A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations

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Abstract

Travel time estimation accounting for on-the-ground realities between the location where a need for emergency obstetric care (EmOC) arises and the health facility capable of providing EmOC is essential for improving pregnancy outcomes. Current understanding of travel time to care is inadequate in many urban areas of Africa, where short distances obscure long travel times and travel times can vary by time of day and road conditions. Here, we describe a database of travel times to comprehensive EmOC facilities in the 15 most populated extended urban areas of Nigeria. The travel times from cells of approximately 0.6 × 0.6 km to facilities were derived from Google Maps Platform’s internal Directions Application Programming Interface, which incorporates traffic considerations to provide closer-to-reality travel time estimates. Computations were done to the first, second and third nearest public or private facilities. Travel time for eight traffic scenarios (including peak and non-peak periods) and number of facilities within specific time thresholds were estimated. The database offers a plethora of opportunities for research and planning towards improving EmOC accessibility.

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Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Nicholas J. Kassebaum, Amelia Bertozzi-Villa, Megan S Coggeshall … (2014)

The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Spatial accessibility of primary care: concepts, methods and challenges

Mark Guagliardo (2004)

Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S. For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care – travel impedance to nearest provider and supply level within bordered areas – lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas. This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

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A global map of travel time to cities to assess inequalities in accessibility in 2015

D Weiss, A. Nelson, H. Gibson … (2018)

The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of 'leaving no one behind' established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

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Author and article information

Contributors

Charlotte Stanton: chstanton@google.com

Aduragbemi Banke-Thomas:

ORCID: http://orcid.org/0000-0002-4449-0131

aduragbemi.banke-thomas@lshtm.ac.uk

Journal

Journal ID (nlm-ta): Sci Data

Journal ID (iso-abbrev): Sci Data

Title: Scientific Data

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2052-4463

Publication date (Electronic): 23 October 2023

Publication date PMC-release: 23 October 2023

Publication date Collection: 2023

Volume: 10

Electronic Location Identifier: 736

Affiliations

[1 ]GRID grid.11505.30, ISNI 0000 0001 2153 5088, Department of Public Health, , Institute of Tropical Medicine, ; Antwerp, Belgium

[2 ]GRID grid.33058.3d, ISNI 0000 0001 0155 5938, Population & Health Impact Surveillance Group, , Kenya Medical Research Institute-Wellcome Trust Research Programme, ; Nairobi, Kenya

[3 ]Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, ( https://ror.org/04f2nsd36) Lancaster, UK

[4 ]Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, ( https://ror.org/00a0jsq62) London, UK

[5 ]GRID grid.414821.a, Department of Community Medicine and Primary Care, , Federal Medical Centre Abeokuta, ; Abeokuta, Ogun Nigeria

[6 ]GRID grid.420451.6, ISNI 0000 0004 0635 6729, Google LLC, ; California, USA

[7 ]Nuffield Department of Population Health, University of Oxford, ( https://ror.org/052gg0110) Oxford, UK

[8 ]Lagos State Ministry of Health, Ikeja, Lagos, Nigeria

[9 ]School of Computing & Mathematical Sciences, University of Greenwich, ( https://ror.org/00bmj0a71) London, UK

[10 ]Dalla Lana School of Public Health, University of Toronto, ( https://ror.org/03dbr7087) Toronto, Canada

[11 ]GRID grid.417199.3, ISNI 0000 0004 0474 0188, Women’s College Hospital Institute for Health System Solutions and Virtual Care, ; Toronto, Canada

[12 ]Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, ( https://ror.org/02gv1gw80) Gweru, Midlands Zimbabwe

[13 ]Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, ( https://ror.org/041y4nv46) Harare, Zimbabwe

[14 ]Maternal and Reproductive Health Research Collective, Lagos, Nigeria

[15 ]Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, ( https://ror.org/05rk03822) Lagos, Nigeria

[16 ]School of Human Sciences, University of Greenwich, ( https://ror.org/00bmj0a71) London, UK

Author information

Peter M. Macharia http://orcid.org/0000-0003-3410-1881

Aduragbemi Banke-Thomas http://orcid.org/0000-0002-4449-0131

Article

Publisher ID: 2651

DOI: 10.1038/s41597-023-02651-9

PMC ID: 10593805

PubMed ID: 37872185

SO-VID: 55591331-92fb-4bfa-89d5-fa82acc914fa

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 25 May 2023

Date accepted : 16 October 2023

Funding

Funded by: FundRef https://doi.org/10.13039/100000865, Bill and Melinda Gates Foundation (Bill & Melinda Gates Foundation);

Funded by: FundRef https://doi.org/10.13039/100006785, Google;

Funded by: FundRef https://doi.org/10.13039/501100003130, Fonds Wetenschappelijk Onderzoek (Research Foundation Flanders);

Funded by: FundRef https://doi.org/10.13039/501100000666, Oxford University | Nuffield College, University of Oxford;

Funded by: Bill and Melinda Gates Foundation (Bill & Melinda Gates Foundation)

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Keywords: health services, health policy

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A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations

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Most cited references 38

Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Spatial accessibility of primary care: concepts, methods and challenges

A global map of travel time to cities to assess inequalities in accessibility in 2015

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