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Equality in maternal and newborn health: modelling geographic disparities in utilisation of care in five East African countries

Equality in maternal and newborn health: modelling geographic disparities in utilisation of care in five East African countries
Equality in maternal and newborn health: modelling geographic disparities in utilisation of care in five East African countries
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.
1932-6203
1-17
Ruktanonchai, Corrine W.
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Ruktanonchai, Nick W.
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Nove, Andrea
90e094cf-1931-4d79-a8c1-ad04779e61e0
Lopes, Sofia
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Pezzulo, Carla
876a5393-ffbd-479a-9edf-f72a59ca2cb5
Bosco, Claudio
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Alegana, Victor A.
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Burgert, Clara R.
bdf2e25a-1bf4-4736-a351-482628097178
Ayiko, Rogers
87788f7b-3c32-4ebb-87cf-3be8aeea2832
Charles, Andrew S.E.K.
b91af20d-a64c-461e-ba74-d330e913e718
Lambert, Nkurunziza
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Msechu, Esther
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Kathini, Esther
31658fb6-6ea8-482a-ba64-b31840b24a2b
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Ruktanonchai, Corrine W.
a576fb11-a475-4d48-885a-85938b60a7a8
Ruktanonchai, Nick W.
fe68cb8d-3760-4955-99fa-47d43f86580a
Nove, Andrea
90e094cf-1931-4d79-a8c1-ad04779e61e0
Lopes, Sofia
b810134e-d2c3-43f4-89ba-87beac2670ea
Pezzulo, Carla
876a5393-ffbd-479a-9edf-f72a59ca2cb5
Bosco, Claudio
9bf27082-5f4c-4b9f-8f12-6c4159f556f5
Alegana, Victor A.
6fdaa47e-c08c-48bc-b881-1dc7b89085e4
Burgert, Clara R.
bdf2e25a-1bf4-4736-a351-482628097178
Ayiko, Rogers
87788f7b-3c32-4ebb-87cf-3be8aeea2832
Charles, Andrew S.E.K.
b91af20d-a64c-461e-ba74-d330e913e718
Lambert, Nkurunziza
2a87fe11-c1f0-46b4-a790-04951475a05a
Msechu, Esther
ecf67f96-6810-49cd-8353-6320a9953591
Kathini, Esther
31658fb6-6ea8-482a-ba64-b31840b24a2b
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e

Ruktanonchai, Corrine W., Ruktanonchai, Nick W., Nove, Andrea, Lopes, Sofia, Pezzulo, Carla, Bosco, Claudio, Alegana, Victor A., Burgert, Clara R., Ayiko, Rogers, Charles, Andrew S.E.K., Lambert, Nkurunziza, Msechu, Esther, Kathini, Esther, Matthews, Zoe and Tatem, Andrew J. (2016) Equality in maternal and newborn health: modelling geographic disparities in utilisation of care in five East African countries. PLoS ONE, 11 (8), 1-17. (doi:10.1371/journal.pone.0162006).

Record type: Article

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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Accepted/In Press date: 16 August 2016
e-pub ahead of print date: 25 August 2016
Published date: 25 August 2016
Organisations: Global Env Change & Earth Observation, WorldPop, Population, Health & Wellbeing (PHeW)

Identifiers

Local EPrints ID: 399816
URI: https://eprints.soton.ac.uk/id/eprint/399816
ISSN: 1932-6203
PURE UUID: 5f09427e-4a14-45af-beb7-98a2f0813669
ORCID for Andrew J. Tatem: ORCID iD orcid.org/0000-0002-7270-941X

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Date deposited: 30 Aug 2016 09:16
Last modified: 03 Dec 2019 01:38

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Contributors

Author: Corrine W. Ruktanonchai
Author: Nick W. Ruktanonchai
Author: Andrea Nove
Author: Sofia Lopes
Author: Carla Pezzulo
Author: Claudio Bosco
Author: Victor A. Alegana
Author: Clara R. Burgert
Author: Rogers Ayiko
Author: Andrew S.E.K. Charles
Author: Nkurunziza Lambert
Author: Esther Msechu
Author: Esther Kathini
Author: Zoe Matthews
Author: Andrew J. Tatem ORCID iD

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