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Berete A, Enos J, Berete K, Kumah A, Acheampong G, Camara A. Mapping of Health Resources in Lower Manya Krobo Municipality in the Eastern Region of Ghana. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:70-74. [PMID: 38725888 PMCID: PMC11077519 DOI: 10.36401/jqsh-23-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 05/12/2024]
Abstract
Introduction Spatial disparities impact population health and are linked to social and health disparities. Understanding the scope, nature, and trends of regional inequalities can help create policies, strategies, and interventions that affect the morbidity and mortality of various disease control. The variations in the distribution of health facilities have resulted in differences in health outcomes within Ghana's administrative districts, of which the Lower Manya Krobo Municipality (LMKM) is no exception. The primary objective of this study was to examine the distribution of healthcare resources in the LMKM in the Eastern Region of Ghana. Methods A single case study approach involving all health resources, facilities, and supporting service centers in the LMKM was adopted. All functional health facilities in the municipality during the study were included. The study partly used records of generated coordinates using the global positioning system of other resources and services. Results The Municipality had 16 health facilities and 29 supporting centers. There were 285 clinical health workers in the municipality. Odumase and Akuse had higher percentages of clinical health personnel. The municipality's population per single health worker ratio was 13,201:1. Agomanya had the highest number of facilities and support centers. The population per health facility ratio was 15,086 per facility. Conclusion The study demonstrated disparities in the distribution of health facilities across the municipality. There is a need to ensure that all health resources are allocated to the population size and the health needs of the LMKM.
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Affiliation(s)
- Ansoumane Berete
- Department of Community Health, Ensign College of Public Health, Kpong, Ghana
| | - Juliana Enos
- Department of Public Health, University of Ghana, Accra, Ghana
| | - Karinkan Berete
- Stop Polio Consultant, World Health Organization, Democratic Republic of the Congo
| | | | - Gideon Acheampong
- Department of Community Health, Ensign College of Public Health, Kpong, Ghana
| | - Aissata Camara
- Dubreka District Health Directorate, Ministry of Health and Public Hygiene, Conakry, Guinea
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He C, Zhu Y, Zhou L, Bachwenkizi J, Schneider A, Chen R, Kan H. Flood exposure and pregnancy loss in 33 developing countries. Nat Commun 2024; 15:20. [PMID: 38167351 PMCID: PMC10761804 DOI: 10.1038/s41467-023-44508-0] [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: 01/28/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Floods have affected billions worldwide. Yet, the indirect health impacts of floods on vulnerable groups, particularly women in the developing world, remain underexplored. Here, we evaluated the risk of pregnancy loss for women exposed to floods. We analyzed 90,465 individual pregnancy loss records from 33 developing countries, cross-referencing each with spatial-temporal flood databases. We found that gestational flood exposure is associated with increased pregnancy loss with an odds ratio of 1.08 (95% confidence interval: 1.04 - 1.11). This risk is pronounced for women outside the peak reproductive age range (<21 or >35) or during the mid and late-stage of pregnancy. The risk escalated for women dependent on surface water, with lower income or education levels. We estimated that, over the 2010s, gestational flood events might be responsible for approximately 107,888 (CIs: 53,944 - 148,345) excess pregnancy losses annually across 33 developing countries. Notably, there is a consistent upward trend in annual excess pregnancy losses from 2010 to 2020, and was more prominent over Central America, the Caribbean, South America, and South Asia. Our findings underscore the disparities in maternal and child health aggravated by flood events in an evolving climate.
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Affiliation(s)
- Cheng He
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Lu Zhou
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Jovine Bachwenkizi
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China.
- Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
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Gausman J, Pingray V, Adanu R, Bandoh DAB, Berrueta M, Blossom J, Chakraborty S, Dotse-Gborgbortsi W, Kenu E, Khan N, Langer A, Nigri C, Odikro MA, Ramesh S, Saggurti N, Vázquez P, Williams CR, Jolivet RR. Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data. PLoS One 2023; 18:e0287904. [PMID: 37708180 PMCID: PMC10501555 DOI: 10.1371/journal.pone.0287904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/15/2023] [Indexed: 09/16/2023] Open
Abstract
Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization's indicator "Availability of EmONC facilities" was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate "Availability of EmONC" by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator's value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator's validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.
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Affiliation(s)
- Jewel Gausman
- Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
| | - Richard Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Delia A. B. Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
| | - Jeff Blossom
- Center for Geographic Analysis, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | | | - Ana Langer
- Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carolina Nigri
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
| | - Magdalene A. Odikro
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | | | | | - Paula Vázquez
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
- Department of Health Science, Kinesiology, and Rehabilitation, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Caitlin R. Williams
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
- Department of Maternal & and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - R. Rima Jolivet
- Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Mroz EJ, Willis T, Thomas C, Janes C, Singini D, Njungu M, Smith M. Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia. Int J Health Geogr 2023; 22:17. [PMID: 37525198 PMCID: PMC10391775 DOI: 10.1186/s12942-023-00338-3] [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: 03/29/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Seasonal floods pose a commonly-recognised barrier to women's access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women's walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access.
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Affiliation(s)
- Elizabeth Jade Mroz
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK.
| | - Thomas Willis
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Thomas
- Lincoln Centre for Water & Planetary Health, University of Lincoln, Lincoln, LN6 7DW, UK
| | - Craig Janes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Douglas Singini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mwimanenwa Njungu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mark Smith
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
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Hameed S, Mureed S, Chaudhri R, Khan SA, Khan MS. Postnatal women's perception on person-centered maternity care in twin cities of Rawalpindi and Islamabad: a descriptive study. BMC Pregnancy Childbirth 2023; 23:52. [PMID: 36681786 PMCID: PMC9862516 DOI: 10.1186/s12884-023-05362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Person-Centered Maternity Care (PCMC) is known as one of the most important components of maternal care. Every woman has the ultimate right of respectful health care. Previous research documents that lack of supportive care and respectful behavior experienced by pregnant women can act as a barrier to the utilization of health care services. Few studies have used PCMC tool to document this phenomenon. The objective of this descriptive study was to assess the women's perception of PCMC in Pakistan. METHODS Three hundred and seventy-seven (377) postnatal women of ages 18-49 years participated in the research. The study sites were secondary and tertiary care hospitals located in the twin cities of Rawalpindi and Islamabad. The PCMC tool used in this study is a validated scale with three sub-domains of i) communication and autonomy, ii) supportive care, and iii) dignity and respect. Data was analyzed using SPSS version 16, and descriptive and bivariate analysis was undertaken. RESULTS The PCMC mean score was 54 ± [10.7] out of 90. About half (55%) of women had good perception of PCMC. Sub-domain of supportive care scored the lowest as compared to the other two domains. Overall, 36% women reported physical abuse while 22% reported verbal abuse at the hands of the healthcare providers. Most of the women (88%) said that health providers did not introduce themselves. About 30% women claimed that health care providers never asked for permission before doing any medical procedures and 20% of women claimed that doctors did not describe the purpose of examination while 178 (47%) of women said that health provider explained the purpose of medications all the time, additionally, about 14% were never given the choice to ask questions. CONCLUSION The study concluded that the majority of postnatal women perceived that they were not getting optimum Person-Centered Maternity Care. Some core aspects in supportive care domain were missing. In order to improve the quality of hospital-based childbirths, efforts are needed to improve the quality of care.
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Affiliation(s)
- Sumbal Hameed
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Sheh Mureed
- Health Section, Ministry of Planning Development and Special Initiatives, Islamabad, Pakistan
| | - Rizwana Chaudhri
- grid.414319.a0000 0004 0401 3810Obstetrics and Gynecology Department, Holy Family Hospital, Rawalpindi, Pakistan
| | - Shahzad Ali Khan
- grid.413930.c0000 0004 0606 8575Vice Chancellor, Health Services Academy, Islamabad, Pakistan
| | - Mohsin Saeed Khan
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Gore-Langton GR, Cano J, Simpson H, Tatem A, Tejedor-Garavito N, Wigley A, Carioli A, Gething P, Weiss DJ, Chandramohan D, Walker PGT, Cairns ME, Chico RM. Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001061. [PMID: 36962612 PMCID: PMC10022219 DOI: 10.1371/journal.pgph.0001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Women are at risk of severe adverse pregnancy outcomes attributable to Plasmodium spp. infection in malaria-endemic areas. Malaria control efforts since 2000 have aimed to reduce this burden of disease. METHODS We used data from the Malaria Atlas Project and WorldPop to calculate global pregnancies at-risk of Plasmodium spp. infection. We categorised pregnancies as occurring in areas of stable and unstable P. falciparum and P. vivax transmission. We further stratified stable endemicity as hypo-endemic, meso-endemic, hyper-endemic, or holo-endemic, and estimated pregnancies at risk in 2000, 2005, 2010, 2015, 2017, and 2020. FINDINGS In 2020, globally 120.4M pregnancies were at risk of P. falciparum, two-thirds (81.0M, 67.3%) were in areas of stable transmission; 85 2M pregnancies were at risk of P. vivax, 93.9% (80.0M) were in areas of stable transmission. An estimated 64.6M pregnancies were in areas with both P. falciparum and P. vivax transmission. The number of pregnancies at risk of each of P. falciparum and P. vivax worldwide decreased between 2000 and 2020, with the exception of sub-Saharan Africa, where the total number of pregnancies at risk of P. falciparum increased from 37 3M in 2000 to 52 4M in 2020. INTERPRETATION Historic investments in malaria control have reduced the number of women at risk of malaria in pregnancy in all endemic regions except sub-Saharan Africa. Population growth in Africa has outpaced reductions in malaria prevalence. Interventions that reduce the risk of malaria in pregnancy are needed as much today as ever.
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Affiliation(s)
- Georgia R Gore-Langton
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jorge Cano
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Expanded Special Project for Elimination of Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Hope Simpson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Natalia Tejedor-Garavito
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Adelle Wigley
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Alessandra Carioli
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Peter Gething
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Daniel J Weiss
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Patrick G T Walker
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Matthew E Cairns
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Nilsen K, Tejedor-Garavito N, Leasure DR, Utazi CE, Ruktanonchai CW, Wigley AS, Dooley CA, Matthews Z, Tatem AJ. A review of geospatial methods for population estimation and their use in constructing reproductive, maternal, newborn, child and adolescent health service indicators. BMC Health Serv Res 2021; 21:370. [PMID: 34511089 PMCID: PMC8436450 DOI: 10.1186/s12913-021-06370-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 01/05/2023] Open
Abstract
Background Household survey data are frequently used to measure reproductive, maternal, newborn, child and adolescent health (RMNCAH) service utilisation in low and middle income countries. However, these surveys are typically only undertaken every 5 years and tend to be representative of larger geographical administrative units. Investments in district health management information systems (DHMIS) have increased the capability of countries to collect continuous information on the provision of RMNCAH services at health facilities. However, reliable and recent data on population distributions and demographics at subnational levels necessary to construct RMNCAH coverage indicators are often missing. One solution is to use spatially disaggregated gridded datasets containing modelled estimates of population counts. Here, we provide an overview of various approaches to the production of gridded demographic datasets and outline their potential and their limitations. Further, we show how gridded population estimates can be used as alternative denominators to produce RMNCAH coverage metrics in combination with data from DHMIS, using childhood vaccination as examples. Methods We constructed indicators on the percentage of children one year old for diphtheria, pertussis and tetanus vaccine dose 3 (DTP3) and measles vaccine dose (MCV1) in Zambia and Nigeria at district levels. For the numerators, information on vaccines doses was obtained from each country’s respective DHMIS. For the denominators, the number of children was obtained from 3 different sources including national population projections and aggregated gridded estimates derived using top-down and bottom-up geospatial methods. Results In Zambia, vaccination estimates utilising the bottom-up approach to population estimation substantially reduced the number of districts with > 100% coverage of DTP3 and MCV1 compared to estimates using population projection and the top-down method. In Nigeria, results were mixed with bottom-up estimates having a higher number of districts > 100% and estimates using population projections performing better particularly in the South. Conclusions Gridded demographic data utilising traditional and novel data sources obtained from remote sensing offer new potential in the absence of up to date census information in the estimation of RMNCAH indicators. However, the usefulness of gridded demographic data is dependent on several factors including the availability and detail of input data. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06370-y.
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Affiliation(s)
- Kristine Nilsen
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK.
| | - Natalia Tejedor-Garavito
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Douglas R Leasure
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Corrine W Ruktanonchai
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Adelle S Wigley
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Claire A Dooley
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Zoe Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
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Mansour A, Sirichotiratana N, Viwatwongkasem C, Khan M, Srithamrongsawat S. District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030. Int J Equity Health 2021; 20:5. [PMID: 33407542 PMCID: PMC7789368 DOI: 10.1186/s12939-020-01338-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan. METHODS A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used. RESULTS The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts. CONCLUSION The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.
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Affiliation(s)
- Ashraf Mansour
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Nithat Sirichotiratana
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mahmud Khan
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Gage AD, Carnes F, Blossom J, Aluvaala J, Amatya A, Mahat K, Malata A, Roder-DeWan S, Twum-Danso N, Yahya T, Kruk ME. In Low- And Middle-Income Countries, Is Delivery In High-Quality Obstetric Facilities Geographically Feasible? Health Aff (Millwood) 2020; 38:1576-1584. [PMID: 31479351 DOI: 10.1377/hlthaff.2018.05397] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.
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Affiliation(s)
- Anna D Gage
- Anna D. Gage ( ) is a student in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Fei Carnes
- Fei Carnes is a geographic information systems (GIS) specialist in the Center for Geographic Analyses, Harvard University, in Cambridge, Massachusetts
| | - Jeff Blossom
- Jeff Blossom is the GIS service manager in the Center for Geographic Analyses, Harvard University
| | - Jalemba Aluvaala
- Jalemba Aluvaala is a research fellow in the Department of Paediatrics and Child Health, University of Nairobi School of Medicine, in Kenya
| | - Archana Amatya
- Archana Amatya is an assistant professor of community medicine and public health at the Tribhuvan University Teaching Hospital, in Kathmandu, Nepal
| | - Kishori Mahat
- Kishori Mahat is an advisor in Quality Assurance and Regulation, Nepal Health Sector Support Programme, Department for International Development, in Kathmandu
| | - Address Malata
- Address Malata is principal of the College of Nursing, Malawi University of Science and Technology, in Limbe
| | - Sanam Roder-DeWan
- Sanam Roder-DeWan is a researcher in the Ifakara Health Institute, in Dar es Salaam, Tanzania
| | | | - Talhiya Yahya
- Talhiya Yahya is head of the Quality Management Unit, Ministry of Health, Community Development, Gender, Elderly, and Children, in Dar es Salaam
| | - Margaret E Kruk
- Margaret E. Kruk is an associate professor in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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10
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Leveraging multiple data types to estimate the size of the Zika epidemic in the Americas. PLoS Negl Trop Dis 2020; 14:e0008640. [PMID: 32986701 PMCID: PMC7544039 DOI: 10.1371/journal.pntd.0008640] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/08/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022] Open
Abstract
Several hundred thousand Zika cases have been reported across the Americas since 2015. Incidence of infection was likely much higher, however, due to a high frequency of asymptomatic infection and other challenges that surveillance systems faced. Using a hierarchical Bayesian model with empirically-informed priors, we leveraged multiple types of Zika case data from 15 countries to estimate subnational reporting probabilities and infection attack rates (IARs). Zika IAR estimates ranged from 0.084 (95% CrI: 0.067–0.096) in Peru to 0.361 (95% CrI: 0.214–0.514) in Ecuador, with significant subnational variability in every country. Totaling infection estimates across these and 33 other countries and territories, our results suggest that 132.3 million (95% CrI: 111.3-170.2 million) people in the Americas had been infected by the end of 2018. These estimates represent the most extensive attempt to determine the size of the Zika epidemic in the Americas, offering a baseline for assessing the risk of future Zika epidemics in this region. During the recent Zika epidemic in the Americas millions of people were likely infected, but the true size of the epidemic is unknown because of gaps in the surveillance system. The infection attack rate (IAR)—defined as the proportion of the population that was infected over the course of the epidemic—has important implications for the longer-term epidemiology of Zika in the region, such as the timing, location, and likelihood of future outbreaks. To estimate the IAR and the total number of people infected, we leveraged multiple types of Zika case data from 15 countries and territories where subnational data were publicly available. Datasets included confirmed and suspected Zika cases in pregnant women and in the total population, Zika-associated Guillan-Barré syndrome cases, and cases of congenital Zika syndrome. We used a hierarchical Bayesian model with empirically-informed priors that leveraged the different case report types to simultaneously estimate national and subnational reporting probabilities, the fraction of symptomatic infections, and subnational IARs. In these 15 countries and territories, estimates of Zika IAR ranged from 0.084 (95% CrI: 0.067–0.096) in Peru to 0.361 (95% CrI: 0.214–0.514) in Ecuador. Totaling these infection estimates across these and 33 other countries and territories in the region, our results suggest that 132.3 million (95% CrI: 111.3-170.2 million) people in the Americas were infected with ZIKV by the end of 2018.
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11
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Wigley AS, Tejedor-Garavito N, Alegana V, Carioli A, Ruktanonchai CW, Pezzulo C, Matthews Z, Tatem AJ, Nilsen K. Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa. BMC Med 2020; 18:237. [PMID: 32895051 PMCID: PMC7487649 DOI: 10.1186/s12916-020-01707-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/13/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes. METHODS Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services. RESULTS Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other. CONCLUSION While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.
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Affiliation(s)
- A S Wigley
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - N Tejedor-Garavito
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - V Alegana
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya
- Faculty of Science and Technology, Lancaster University, Lancaster, LA1 4YR, UK
| | - A Carioli
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - C W Ruktanonchai
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - C Pezzulo
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Z Matthews
- Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - A J Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - K Nilsen
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
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12
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Tao Z, Cheng Y, Du S, Feng L, Wang S. Accessibility to delivery care in Hubei Province, China. Soc Sci Med 2020; 260:113186. [PMID: 32683160 DOI: 10.1016/j.socscimed.2020.113186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Accessibility to delivery care is crucial for improving maternal health, which is an important policy goal to ensure healthy lives and promote well-being in China and worldwide, especially with the change of the family planning policy in China in 2016. This study develops a set of methods to project the population of women of child-bearing age and birth population and assess the accessibility to delivery care services in Hubei Province. The Cohort-Component projection method with various scenarios was applied to project the population of women of children-bearing age in 2030. A Gravity-based Variable Two-Step Floating Catchment Area (GV2SFCA) method is developed, which takes into account the heterogeneous catchment areas and distance decay effects for different regions and various levels of delivery care services. The parameters are calibrated by using medical records with patients' addresses. The traditional Supply-Demand Ratio method is also applied. The results demonstrate an overall decreasing trend of birth population in Hubei in all scenarios, but with significant disparities across regions. In 2016, 28% of districts fail to reach the policy goal with 17 beds per thousand births. In 2030, accessibility to delivery care is projected to increase in 98% of districts, while there are still 22% of districts that fail to reach the policy goal. The accessibility scores are further combined with the densities of birth population to identify shortage areas of delivery care. 7% and 6% of districts are classified as Major Shortage Areas in 2016 and 2030, respectively. The findings shed lights on the distributions and future changes of accessibility to and shortage areas of delivery care in Hubei, which can provide evidence-based recommendations for planning and policymaking. It also provides innovative methods for more accurately assessing accessibility to delivery care.
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Affiliation(s)
- Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University; No.19, XinJieKouWai St., Haidian District, Beijing, 100875, China.
| | - Yang Cheng
- Faculty of Geographical Science, Beijing Normal University; No.19, XinJieKouWai St., Haidian District, Beijing, 100875, China.
| | - Shishuai Du
- Faculty of Geographical Science, Beijing Normal University; No.19, XinJieKouWai St., Haidian District, Beijing, 100875, China; Shandong Experimental High School, Jinan, Shandong, 250001, China.
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China.
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China.
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13
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Dotse-Gborgbortsi W, Tatem AJ, Alegana V, Utazi CE, Ruktanonchai CW, Wright J. Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data. Trop Med Int Health 2020; 25:1044-1054. [PMID: 32632981 PMCID: PMC7613541 DOI: 10.1111/tmi.13460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective This study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility. Methods Through a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA and then applied model estimates to spatial layers to assess the probability of SBA at high-spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates and modelled travel time to health facilities. Results Within an hour’s travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services, and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high-quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions. Conclusion Given the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.
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Affiliation(s)
- Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Victor Alegana
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK.,Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya.,Faculty of Science and Technology, Lancaster University, Lancaster, UK
| | - C Edson Utazi
- WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK.,Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Corrine Warren Ruktanonchai
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Jim Wright
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
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14
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Shakya HB, Weeks J, Challa S, Fleming PJ, Cislaghi B, McDougal L, Boyce SC, Raj A, Silverman JG. Spatial analysis of individual- and village-level sociodemographic characteristics associated with age at marriage among married adolescents in rural Niger. BMC Public Health 2020; 20:729. [PMID: 32429949 PMCID: PMC7238637 DOI: 10.1186/s12889-020-08759-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Niger has the highest prevalence of child marriage in the world. While child marriage in Niger is clearly normative in the sense that it is commonly practiced, the social and contextual factors that contribute to it are still unclear. Methods Here, we tested the importance of village-level factors as predictors of young age at marriage for a group of married adolescent girls (N = 1031) in the Dosso district of rural Niger, using multi-level and geographic analyses. We aggregated significant individual level factors to determine whether, independent of a girl’s own sociodemographic characteristics, the impact of each factor is associated at the village level. Finally, we tested for spatial dependence and heterogeneity in examining whether the village-level associations we find with age at marriage differ geographically. Results The mean age of marriage for girls in our study was 14.20 years (SD 1.8). Our statistical results are consistent with other literature suggesting that education is associated with delayed marriage, even among adolescent girls. Younger ages at marriage are also associated with a greater age difference between spouses and with a greater likelihood of women being engaged in agricultural work. Consistent with results at the individual level, at the village level we found that the proportion of girls who do agricultural work and the mean age difference between spouses were both predictive of a lower age at marriage for individual girls. Finally, mapping age at marriage at the village level revealed that there is geographical variation in age at marriage, with a cluster of hot spots in the Hausa-dominated eastern area where age at marriage is particularly low and a cluster of cold spots in the Zarma-dominated western areas where age at marriage is relatively high. Conclusions Our findings suggest that large-scale approaches to eliminating child marriage in these communities may be less successful if they do not take into consideration geographically and socially determined contextual factors at the village level.
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Affiliation(s)
- Holly B Shakya
- Center on Gender Equity and Health, University of California San Diego, 9100 Gilman Dr, La Jolla, CA, USA.
| | - John Weeks
- San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Sneha Challa
- Center on Gender Equity and Health, University of California San Diego, 9100 Gilman Dr, La Jolla, CA, USA
| | - Paul J Fleming
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, 9100 Gilman Dr, La Jolla, CA, USA
| | - Sabrina C Boyce
- University of California Berkeley, 50 University Ave Hall #7360, Berkeley, CA, 94720, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, 9100 Gilman Dr, La Jolla, CA, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, University of California San Diego, 9100 Gilman Dr, La Jolla, CA, USA
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15
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Ocholla IA, Agutu NO, Ouma PO, Gatungu D, Makokha FO, Gitaka J. Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya. BMC Pregnancy Childbirth 2020; 20:287. [PMID: 32397969 PMCID: PMC7216545 DOI: 10.1186/s12884-020-02977-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deaths, inequality in access to care and quality care have been identified as current barriers. Contributing to these barriers are the bypassing behaviour and geographical access which leads to delay in seeking newborn care. This study (i) measured geographical accessibility of inpatient newborn care, and (ii), characterized bypassing behaviour using the geographical accessibility of the inpatient newborn care seekers. METHODS Geographical accessibility to the inpatient newborn units was modelled based on travel time to the units across Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whose newborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced and were used against the modelled travel time to define bypassing behaviour. RESULTS Approximately 90% of the sick newborn population have access to nearest newborn units (< 2 h). However, 36% of the mothers bypassed their nearest inpatient newborn facility, with lack of diagnostic services (28%) and distrust of health personnel (37%) being the major determinants for bypassing. Approximately 75% of the care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison to sub-county facilities which mostly were bypassed and remained underutilised. CONCLUSION Our findings suggest that though majority of the population have access to care, sub-county inpatient newborn facilities have high risk of being bypassed. There is need to improve quality of care in maternal care, to reduce bypassing behaviour and improving neonatal outcome.
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Affiliation(s)
- Ian A. Ocholla
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Nathan O. Agutu
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Paul O. Ouma
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Daniel Gatungu
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | | | - Jesse Gitaka
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
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16
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Ruktanonchai CW, Nieves JJ, Ruktanonchai NW, Nilsen K, Steele JE, Matthews Z, Tatem AJ. Estimating uncertainty in geospatial modelling at multiple spatial resolutions: the pattern of delivery via caesarean section in Tanzania. BMJ Glob Health 2020; 4:e002092. [PMID: 32154032 PMCID: PMC7044704 DOI: 10.1136/bmjgh-2019-002092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 11/03/2022] Open
Abstract
Visualising maternal and newborn health (MNH) outcomes at fine spatial resolutions is crucial to ensuring the most vulnerable women and children are not left behind in improving health. Disaggregated data on life-saving MNH interventions remain difficult to obtain, however, necessitating the use of Bayesian geostatistical models to map outcomes at small geographical areas. While these methods have improved model parameter estimates and precision among spatially correlated health outcomes and allowed for the quantification of uncertainty, few studies have examined the trade-off between higher spatial resolution modelling and how associated uncertainty propagates. Here, we explored the trade-off between model outcomes and associated uncertainty at increasing spatial resolutions by quantifying the posterior distribution of delivery via caesarean section (c-section) in Tanzania. Overall, in modelling delivery via c-section at multiple spatial resolutions, we demonstrated poverty to be negatively correlated across spatial resolutions, suggesting important disparities in obtaining life-saving obstetric surgery persist across sociodemographic factors. Lastly, we found that while uncertainty increased with higher spatial resolution input, model precision was best approximated at the highest spatial resolution, suggesting an important policy trade-off between identifying concealed spatial heterogeneities in health indicators.
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Affiliation(s)
| | - Jeremiah J Nieves
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Nick W Ruktanonchai
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Kristine Nilsen
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Jessica E Steele
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Zoe Matthews
- Department of Social Statistics & Demography, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
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17
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Dotse-Gborgbortsi W, Dwomoh D, Alegana V, Hill A, Tatem AJ, Wright J. The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana. BMJ Glob Health 2020; 4:e002020. [PMID: 32154031 PMCID: PMC7044703 DOI: 10.1136/bmjgh-2019-002020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana. Methods We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns. Results A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community. Conclusion This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence-based information for improving maternal health service provision by targeting specific communities and health facilities.
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Affiliation(s)
- Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Victor Alegana
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK.,Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme P.O. Box 43640-00100, Nairobi, Kenya.,Faculty of Science and Technology, Lancaster University, Lancaster, UK
| | - Allan Hill
- Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- School of Geography and Environmental Science, University of Southampton, Southampton, UK.,WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Jim Wright
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
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18
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Chuang YC, Chuang TW, Chao HJ, Tseng KC, Nkoka O, Sunaringsih S, Chuang KY. Contextual Factors and Spatial Patterns of Childhood Malnutrition in Provinces of Burkina Faso. J Trop Pediatr 2020; 66:66-74. [PMID: 31086979 DOI: 10.1093/tropej/fmz031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Approximately 45% of all children's deaths are associated with malnutrition, and sub-Saharan Africa is hardest hit by this phenomenon. However, information on geographical variations of malnutrition in developing countries is limited. This study examined the geographical distribution and community characteristics associated with child malnutrition in Burkina Faso. DESIGN Data from the 2011 Burkina Faso Demographic Health Survey were analyzed. A general Kriging interpolation method was used to generate spatial malnutrition patterns. The global Moran's I test was used to identify significant malnutrition spatial patterns. Generalized estimating equations (GEEs) were fitted to examine the association between community level factors and malnutrition. RESULTS Average rates of stunting and wasting in the communities were 32.48% and 15.05%, respectively. Stunting hotspots were observed in the eastern and northeastern parts of Burkina Faso (i.e. Oudolan, Séno and Yagha, among others), while high rates of wasting were observed in the north-central part. The GEE results revealed lower stunting rates in communities with a higher percentage of households with improved sanitation. Communities with higher rates of professionally assisted births were associated with low wasting rates, while communities with higher rates of households with a low wealth index reported higher rates of wasting. CONCLUSIONS Spatial statistical models of malnutrition prevalence are useful for indicating hotspots over wide areas and hence, for guiding intervention strategies. This study revealed significant geographical patterns and community factors associated with childhood malnutrition. These factors should be considered in future programs aimed at reducing malnutrition in Burkina Faso.
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Affiliation(s)
- Ying-Chih Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
| | - Kuo-Chien Tseng
- School of Public Health, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
| | - Owen Nkoka
- School of Public Health, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
| | - Sri Sunaringsih
- School of Public Health, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, 250 Wu-Hsing St, Taipei 11031, Taiwan
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Geospatial Disaggregation of Population Data in Supporting SDG Assessments: A Case Study from Deqing County, China. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2019. [DOI: 10.3390/ijgi8080356] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quantitative assessments and dynamic monitoring of indicators based on fine-scale population data are necessary to support the implementation of the United Nations (UN) 2030 Agenda and to comprehensively achieve its 17 Sustainable Development Goals (SDGs). However, most population data are collected by administrative units, and it is difficult to reflect true distribution and uniformity in space. To solve this problem, based on fine building information, a geospatial disaggregation method of population data for supporting SDG assessments is presented in this paper. First, Deqing County in China, which was divided into residential areas and nonresidential areas according to the idea of dasymetric mapping, was selected as the study area. Then, the town administrative areas were taken as control units, building area and number of floors were used as weighting factors to establish the disaggregation model, and population data with a resolution of 30 m in Deqing County in 2016 were obtained. After analyzing the statistical population of 160 villages and the disaggregation results, we found that the global average accuracy was 87.08%. Finally, by using the disaggregation population data, indicators 3.8.1, 4.a.1, and 9.1.1 were selected to conduct an accessibility analysis and a buffer analysis in a quantitative assessment of the SDGs. The results showed that the SDG measurement and assessment results based on the disaggregated population data were more accurate and effective than the results obtained using the traditional method.
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20
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Dube YP, Ruktanonchai CW, Sacoor C, Tatem AJ, Munguambe K, Boene H, Vilanculo FC, Sevene E, Matthews Z, von Dadelszen P, Makanga PT. How accurate are modelled birth and pregnancy estimates? Comparison of four models using high resolution maternal health census data in southern Mozambique. BMJ Glob Health 2019; 4:e000894. [PMID: 31354980 PMCID: PMC6623987 DOI: 10.1136/bmjgh-2018-000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 11/06/2022] Open
Abstract
Background Existence of inequalities in quality and access to healthcare services at subnational levels has been identified despite a decline in maternal and perinatal mortality rates at national levels, leading to the need to investigate such conditions using geographical analysis. The need to assess the accuracy of global demographic distribution datasets at all subnational levels arises from the current emphasis on subnational monitoring of maternal and perinatal health progress, by the new targets stated in the Sustainable Development Goals. Methods The analysis involved comparison of four models generated using Worldpop methods, incorporating region-specific input data, as measured through the Community Level Intervention for Pre-eclampsia (CLIP) project. Normalised root mean square error was used to determine and compare the models’ prediction errors at different administrative unit levels. Results The models’ prediction errors are lower at higher administrative unit levels. All datasets showed the same pattern for both the live birth and pregnancy estimates. The effect of improving spatial resolution and accuracy of input data was more prominent at higher administrative unit levels. Conclusion The validation successfully highlighted the impact of spatial resolution and accuracy of maternal and perinatal health data in modelling estimates of pregnancies and live births. There is a need for more data collection techniques that conduct comprehensive censuses like the CLIP project. It is also imperative for such projects to take advantage of the power of mapping tools at their disposal to fill the gaps in the availability of datasets for populated areas.
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Affiliation(s)
- Yolisa Prudence Dube
- Faculty of Science and Technology, Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
| | | | | | - Andrew J Tatem
- Department of Geography and Environment, University of Southampton, Southampton, UK.,Flowminder Foundation, Stockholm, Sweden
| | | | - Helena Boene
- Centro de Investigacao em Saude de Manhica, Manhica, Mozambique
| | | | | | - Zoe Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | - Prestige Tatenda Makanga
- Faculty of Science and Technology, Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
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21
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Maina J, Ouma PO, Macharia PM, Alegana VA, Mitto B, Fall IS, Noor AM, Snow RW, Okiro EA. A spatial database of health facilities managed by the public health sector in sub Saharan Africa. Sci Data 2019; 6:134. [PMID: 31346183 PMCID: PMC6658526 DOI: 10.1038/s41597-019-0142-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Health facilities form a central component of health systems, providing curative and preventative services and structured to allow referral through a pyramid of increasingly complex service provision. Access to health care is a complex and multidimensional concept, however, in its most narrow sense, it refers to geographic availability. Linking health facilities to populations has been a traditional per capita index of heath care coverage, however, with locations of health facilities and higher resolution population data, Geographic Information Systems allow for a more refined metric of health access, define geographic inequalities in service provision and inform planning. Maximizing the value of spatial heath access requires a complete census of providers and their locations. To-date there has not been a single, geo-referenced and comprehensive public health facility database for sub-Saharan Africa. We have assembled national master health facility lists from a variety of government and non-government sources from 50 countries and islands in sub Saharan Africa and used multiple geocoding methods to provide a comprehensive spatial inventory of 98,745 public health facilities.
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Affiliation(s)
- Joseph Maina
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Paul O Ouma
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
- Geography and Environmental Science, University of Southampton, Southampton, UK
- Faculty of Science and Technology, Lancaster University, LA1 4YR, UK
| | - Benard Mitto
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Abdisalan M Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.
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22
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Ononokpono DN, Gayawan E, Adedini SA. Regional variations in the use of postnatal care in Nigeria: a spatial analysis. Women Health 2019; 60:440-455. [PMID: 31328689 DOI: 10.1080/03630242.2019.1643816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal health outcomes vary considerably in Nigeria, with maternal mortality ratio ranging from 165 per 100,000 live births in the South-west to 1549 per 100,000 live births in the North-east. One important maternal health indicator is an adequate use of postnatal care (PNC); however, the evidence is sparse on its spatial distribution across regions in Nigeria. This paper thus examined the spatial distribution of uptake of postnatal care in Nigeria using data from the 2013 Nigeria Demographic and Health Survey, with a sample of 12,127 women aged 15-49 years. The Bayesian-structured additive regression of the logit model was used to examine the spatial relationships. The results revealed a north-south divide in the use of postnatal care, with higher PNC uptake established in the latter. Interestingly, results showed significant intra-region residual spatial variations with higher PNC use in Yobe and Bauchi in North-east Nigeria compared to other states within the region. The findings indicate the need for policymakers to develop state- and region-specific health policy and intervention programs to address the inequity in postnatal care coverage and usage across regions in Nigeria.
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Affiliation(s)
| | - Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
| | - Sunday A Adedini
- Demography and Social Statistics Department, Obafemi Awolowo University, Ile-Ife, Nigeria.,Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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23
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Increased Rwandan Access to Obstetrician–Gynecologists Through a U.S.–Rwanda Academic Training Partnership. Obstet Gynecol 2019; 134:149-156. [DOI: 10.1097/aog.0000000000003317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keyes EB, Parker C, Zissette S, Bailey PE, Augusto O. Geographic access to emergency obstetric services: a model incorporating patient bypassing using data from Mozambique. BMJ Glob Health 2019; 4:e000772. [PMID: 31321090 PMCID: PMC6606078 DOI: 10.1136/bmjgh-2018-000772] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/14/2018] [Accepted: 05/28/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Targeted approaches to further reduce maternal mortality require thorough understanding of the geographic barriers that women face when seeking care. Common measures of geographic access do not account for the time needed to reach services, despite substantial evidence that links proximity with greater use of facility services. Further, methods for measuring access often ignore the evidence that women frequently bypass close facilities based on perceptions of service quality. This paper aims to adapt existing approaches for measuring geographic access to better reflect women's bypassing behaviour, using data from Mozambique. Methods Using multiple data sources and modelling within a geographic information system, we calculated two segments of a patient's time to care: (1) home to the first preferred facility, assuming a woman might travel longer to reach a facility she perceived to be of higher quality; and (2) referral between the first preferred facility and facilities providing the highest level of care (eg, surgery). Combined, these two segments are total travel time to highest care. We then modelled the impact of expanding services and emergency referral infrastructure. Results The combination of upgrading geographically strategic facilities to provide the highest level of care and providing transportation to midlevel facilities modestly increased the percentage of the population with 2-hour access to the highest level of care (from 41% to 45%). The mean transfer time between facilities would be reduced by 39% (from 2.9 to 1.8 hours), and the mean total journey time by 18% (from 2.5 to 2.0 hours). Conclusion This adapted methodology is an effective tool for health planners at all levels of the health system, particularly to identify areas of very poor access. The modelled changes indicate substantial improvements in access and identify populations outside timely access for whom more innovative interventions are needed.
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Affiliation(s)
- Emily B Keyes
- Reproductive, Maternal, Newborn and Child Health, FHI 360, Durham, North Carolina, USA
| | - Caleb Parker
- Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | - Seth Zissette
- Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | - Patricia E Bailey
- Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
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25
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Abstract
Measles vaccine is a highly effective healthcare intervention, but getting vaccine to those in need remains a major problem. Complicating the issue, high-burden countries typically have low-quality infrastructure, severely limiting the number of infections detected and therefore limiting our understanding of local epidemiology. Here we show that statistical disease models can be fitted to sparse case data from Pakistan using a fast linear regression approach. This method yields estimates of the effects of past interventions, the seasonal likelihood of measles transmission, and the magnitude of future outbreaks under different intervention policies. We use these models to understand in general when and where vaccine should be distributed, and these results were used to inform Pakistan’s 2018 vaccination campaign planning. Measles remains a major contributor to preventable child mortality, and bridging gaps in measles immunity is a fundamental challenge to global health. In high-burden settings, mass vaccination campaigns are conducted to increase access to vaccine and address this issue. Ensuring that campaigns are optimally effective is a crucial step toward measles elimination; however, the relationship between campaign impact and disease dynamics is poorly understood. Here, we study measles in Pakistan, and we demonstrate that campaign timing can be tuned to optimally interact with local transmission seasonality and recent incidence history. We develop a mechanistic modeling approach to optimize timing in general high-burden settings, and we find that in Pakistan, hundreds of thousands of infections can be averted with no change in campaign cost.
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26
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Schmitz MM, Serbanescu F, Kamara V, Kraft JM, Cunningham M, Opio G, Komakech P, Conlon CM, Goodwin MM. Did Saving Mothers, Giving Life Expand Timely Access to Lifesaving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:S151-S167. [PMID: 30867215 PMCID: PMC6519675 DOI: 10.9745/ghsp-d-18-00366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
Abstract
A spatial analysis of facility accessibility, taking into account road networks and environmental constraints on travel, suggests that the Saving Mothers, Giving Life (SMGL) initiative increased access to emergency obstetric and neonatal care in SMGL-supported districts in Uganda. Spatial travel-time analyses can inform policy and program efforts targeting underserved populations in conjunction with the geographic distribution of maternity services. Introduction: Interventions for the Saving Mothers, Giving Life (SMGL) initiative aimed to ensure all pregnant women in SMGL-supported districts have timely access to emergency obstetric and newborn care (EmONC). Spatial travel-time analyses provide a visualization of changes in timely access. Methods: We compared travel-time estimates to EmONC health facilities in SMGL-supported districts in western Uganda in 2012, 2013, and 2016. To examine EmONC access, we analyzed a categorical variable of travel-time duration in 30-minute increments. Data sources included health facility assessments, geographic coordinates of EmONC facilities, geolocated population estimates of women of reproductive age (WRA), and other road network and geographic sources. Results: The number of EmONC facilities almost tripled between 2012 and 2016, increasing geographic access to EmONC. Estimated travel time to EmONC facilities declined significantly during the 5-year period. The proportion of WRA able to access any EmONC and comprehensive EmONC (CEmONC) facility within 2 hours by motorcycle increased by 18% (from 61.3% to 72.1%, P < .01) and 37% (from 51.1% to 69.8%, P < .01), respectively from baseline to 2016. Similar increases occurred among WRA accessing EmONC and CEmONC respectively if 4-wheeled vehicles (14% and 31% increase, P < .01) could be used. Increases in timely access were also substantial for nonmotorized transportation such as walking and/or bicycling. Conclusions: Largely due to the SMGL-supported expansion of EmONC capability, timely access to EmONC significantly improved. Our analysis developed a geographic outline of facility accessibility using multiple types of transportation. Spatial travel-time analyses, along with other EmONC indicators, can be used by planners and policy makers to estimate need and target underserved populations to achieve further gains in EmONC accessibility. In addition to increasing the number and geographic distribution of EmONC facilities, complementary efforts to make motorized transportation available are necessary to achieve meaningful increases in EmONC access.
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Affiliation(s)
- Michelle M Schmitz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Vincent Kamara
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Joan Marie Kraft
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc Cunningham
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA
| | - Gregory Opio
- Infectious Diseases Institute, Makerere University, Kibaale, Uganda
| | - Patrick Komakech
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Mary M Goodwin
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Banke-Thomas A, Wright K, Collins L. Assessing geographical distribution and accessibility of emergency obstetric care in sub-Saharan Africa: a systematic review. J Glob Health 2019; 9:010414. [PMID: 30603080 PMCID: PMC6304172 DOI: 10.7189/jogh.09.010414] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methods Two reviewers systematically searched multiple databases for articles published between January 2009 and June 2018. Both screened and selected studies based on the set inclusion criteria. Following quality assessments, data on study characteristics, process of data collection and analysis and findings reported were extracted. Extracted data were synthesised and presented in tables and charts. Narrative synthesis was used to summarise reported findings. Results 15 studies met the inclusion criteria, with varying assessed quality: high (7 studies), medium (4 studies) and low (4 studies). 8 studies were conducted at a national level while 7 were sub-national. 8 studies focused on assessing Indicator 2, while the others assessed multiple EmOC indicators. Only about half of the studies presented details of analysis for assessing geographical distribution, provided a map and interpreted their findings. Similarly, half of the studies used geographic information systems (GIS) for analyses. Of these, GIS was used to map EmOC facilities or relate facility numbers to 500 000 population (3), estimate straight-line distances between facilities and residences of women (2) and model travel scenarios (3). EmOC facilities in SSA are concentrated in capitals, central and urban areas and at least a third of women in the region cannot reach their nearest EmOC facility within the recommended two-hour time-frame. Conclusions There is a limited number of studies that have assessed EmOC geographical distribution in SSA. When available, completeness and quality of analysis are questionable. Comprehensive assessments need to maximise recent advancements in mobile and GIS open-source technology to provide more realistic representation of EmOC access for service planners and policy-makers. PROSPERO Registration CRD42018099882.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Health Policy, London School of Economics and Political Science, London, UK.,McCain Institute for International Leadership, Arizona State University, Tempe, Arizona, USA
| | - Kikelomo Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Lindsey Collins
- Decision Theatre Network, Arizona State University, Tempe, Arizona, USA.,School of Geographical Sciences and Urban Planning, Arizona State University, Arizona, USA
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Comparison of Micro-Census Results for Magarya Ward, Wurno Local Government Area of Sokoto State, Nigeria, with Other Sources of Denominator Data. DATA 2019; 4:20. [PMID: 30956970 PMCID: PMC6444184 DOI: 10.3390/data4010020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Routine immunization coverage in Nigeria is suboptimal. In the northwestern state of Sokoto, an independent population-based survey for 2016 found immunization coverage with the third dose of Pentavalent vaccine to be 3%, whereas administrative coverage in 2016 was reported to be 69%. One possibility driving this large discrepancy is that administrative coverage is calculated using an under-estimated target population. Official population projections from the 2006 Census are based on state-specific standard population growth rates. Immunization target population estimates from other sources have not been independently validated. We conducted a micro-census in Magarya ward, Wurno Local Government Area of Sokoto state to obtain an accurate count of the total population living in the ward, and to compare these results with other sources of denominator data. We developed a precise micro-plan using satellite imagery, and used the navigation tool EpiSample v1 in the field to guide teams to each building, without duplications or omissions. The particular characteristics of the selected ward underscore the importance of using standardized shape files to draw precise boundaries for enumeration micro-plans. While the use of this methodology did not resolve the discrepancy between independent and administrative vaccination coverage rates, a simplified application can better define the target population for routine immunization services and estimate the number of children still unprotected from vaccine-preventable diseases.
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29
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Wong KLM, Brady OJ, Campbell OMR, Benova L. Comparison of spatial interpolation methods to create high-resolution poverty maps for low- and middle-income countries. J R Soc Interface 2018; 15:20180252. [PMID: 30333244 PMCID: PMC6228471 DOI: 10.1098/rsif.2018.0252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/17/2018] [Indexed: 11/12/2022] Open
Abstract
High-resolution poverty maps are important tools for promoting equitable and sustainable development. In settings without data at every location, we can use spatial interpolation (SI) to create such maps using sample-based surveys and additional covariates. In the model-based geostatistics (MBG) framework for SI, it is typically assumed that the similarity of two areas is inversely related to their distance between one another. Applications of spline interpolation take a contrasting approach that an area's absolute location and its characteristics are more important for prediction than distance to/characteristics of other locations. This study compares prediction accuracy of the MBG approach with spline interpolation as part of a generalized additive model (GAM) for four low- and middle-income countries. We also identify any potentially generalizable data characteristics influencing comparative accuracy. We found spatially scattered pockets of wealth in Malawi and Tanzania (corresponding to the major cities), and overarching spatial gradients in Kenya and Nigeria. Spline interpolation/GAM performed better than MBG for Malawi, Nigeria and Tanzania, but marginally worse in Kenya. We conclude that the spatial patterns of wealth and other covariates should be carefully accounted for when choosing the best SI approach. This is particularly pertinent as different methods capture geographical variation differently.
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Affiliation(s)
- Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Oliver J Brady
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Centre for Mathematical Modelling for Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet 2018; 392:857-865. [PMID: 30173907 PMCID: PMC6338336 DOI: 10.1016/s0140-6736(18)31437-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/02/2018] [Accepted: 06/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND A substantial portion of child deaths in Africa take place in countries with recent history of armed conflict and political instability. However, the extent to which armed conflict is an important cause of child mortality, especially in Africa, remains unknown. METHODS We matched child survival with proximity to armed conflict using information in the Uppsala Conflict Data Program Georeferenced Events Dataset on the location and intensity of armed conflict from 1995 to 2015 together with the location, timing, and survival of infants younger than 1 year (primary outcome) in 35 African countries. We measured the increase in mortality risk for infants exposed to armed conflicts within 50 km in the year of birth and, to study conflicts' extended health risks, up to 250 km away and 10 years before birth. We also examined the effects of conflicts of varying intensity and chronicity (conflicts lasting several years), and effect heterogeneity by residence and sex of the child. We then estimated the number and portion of deaths of infants younger than 1 year related to conflict. FINDINGS We identified 15 441 armed conflict events that led to 968 444 combat-related deaths and matched these data with 1·99 million births and 133 361 infant deaths (infant mortality of 67 deaths per 1000 births) between 1995 and 2015. A child born within 50 km of an armed conflict had a risk of dying before reaching age 1 year of 5·2 per 1000 births higher than being born in the same region during periods without conflict (95% CI 3·7-6·7; a 7·7% increase above baseline). This increased risk of dying ranged from a 3·0% increase for armed conflicts with one to four deaths to a 26·7% increase for armed conflicts with more than 1000 deaths. We find evidence of increased mortality risk from an armed conflict up to 100 km away, and for 8 years after conflicts, with cumulative increase in infant mortality two to four times higher than the contemporaneous increase. In the entire continent, the number of infant deaths related to conflict from 1995 to 2015 was between 3·2 and 3·6 times the number of direct deaths from armed conflicts. INTERPRETATION Armed conflict substantially and persistently increases infant mortality in Africa, with effect sizes on a scale with malnutrition and several times greater than existing estimates of the mortality burden of conflict. The toll of conflict on children, who are presumably not combatants, underscores the indirect toll of conflict on civilian populations, and the importance of developing interventions to address child health in areas of conflict. FUNDING The Doris Duke Charitable Foundation, and the Centre for Global Child Health at the Hospital for Sick Children.
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Affiliation(s)
- Zachary Wagner
- Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA; Department of Earth System Science, Stanford University, Stanford, CA, USA
| | - Eran Bendavid
- Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
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Gridded birth and pregnancy datasets for Africa, Latin America and the Caribbean. Sci Data 2018; 5:180090. [PMID: 29786689 PMCID: PMC5963337 DOI: 10.1038/sdata.2018.90] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/20/2018] [Indexed: 11/25/2022] Open
Abstract
Understanding the fine scale spatial distribution of births and pregnancies is crucial for informing planning decisions related to public health. This is especially important in lower income countries where infectious disease is a major concern for pregnant women and new-borns, as highlighted by the recent Zika virus epidemic. Despite this, the spatial detail of basic data on the numbers and distribution of births and pregnancies is often of a coarse resolution and difficult to obtain, with no co-ordination between countries and organisations to create one consistent set of subnational estimates. To begin to address this issue, under the framework of the WorldPop program, an open access archive of high resolution gridded birth and pregnancy distribution datasets for all African, Latin America and Caribbean countries has been created. Datasets were produced using the most recent and finest level census and official population estimate data available and are at a resolution of 30 arc seconds (approximately 1 km at the equator). All products are available through WorldPop.
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Ouma PO, Maina J, Thuranira PN, Macharia PM, Alegana VA, English M, Okiro EA, Snow RW. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. Lancet Glob Health 2018; 6:e342-e350. [PMID: 29396220 PMCID: PMC5809715 DOI: 10.1016/s2214-109x(17)30488-6] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/18/2017] [Accepted: 12/04/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Timely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complete a geocoded inventory of hospital services in Africa in relation to how populations might access these services in 2015, with focus on women of child bearing age. METHODS We assembled a geocoded inventory of public hospitals across 48 countries and islands of sub-Saharan Africa, including Zanzibar, using data from various sources. We only included public hospitals with emergency services that were managed by governments at national or local levels and faith-based or non-governmental organisations. For hospital listings without geographical coordinates, we geocoded each facility using Microsoft Encarta (version 2009), Google Earth (version 7.3), Geonames, Fallingrain, OpenStreetMap, and other national digital gazetteers. We obtained estimates for total population and women of child bearing age (15-49 years) at a 1 km2 spatial resolution from the WorldPop database for 2015. Additionally, we assembled road network data from Google Map Maker Project and OpenStreetMap using ArcMap (version 10.5). We then combined the road network and the population locations to form a travel impedance surface. Subsequently, we formulated a cost distance algorithm based on the location of public hospitals and the travel impedance surface in AccessMod (version 5) to compute the proportion of populations living within a combined walking and motorised travel time of 2 h to emergency hospital services. FINDINGS We consulted 100 databases from 48 sub-Saharan countries and islands, including Zanzibar, and identified 4908 public hospitals. 2701 hospitals had either full or partial information about their geographical coordinates. We estimated that 287 282 013 (29·0%) people and 64 495 526 (28·2%) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital. INTERPRETATION Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa. FUNDING Wellcome Trust and the UK Department for International Development.
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Affiliation(s)
- Paul O Ouma
- Population Health Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Joseph Maina
- Population Health Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Pamela N Thuranira
- Population Health Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Victor A Alegana
- Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Mike English
- Health Services Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Hanson C, Gabrysch S, Mbaruku G, Cox J, Mkumbo E, Manzi F, Schellenberg J, Ronsmans C. Access to maternal health services: geographical inequalities, United Republic of Tanzania. Bull World Health Organ 2017; 95:810-820. [PMID: 29200522 PMCID: PMC5710083 DOI: 10.2471/blt.17.194126] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To determine if improved geographical accessibility led to increased uptake of maternity care in the south of the United Republic of Tanzania. Methods In a household census in 2007 and another large household survey in 2013, we investigated 22 243 and 13 820 women who had had a recent live birth, respectively. The proportions calculated from the 2013 data were weighted to account for the sampling strategy. We examined the association between the straight-line distances to the nearest primary health facility or hospital and uptake of maternity care. Findings The percentages of live births occurring in primary facilities and hospitals rose from 12% (2571/22 243) and 29% (6477/22 243), respectively, in 2007 to weighted values of 39% and 40%, respectively, in 2013. Between the two surveys, women living far from hospitals showed a marked gain in their use of primary facilities, but the proportion giving birth in hospitals remained low (20%). Use of four or more antenatal visits appeared largely unaffected by survey year or the distance to the nearest antenatal clinic. Although the overall percentage of live births delivered by caesarean section increased from 4.1% (913/22 145) in the first survey to a weighted value of 6.5% in the second, the corresponding percentages for women living far from hospital were very low in 2007 (2.8%; 35/1254) and 2013 (3.3%). Conclusion For women living in our study districts who sought maternity care, access to primary facilities appeared to improve between 2007 and 2013, however access to hospital care and caesarean sections remained low.
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Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT England
| | - Sabine Gabrysch
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Godfrey Mbaruku
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Jonathan Cox
- Bill and Melinda Gates Foundation, Seattle, United States of America
| | - Elibariki Mkumbo
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT England
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
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Chen YN, Schmitz MM, Serbanescu F, Dynes MM, Maro G, Kramer MR. Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:430-445. [PMID: 28839113 PMCID: PMC5620339 DOI: 10.9745/ghsp-d-17-00110] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022]
Abstract
32% of estimated live births in the region may not be able to reach emergency obstetric and neonatal care (EmONC) services within 2 hours in dry season, regardless of the type of transportation available. However, bicycles, motorcycles, and cars provide a significant increase in geographic accessibility in some areas. Achieving good access may require upgrading non-EmONC facilities to EmONC facilities in some districts while incorporating bicycles and motorcycles into the health transportation strategy in others. Background: Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the proportion of live births (a proxy indicator of women needing delivery care) with poor geographic access to EmONC services. Methods: The 2014 Reproductive Health Survey of Kigoma Region identified 4 primary means of transportation used to travel to health facilities: walking, cycling, motorcycle, and 4-wheeled motor vehicle. A raster-based travel time model was used to map the 2-hour travel time catchment for each mode of transportation. Live birth density distributions were aggregated by travel time catchments, and by administrative council, to estimate the proportion of births with poor access. Results: Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmONC facilities within 2 hours on foot, 33% in areas that can be reached within 2 hours only by motorized vehicles, and 32% where it is impossible to reach EmONC facilities within 2 hours. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles. Conclusion: Significant differences in geographic access to EmONC in Kigoma Region, Tanzania, were observed both by location and by primary transportation type. As most of the population may only have good EmONC access when using mechanized or motorized vehicles, bicycles and motorcycles should be incorporated into the health transportation strategy. Collaboration between private transportation sectors and obstetric service providers could improve access to EmONC services among most populations. In areas where residents may not access EmONC facilities within 2 hours regardless of the type of transportation used, upgrading EmONC capacity among nearby non-EmONC facilities may be required to improve accessibility.
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Affiliation(s)
- Yi No Chen
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle M Schmitz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle M Dynes
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Godson Maro
- Bloomberg Philanthropies, Kigoma, United Republic of Tanzania
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Wong KLM, Benova L, Campbell OMR. A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa. PLoS One 2017; 12:e0184432. [PMID: 28910302 PMCID: PMC5598961 DOI: 10.1371/journal.pone.0184432] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa. METHOD We defined spatial separation as the distance/travel time between women and skilled care services. The use of skilled care at birth referred to either the location or attendant of childbirth. The main criterion for inclusion was any quantification of the relationship between spatial separation and use of skilled care at birth. The approaches undertaken to measure distance/travel time were summarized in a narrative format. We obtained pooled adjusted odds ratios (aOR) from studies that controlled for financial means, education and (perceived) need of care in a meta-analysis. RESULTS 57 articles were included (40 studied distance and 25 travel time), in which distance/travel time were found predominately self-reported or estimated in a geographic information system based on geographic coordinates. Approaches of distance/travel time measurement were generally poorly detailed, especially for self-reported data. Crucial features such as start point of origin and the mode of transportation for travel time were most often unspecified. Meta-analysis showed that increased distance to maternity care had an inverse association with utilization (n = 10, pooled aOR = 0.90/1km, 95%CI = 0.85-0.94). Distance from a hospital for rural women showed an even more pronounced effect on utilization (n = 2, pooled aOR = 0.58/1km increase, 95%CI = 0.31,1.09). The effect of spatial separation appears to level off beyond critical point when utilization was generally low. CONCLUSION Although the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care.
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Affiliation(s)
- Kerry L. M. Wong
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lenka Benova
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oona M. R. Campbell
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Macharia PM, Odera PA, Snow RW, Noor AM. Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya. Malar J 2017; 16:367. [PMID: 28899379 PMCID: PMC5596856 DOI: 10.1186/s12936-017-2009-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In high to moderate malaria transmission areas of Kenya, long-lasting insecticidal nets (LLINs) are provided free of charge to pregnant women and infants during routine antenatal care (ANC) and immunization respectively. Quantities of LLINs distributed to clinics are quantified based on a combination of monthly consumption data and population size of target counties. However, this approach has been shown to lead to stock-outs in targeted clinics. In this study, a novel LLINs need quantification approach for clinics in the routine distribution system was developed. The estimated need was then compared to the actual allocation to identify potential areas of LLIN over- or under-allocation in the high malaria transmission areas of Western Kenya. METHODS A geocoded database of public health facilities was developed and linked to monthly LLIN allocation. A network analysis approach was implemented using the location of all public clinics and topographic layers to model travel time. Estimated travel time, socio-economic and ANC attendance data were used to model clinic catchment areas and the probability of ANC service use within these catchments. These were used to define the number of catchment population who were likely to use these clinics for the year 2015 equivalent to LLIN need. Actual LLIN allocation was compared with the estimated need. Clinics were then classified based on whether allocation matched with the need, and if not, whether they were over or under-allocated. RESULTS 888 (70%) public health facilities were allocated 591,880 LLINs in 2015. Approximately 682,377 (93%) pregnant women and infants were likely to have attended an LLIN clinic. 36% of the clinics had more LLIN than was needed (over-allocated) while 43% had received less (under-allocated). Increasing efficiency of allocation by diverting over supply of LLIN to clinics with less stock and fully covering 43 clinics that did not receive nets in 2015 would allow for complete matching of need with distribution. CONCLUSION The proposed spatial modelling framework presents a rationale for equitable allocation of routine LLINs and could be used for quantification of other maternal and child health commodities applicable in different settings. Western Kenya region received adequate LLINs for routine distribution in line with government of Kenya targets, however, the model shows important inefficiencies in the allocation of the LLINs at clinic level.
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Affiliation(s)
- Peter M Macharia
- Department of Geomatic Engineering and Geospatial Information Systems, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya. .,Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.
| | - Patroba A Odera
- Division of Geomatics, School of Architecture, Planning and Geomatics, University of Cape Town, Cape Town, South Africa
| | - Robert W Snow
- Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Abdisalan M Noor
- Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Sub-national mapping of population pyramids and dependency ratios in Africa and Asia. Sci Data 2017; 4:170089. [PMID: 28722706 PMCID: PMC5516541 DOI: 10.1038/sdata.2017.89] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/02/2017] [Indexed: 11/08/2022] Open
Abstract
The age group composition of populations varies substantially across continents and within countries, and is linked to levels of development, health status and poverty. The subnational variability in the shape of the population pyramid as well as the respective dependency ratio are reflective of the different levels of development of a country and are drivers for a country's economic prospects and health burdens. Whether measured as the ratio between those of working age and those young and old who are dependent upon them, or through separate young and old-age metrics, dependency ratios are often highly heterogeneous between and within countries. Assessments of subnational dependency ratio and age structure patterns have been undertaken for specific countries and across high income regions, but to a lesser extent across the low income regions. In the framework of the WorldPop Project, through the assembly of over 100 million records across 6,389 subnational administrative units, subnational dependency ratio and high resolution gridded age/sex group datasets were produced for 87 countries in Africa and Asia.
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Thomson DR, Stevens FR, Ruktanonchai NW, Tatem AJ, Castro MC. GridSample: an R package to generate household survey primary sampling units (PSUs) from gridded population data. Int J Health Geogr 2017; 16:25. [PMID: 28724433 PMCID: PMC5518145 DOI: 10.1186/s12942-017-0098-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/04/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Household survey data are collected by governments, international organizations, and companies to prioritize policies and allocate billions of dollars. Surveys are typically selected from recent census data; however, census data are often outdated or inaccurate. This paper describes how gridded population data might instead be used as a sample frame, and introduces the R GridSample algorithm for selecting primary sampling units (PSU) for complex household surveys with gridded population data. With a gridded population dataset and geographic boundary of the study area, GridSample allows a two-step process to sample "seed" cells with probability proportionate to estimated population size, then "grows" PSUs until a minimum population is achieved in each PSU. The algorithm permits stratification and oversampling of urban or rural areas. The approximately uniform size and shape of grid cells allows for spatial oversampling, not possible in typical surveys, possibly improving small area estimates with survey results. RESULTS We replicated the 2010 Rwanda Demographic and Health Survey (DHS) in GridSample by sampling the WorldPop 2010 UN-adjusted 100 m × 100 m gridded population dataset, stratifying by Rwanda's 30 districts, and oversampling in urban areas. The 2010 Rwanda DHS had 79 urban PSUs, 413 rural PSUs, with an average PSU population of 610 people. An equivalent sample in GridSample had 75 urban PSUs, 405 rural PSUs, and a median PSU population of 612 people. The number of PSUs differed because DHS added urban PSUs from specific districts while GridSample reallocated rural-to-urban PSUs across all districts. CONCLUSIONS Gridded population sampling is a promising alternative to typical census-based sampling when census data are moderately outdated or inaccurate. Four approaches to implementation have been tried: (1) using gridded PSU boundaries produced by GridSample, (2) manually segmenting gridded PSU using satellite imagery, (3) non-probability sampling (e.g. random-walk, "spin-the-pen"), and random sampling of households. Gridded population sampling is in its infancy, and further research is needed to assess the accuracy and feasibility of gridded population sampling. The GridSample R algorithm can be used to forward this research agenda.
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Affiliation(s)
- Dana R. Thomson
- Department of Social Statistics and Demography, University of Southampton, Building 58, Southampton, SO17 1BJ UK
- WorldPop, Department of Geography and Environment, University of Southampton, Building 44, Southampton, SO17 1BJ UK
- Flowminder Foundation, Roslagsgatan 17, 11355 Stockholm, Sweden
| | - Forrest R. Stevens
- Flowminder Foundation, Roslagsgatan 17, 11355 Stockholm, Sweden
- Department of Geography and Geosciences, University of Louisville, 200 E Shipp Ave, Louisville, KY 40208 USA
| | - Nick W. Ruktanonchai
- WorldPop, Department of Geography and Environment, University of Southampton, Building 44, Southampton, SO17 1BJ UK
- Flowminder Foundation, Roslagsgatan 17, 11355 Stockholm, Sweden
| | - Andrew J. Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Building 44, Southampton, SO17 1BJ UK
- Flowminder Foundation, Roslagsgatan 17, 11355 Stockholm, Sweden
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115 USA
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Makanga PT, Schuurman N, Sacoor C, Boene HE, Vilanculo F, Vidler M, Magee L, von Dadelszen P, Sevene E, Munguambe K, Firoz T. Seasonal variation in geographical access to maternal health services in regions of southern Mozambique. Int J Health Geogr 2017; 16:1. [PMID: 28086893 PMCID: PMC5237329 DOI: 10.1186/s12942-016-0074-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/08/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Geographic proximity to health facilities is a known determinant of access to maternal care. Methods of quantifying geographical access to care have largely ignored the impact of precipitation and flooding. Further, travel has largely been imagined as unimodal where one transport mode is used for entire journeys to seek care. This study proposes a new approach for modeling potential spatio-temporal access by evaluating the impact of precipitation and floods on access to maternal health services using multiple transport modes, in southern Mozambique. METHODS A facility assessment was used to classify 56 health centres. GPS coordinates of the health facilities were acquired from the Ministry of Health while roads were digitized and classified from high-resolution satellite images. Data on the geographic distribution of populations of women of reproductive age, pregnancies and births within the preceding 12 months, and transport options available to pregnant women were collected from a household census. Daily precipitation and flood data were used to model the impact of severe weather on access for a 17-month timeline. Travel times to the nearest health facilities were calculated using the closest facility tool in ArcGIS software. RESULTS Forty-six and 87 percent of pregnant women lived within a 1-h of the nearest primary care centre using walking or public transport modes respectively. The populations within these catchments dropped by 9 and 5% respectively at the peak of the wet season. For journeys that would have commenced with walking to primary facilities, 64% of women lived within 2 h of life-saving care, while for those that began journeys with public transport, the same 2-hour catchment would have contained 95% of the women population. The population of women within two hours of life-saving care dropped by 9% for secondary facilities and 18% for tertiary facilities during the wet season. CONCLUSIONS Seasonal variation in access to maternal care should not be imagined through a dichotomous and static lens of wet and dry seasons, as access continually fluctuates in both. This new approach for modelling spatio-temporal access allows for the GIS output to be utilized not only for health services planning, but also to aid near real time community-level delivery of maternal health services.
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Affiliation(s)
- Prestige Tatenda Makanga
- Department of Geography, Simon Fraser University, RCB7106 8888 University Drive, Burnaby, BC V5A1S6 Canada
- Department of Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, RCB7106 8888 University Drive, Burnaby, BC V5A1S6 Canada
| | | | | | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Laura Magee
- Department of Obstetrics and Gynaecology, St George’s, University of London, London, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George’s, University of London, London, UK
| | | | | | - Tabassum Firoz
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Molla YB, Rawlins B, Makanga PT, Cunningham M, Ávila JEH, Ruktanonchai CW, Singh K, Alford S, Thompson M, Dwivedi V, Moran AC, Matthews Z. Geographic information system for improving maternal and newborn health: recommendations for policy and programs. BMC Pregnancy Childbirth 2017; 17:26. [PMID: 28077095 PMCID: PMC5225565 DOI: 10.1186/s12884-016-1199-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 12/15/2016] [Indexed: 11/29/2022] Open
Abstract
This correspondence argues and offers recommendations for how Geographic Information System (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality. These recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the United States Agency for International Development's (USAID) global Maternal and Child Survival Program (MCSP). Approximately 72 participants from over 25 global health organizations, government agencies, donors, universities, and other groups participated in the meeting.The meeting placed emphases on how improved use of mapping could contribute to the post-2015 United Nation's Sustainable Development Goals (SDGs), agenda in general and to contribute to better maternal and neonatal health outcomes in particular. Researchers and policy makers have been calling for more equitable improvement in Maternal and Newborn Health (MNH), specifically addressing hard-to-reach populations at sub-national levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs and community participation.
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Affiliation(s)
- Yordanos B. Molla
- USAID’s Maternal and Child Survival Program/Save the Children, Washington, DC USA
- USAID’s Maternal and Child Survival Program/Save the Children, 14136 Grand Pre Rd #34, Silver Spring, MD Zip: 20906 USA
| | - Barbara Rawlins
- USAID’s Maternal and Child Survival Program/Jhpiego, Washington, DC USA
| | - Prestige Tatenda Makanga
- Geography Department, Simon Fraser University, Burnaby, BC Canada
- Department of Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe
| | | | | | | | - Kavita Singh
- MEASURE Evaluation/Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Sylvia Alford
- Global Health Fellows Program II, United States Agency for International Development (USAID), Washington, DC USA
| | - Mira Thompson
- USAID’s Maternal and Child Survival Program/Jhpiego, Washington, DC USA
| | - Vikas Dwivedi
- USAID’s Maternal and Child Survival Program/ John Snow Inc, Washington, DC USA
| | - Allisyn C. Moran
- Global Health Fellows Program II, United States Agency for International Development (USAID), Washington, DC USA
| | - Zoe Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
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Armstrong CE, Martínez-Álvarez M, Singh NS, John T, Afnan-Holmes H, Grundy C, Ruktanochai CW, Borghi J, Magoma M, Msemo G, Matthews Z, Mtei G, Lawn JE. Subnational variation for care at birth in Tanzania: is this explained by place, people, money or drugs? BMC Public Health 2016; 16 Suppl 2:795. [PMID: 27634353 PMCID: PMC5025821 DOI: 10.1186/s12889-016-3404-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tanzania achieved the Millennium Development Goal for child survival, yet made insufficient progress for maternal and neonatal survival and stillbirths, due to low coverage and quality of services for care at birth, with rural women left behind. Our study aimed to evaluate Tanzania's subnational (regional-level) variations for rural care at birth outcomes, i.e., rural women giving birth in a facility and by Caesarean section (C-section), and associations with health systems inputs (financing, health workforce, facilities, and commodities), outputs (readiness and quality of care) and context (education and GDP). METHODS We undertook correlation analyses of subnational-level associations between health system inputs, outputs, context, and rural care at birth outcomes; and constructed implementation readiness barometers using benchmarks for each health system input indicator. We used geographical information system (GIS) mapping to visualise subnational variations in care at birth for rural women, with a focus on service availability and readiness, and collected qualitative data to investigate financial flows from national to council level to understand variation in financing inputs. RESULTS We found wide subnational variation for rural care at birth outcomes, health systems inputs, and contextual indicators. There was a positive association between rural women giving birth in a facility and by C-section; maternal education; workforce and facility density; and quality of care. There was a negative association between these outcomes and proportion of all births to rural women, total fertility rate, and availability of essential commodities at facilities. Per capita recurrent expenditure was positively associated with facility births (correlation coefficient = 0.43; p = 0.05) but not with C-section. Qualitative results showed that the health financing system is complex and insufficient for providing care at birth services. Bottlenecks for care at birth included low density of health workers, poor availability of essential commodities, and low health financing in Lake and Western Zones. CONCLUSIONS No region meets the benchmarks for the four health systems building blocks including health finance, health workforce, health facilities, and commodities. Strategies for addressing health system inequities, including overall increases in health expenditure, are needed in rural populations and areas of highest unmet need for family planning to improve coverage of care at birth for rural women in Tanzania.
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Affiliation(s)
- Corinne E. Armstrong
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
- Evidence for Action, Dar es Salaam, Tanzania
| | - Melisa Martínez-Álvarez
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Neha S. Singh
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Theopista John
- World Health Organization, 1 Luthuli Street, PO Box 9292, Dar es Salaam, Tanzania
| | - Hoviyeh Afnan-Holmes
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
- Independent consultant, London, UK
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Corrine W. Ruktanochai
- Department of Geography & Environment, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Josephine Borghi
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Moke Magoma
- Evidence for Action, Dar es Salaam, Tanzania
| | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Zoe Matthews
- Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Highfield, Southampton, UK
| | - Gemini Mtei
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joy E. Lawn
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
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Ruktanonchai CW, Ruktanonchai NW, Nove A, Lopes S, Pezzulo C, Bosco C, Alegana VA, Burgert CR, Ayiko R, Charles ASEK, Lambert N, Msechu E, Kathini E, Matthews Z, Tatem AJ. Equality in Maternal and Newborn Health: Modelling Geographic Disparities in Utilisation of Care in Five East African Countries. PLoS One 2016; 11:e0162006. [PMID: 27561009 PMCID: PMC4999282 DOI: 10.1371/journal.pone.0162006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 08/16/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Geographic accessibility to health facilities represents a fundamental barrier to utilisation of maternal and newborn health (MNH) services, driving historically hidden spatial pockets of localized inequalities. Here, we examine utilisation of MNH care as an emergent property of accessibility, highlighting high-resolution spatial heterogeneity and sub-national inequalities in receiving care before, during, and after delivery throughout five East African countries. METHODS We calculated a geographic inaccessibility score to the nearest health facility at 300 x 300 m using a dataset of 9,314 facilities throughout Burundi, Kenya, Rwanda, Tanzania and Uganda. Using Demographic and Health Surveys data, we utilised hierarchical mixed effects logistic regression to examine the odds of: 1) skilled birth attendance, 2) receiving 4+ antenatal care visits at time of delivery, and 3) receiving a postnatal health check-up within 48 hours of delivery. We applied model results onto the accessibility surface to visualise the probabilities of obtaining MNH care at both high-resolution and sub-national levels after adjusting for live births in 2015. RESULTS Across all outcomes, decreasing wealth and education levels were associated with lower odds of obtaining MNH care. Increasing geographic inaccessibility scores were associated with the strongest effect in lowering odds of obtaining care observed across outcomes, with the widest disparities observed among skilled birth attendance. Specifically, for each increase in the inaccessibility score to the nearest health facility, the odds of having skilled birth attendance at delivery was reduced by over 75% (0.24; CI: 0.19-0.3), while the odds of receiving antenatal care decreased by nearly 25% (0.74; CI: 0.61-0.89) and 40% for obtaining postnatal care (0.58; CI: 0.45-0.75). CONCLUSIONS Overall, these results suggest decreasing accessibility to the nearest health facility significantly deterred utilisation of all maternal health care services. These results demonstrate how spatial approaches can inform policy efforts and promote evidence-based decision-making, and are particularly pertinent as the world shifts into the Sustainable Goals Development era, where sub-national applications will become increasingly useful in identifying and reducing persistent inequalities.
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Affiliation(s)
- Corrine W. Ruktanonchai
- WorldPop Project, Geography & Environment, University of Southampton, Southampton, United Kingdom
- Flowminder Foundation, Stockholm, Sweden
- * E-mail:
| | - Nick W. Ruktanonchai
- WorldPop Project, Geography & Environment, University of Southampton, Southampton, United Kingdom
- Flowminder Foundation, Stockholm, Sweden
| | | | | | - Carla Pezzulo
- WorldPop Project, Geography & Environment, University of Southampton, Southampton, United Kingdom
- Flowminder Foundation, Stockholm, Sweden
| | - Claudio Bosco
- WorldPop Project, Geography & Environment, University of Southampton, Southampton, United Kingdom
- Flowminder Foundation, Stockholm, Sweden
| | - Victor A. Alegana
- WorldPop Project, Geography & Environment, University of Southampton, Southampton, United Kingdom
- Flowminder Foundation, Stockholm, Sweden
| | - Clara R. Burgert
- The DHS Program, ICF International, Rockville, Maryland, United States of America
| | - Rogers Ayiko
- Open Health Initiative, East African Community Secretariat, Arusha, Tanzania
| | - Andrew SEK Charles
- Open Health Initiative, East African Community Secretariat, Arusha, Tanzania
| | | | - Esther Msechu
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | - Zoë Matthews
- Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
| | - Andrew J. Tatem
- WorldPop Project, Geography & Environment, University of Southampton, Southampton, United Kingdom
- Flowminder Foundation, Stockholm, Sweden
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Perkins TA, Siraj AS, Ruktanonchai CW, Kraemer MUG, Tatem AJ. Model-based projections of Zika virus infections in childbearing women in the Americas. Nat Microbiol 2016; 1:16126. [DOI: 10.1038/nmicrobiol.2016.126] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/28/2016] [Indexed: 01/22/2023]
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Messina JP, Kraemer MU, Brady OJ, Pigott DM, Shearer FM, Weiss DJ, Golding N, Ruktanonchai CW, Gething PW, Cohn E, Brownstein JS, Khan K, Tatem AJ, Jaenisch T, Murray CJ, Marinho F, Scott TW, Hay SI. Mapping global environmental suitability for Zika virus. eLife 2016; 5. [PMID: 27090089 PMCID: PMC4889326 DOI: 10.7554/elife.15272] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/10/2016] [Indexed: 01/07/2023] Open
Abstract
Zika virus was discovered in Uganda in 1947 and is transmitted by Aedes mosquitoes, which also act as vectors for dengue and chikungunya viruses throughout much of the tropical world. In 2007, an outbreak in the Federated States of Micronesia sparked public health concern. In 2013, the virus began to spread across other parts of Oceania and in 2015, a large outbreak in Latin America began in Brazil. Possible associations with microcephaly and Guillain-Barré syndrome observed in this outbreak have raised concerns about continued global spread of Zika virus, prompting its declaration as a Public Health Emergency of International Concern by the World Health Organization. We conducted species distribution modelling to map environmental suitability for Zika. We show a large portion of tropical and sub-tropical regions globally have suitable environmental conditions with over 2.17 billion people inhabiting these areas. DOI:http://dx.doi.org/10.7554/eLife.15272.001 Zika virus is transmitted between humans by mosquitoes. The majority of infections cause mild flu-like symptoms, but neurological complications in adults and infants have been found in recent outbreaks. Although it was discovered in Uganda in 1947, Zika only caused sporadic infections in humans until 2007, when it caused a large outbreak in the Federated States of Micronesia. The virus later spread across Oceania, was first reported in Brazil in 2015 and has since rapidly spread across Latin America. This has led many people to question how far it will continue to spread. There was therefore a need to define the areas where the virus could be transmitted, including the human populations that might be risk in these areas. Messina et al. have now mapped the areas that provide conditions that are highly suitable for the spread of the Zika virus. These areas occur in many tropical and sub-tropical regions around the globe. The largest areas of risk in the Americas lie in Brazil, Colombia and Venezuela. Although Zika has yet to be reported in the USA, a large portion of the southeast region from Texas through to Florida is highly suitable for transmission. Much of sub-Saharan Africa (where several sporadic cases have been reported since the 1950s) also presents an environment that is highly suitable for the Zika virus. While no cases have yet been reported in India, a large portion of the subcontinent is also suitable for Zika transmission. Over 2 billion people live in Zika-suitable areas globally, and in the Americas alone, over 5.4 million births occurred in 2015 within such areas. It is important, however, to recognize that not all individuals living in suitable areas will necessarily be exposed to Zika. We still lack a great deal of basic epidemiological information about Zika. More needs to be known about the species of mosquito that spreads the disease and how the Zika virus interacts with related viruses such as dengue. As such information becomes available and clinical cases become routinely diagnosed, the global evidence base will be strengthened, which will improve the accuracy of future maps. DOI:http://dx.doi.org/10.7554/eLife.15272.002
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Affiliation(s)
- Jane P Messina
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Oliver J Brady
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - David M Pigott
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Freya M Shearer
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Daniel J Weiss
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Nick Golding
- Department of BioSciences, University of Melbourne, Parkville, United Kingdom
| | - Corrine W Ruktanonchai
- WorldPop project, Department of Geography and Environment, University of Southampton, Southampton, United Kingdom
| | - Peter W Gething
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Emily Cohn
- Boston Children's Hospital, Harvard Medical School, Boston, United Kingdom
| | - John S Brownstein
- Boston Children's Hospital, Harvard Medical School, Boston, United Kingdom
| | - Kamran Khan
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Andrew J Tatem
- WorldPop project, Department of Geography and Environment, University of Southampton, Southampton, United Kingdom.,Flowminder Foundation, Stockholm, Sweden
| | - Thomas Jaenisch
- Section Clinical Tropical Medicine, Department for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,German Centre for Infection Research (DZIF), Heidelberg partner site, Heidelberg, Germany
| | - Christopher Jl Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Fatima Marinho
- Secretariat of Health Surveillance, Ministry of Health Brazil, Brasilia, Brazil
| | - Thomas W Scott
- Department of Entomology and Nematology, University of California Davis, Davis, United States
| | - Simon I Hay
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
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Tappis H, Koblinsky M, Doocy S, Warren N, Peters DH. Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan. J Midwifery Womens Health 2016; 61:185-95. [PMID: 26861932 DOI: 10.1111/jmwh.12359] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objective of this study was to assess the association between health facility characteristics and other individual/household factors with a woman's likelihood of skilled birth attendance in north-central Afghanistan. METHODS Data from a 2010 household survey of 6879 households in 9 provinces of Afghanistan were linked to routine facility data. Hierarchical logistic regression models were used to assess determinants of skilled birth attendance. RESULTS Women who reported having at least one antenatal visit with a skilled provider were 5.6 times more likely to give birth with a skilled attendant than those who did not. The odds of skilled birth attendance were 84% higher for literate women than those without literacy skills and 79% higher among women in the upper 2 wealth quintiles than women in the poorest quintile. This study did not show any direct linkages between facility characteristics and skilled birth attendance but provided insights into why studies assuming that women seek care at the nearest primary care facility may lead to misinterpretation of care-seeking patterns. Findings reveal a 36 percentage point gap between women who receive skilled antenatal care and those who received skilled birth care. Nearly 60% of women with a skilled attendant at their most recent birth bypassed the nearest primary care facility to give birth at a more distant primary care facility, hospital, or private clinic. Distance and transport barriers were reported as the most common reasons for home birth. DISCUSSION Assumptions that women who give birth with a skilled attendant do so at the closest health facility may mask the importance of supply-side determinants of skilled birth attendance. More research based on actual utilization patterns, not assumed catchment areas, is needed to truly understand the factors influencing care-seeking decisions in both emergency and nonemergency situations and to adapt strategies to reduce preventable mortality and morbidity in Afghanistan.
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Pérez S, Laperrière V, Borderon M, Padilla C, Maignant G, Oliveau S. Evolution of research in health geographics through the International Journal of Health Geographics (2002-2015). Int J Health Geogr 2016; 15:3. [PMID: 26790403 PMCID: PMC4719657 DOI: 10.1186/s12942-016-0032-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/07/2016] [Indexed: 01/04/2023] Open
Abstract
Health geographics is a fast-developing research area. Subjects broached in scientific literature are most varied, ranging from vectorial diseases to access to healthcare, with a recent revival of themes such as the implication of health in the Smart City, or a predominantly individual-centered approach. Far beyond standard meta-analyses, the present study deliberately adopts the standpoint of questioning space in its foundations, through various authors of the International Journal of Health Geographics, a highly influential journal in that field. The idea is to find space as the common denominator in this specialized literature, as well as its relation to spatial analysis, without for all that trying to tend towards exhaustive approaches. 660 articles have being published in the journal since launch, but 359 articles were selected based on the presence of the word “Space” in either the title, or the abstract or the text over 13 years of the journal’s existence. From that database, a lexical analysis (tag cloud) reveals the perception of space in literature, and shows how approaches are evolving, thus underlining that the scope of health geographics is far from narrowing.
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Affiliation(s)
- Sandra Pérez
- UMR ESPACE 7300, University of Nice Sophia, Nice, France.
| | | | - Marion Borderon
- UMR ESPACE 7300, University of Aix-Marseille, Aix-en-Provence, France.
| | | | | | - Sébastien Oliveau
- UMR ESPACE 7300, University of Aix-Marseille, Aix-en-Provence, France.
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47
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Alegana VA, Atkinson PM, Pezzulo C, Sorichetta A, Weiss D, Bird T, Erbach-Schoenberg E, Tatem AJ. Fine resolution mapping of population age-structures for health and development applications. J R Soc Interface 2015; 12:rsif.2015.0073. [PMID: 25788540 PMCID: PMC4387535 DOI: 10.1098/rsif.2015.0073] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The age-group composition of populations varies considerably across the world, and obtaining accurate, spatially detailed estimates of numbers of children under 5 years is important in designing vaccination strategies, educational planning or maternal healthcare delivery. Traditionally, such estimates are derived from population censuses, but these can often be unreliable, outdated and of coarse resolution for resource-poor settings. Focusing on Nigeria, we use nationally representative household surveys and their cluster locations to predict the proportion of the under-five population in 1 × 1 km using a Bayesian hierarchical spatio-temporal model. Results showed that land cover, travel time to major settlements, night-time lights and vegetation index were good predictors and that accounting for fine-scale variation, rather than assuming a uniform proportion of under 5 year olds can result in significant differences in health metrics. The largest gaps in estimated bednet and vaccination coverage were in Kano, Katsina and Jigawa. Geolocated household surveys are a valuable resource for providing detailed, contemporary and regularly updated population age-structure data in the absence of recent census data. By combining these with covariate layers, age-structure maps of unprecedented detail can be produced to guide the targeting of interventions in resource-poor settings.
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Affiliation(s)
- V A Alegana
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK
| | - P M Atkinson
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK
| | - C Pezzulo
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK
| | - A Sorichetta
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK
| | - D Weiss
- Department of Zoology, University of Oxford, Oxford, UK
| | - T Bird
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK
| | - E Erbach-Schoenberg
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK
| | - A J Tatem
- Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield Southampton, UK Fogarty International Center, National Institutes of Health, Bethesda, MD, USA Flowminder Foundation, Stockholm, Sweden
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Kraemer MUG, Hay SI, Pigott DM, Smith DL, Wint GRW, Golding N. Progress and Challenges in Infectious Disease Cartography. Trends Parasitol 2015; 32:19-29. [PMID: 26604163 DOI: 10.1016/j.pt.2015.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/30/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
Quantitatively mapping the spatial distributions of infectious diseases is key to both investigating their epidemiology and identifying populations at risk of infection. Important advances in data quality and methodologies have allowed for better investigation of disease risk and its association with environmental factors. However, incorporating dynamic human behavioural processes in disease mapping remains challenging. For example, connectivity among human populations, a key driver of pathogen dispersal, has increased sharply over the past century, along with the availability of data derived from mobile phones and other dynamic data sources. Future work must be targeted towards the rapid updating and dissemination of appropriately designed disease maps to guide the public health community in reducing the global burden of infectious disease.
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Affiliation(s)
- Moritz U G Kraemer
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK.
| | - Simon I Hay
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA
| | - David M Pigott
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - David L Smith
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA; Sanaria Institute for Global Health and Tropical Medicine, Rockville, MD 20850, USA
| | - G R William Wint
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Environmental Research Group Oxford (ERGO), Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK
| | - Nick Golding
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
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Fogliati P, Straneo M, Brogi C, Fantozzi PL, Salim RM, Msengi HM, Azzimonti G, Putoto G. How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania. PLoS One 2015; 10:e0139460. [PMID: 26422687 PMCID: PMC4589408 DOI: 10.1371/journal.pone.0139460] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/14/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Maternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access. Methods Data on health facilities’ location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites. Results About half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District). Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours’ walking time. Conclusions Our findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services in resource-limited settings.
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Affiliation(s)
| | | | - Cosimo Brogi
- Department of Physical Sciences, Earth and Environment, University of Siena, Siena, Italy
| | - Pier Lorenzo Fantozzi
- Department of Physical Sciences, Earth and Environment, University of Siena, Siena, Italy
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Quantifying seasonal population fluxes driving rubella transmission dynamics using mobile phone data. Proc Natl Acad Sci U S A 2015; 112:11114-9. [PMID: 26283349 DOI: 10.1073/pnas.1423542112] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Changing patterns of human aggregation are thought to drive annual and multiannual outbreaks of infectious diseases, but the paucity of data about travel behavior and population flux over time has made this idea difficult to test quantitatively. Current measures of human mobility, especially in low-income settings, are often static, relying on approximate travel times, road networks, or cross-sectional surveys. Mobile phone data provide a unique source of information about human travel, but the power of these data to describe epidemiologically relevant changes in population density remains unclear. Here we quantify seasonal travel patterns using mobile phone data from nearly 15 million anonymous subscribers in Kenya. Using a rich data source of rubella incidence, we show that patterns of population travel (fluxes) inferred from mobile phone data are predictive of disease transmission and improve significantly on standard school term time and weather covariates. Further, combining seasonal and spatial data on travel from mobile phone data allows us to characterize seasonal fluctuations in risk across Kenya and produce dynamic importation risk maps for rubella. Mobile phone data therefore offer a valuable previously unidentified source of data for measuring key drivers of seasonal epidemics.
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