to childbirth care in health facilities: Evidence from the 2018 Nigeria Demographic and Health Survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000868. [PMID: 36962594 PMCID: PMC10021361 DOI: 10.1371/journal.pgph.0000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15-49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women's socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90-41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55-3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.
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Affiliation(s)
- Cephas Ke-On Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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