Dataset Information

Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria.

ABSTRACT:

Background

Better geographical accessibility to comprehensive emergency obstetric care (CEmOC) facilities can significantly improve pregnancy outcomes. However, with other factors, such as affordability critical for care access, it is important to explore accessibility across groups. We assessed CEmOC geographical accessibility by wealth status in the 15 most-populated Nigerian cities.

Methods

We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assembled population distribution for women of childbearing age and Meta's Relative Wealth Index (RWI). We used the Google Maps Platform's internal Directions Application Programming Interface to obtain driving times to public and private facilities. City-level median travel time (MTT) and number of CEmOC facilities reachable within 60 min were summarised for peak and non-peak hours per wealth quintile. The correlation between RWI and MTT to the nearest public CEmOC was calculated.

Results

We show that MTT to the nearest public CEmOC facility is lowest in the wealthiest 20% in all cities, with the largest difference in MTT between the wealthiest 20% and least wealthy 20% seen in Onitsha (26 vs 81 min) and the smallest in Warri (20 vs 30 min). Similarly, the average number of public CEmOC facilities reachable within 60 min varies (11 among the wealthiest 20% and six among the least wealthy in Kano). In five cities, zero facilities are reachable under 60 min for the least wealthy 20%. Those who live in the suburbs particularly have poor accessibility to CEmOC facilities.

Conclusions

Our findings show that the least wealthy mostly have poor accessibility to care. Interventions addressing CEmOC geographical accessibility targeting poor people are needed to address inequities in urban settings.

SUBMITTER: Wong KLM

PROVIDER: S-EPMC10902387 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria.

Wong Kerry L M KLM Banke-Thomas Aduragbemi A Olubodun Tope T Macharia Peter M PM Stanton Charlotte C Sundararajan Narayanan N Shah Yash Y Prasad Gautam G Kansal Mansi M Vispute Swapnil S Shekel Tomer T Ogunyemi Olakunmi O Gwacham-Anisiobi Uchenna U Wang Jia J Abejirinde Ibukun-Oluwa Omolade IO Makanga Prestige Tatenda PT Afolabi Bosede B BB Beňová Lenka L

Communications medicine 20240228 1

<h4>Background</h4>Better geographical accessibility to comprehensive emergency obstetric care (CEmOC) facilities can significantly improve pregnancy outcomes. However, with other factors, such as affordability critical for care access, it is important to explore accessibility across groups. We assessed CEmOC geographical accessibility by wealth status in the 15 most-populated Nigerian cities.<h4>Methods</h4>We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assemb ...[more]

PMID: 38418903

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Project description:Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify 'hotspots' of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2-240 minutes (without referral) and 7-320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.

Project description:BackgroundThe DHS wealth index - based on a statistical technique known as principal component analysis - is used extensively in mainstream surveys and epidemiological studies to assign individuals to wealth categories from information collected on common assets and household characteristics. Since its development in the late nineties, the index has established itself as a standard and, due to its ease of use, has led to a large and welcome increase in the analysis of inequalities. The index is, however, known to present some serious limitations, one being a bias towards patterns of urban wealth: the so-called "urban bias".MethodsWe use 10 data sets - 5 MICS (Multiple Indicator Cluster Survey), 4 DHS (Demographic and Health Survey) and one HBS (Household Budget Survey) - to demonstrate that urban bias continues to be a prominent and worrying feature of the wealth index, even after several methodological changes implemented in recent years to try to reduce it. We then propose and investigate an approach to improve the performance of the index and reduce the urban bias. This approach involves the use of ordinal rather than dummy variables, of a polychoric instead of a product-moment correlation matrix, and the use of two principal components rather than one. These approaches are used jointly to produce the polychoric dual-component wealth index (P2C).ResultsThe P2C index enables a larger proportion of the variance of the asset variables to be accounted for, results in all assets contributing positively to the wealth score, exploits added analytical power from ordinal variables, and incorporates the extra dimension of wealth expressed by the second principal component. It results in a better representation of typically rural characteristics of wealth and leads to the identification of more plausible distributions of both the urban and rural populations across wealth quintiles, which are closer to expenditure quintiles than the standard DHS index.ConclusionsThe P2C wealth index can be easily applied to mainstream surveys, such as the MICS and DHS, and to epidemiological studies; it yields more credible distributions of rural and urban subpopulations across wealth quintiles. It is proposed as an alternative to the DHS wealth index.

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Dataset Information

Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria.

Background

Methods

Results

Conclusions

Publications

Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria.

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