Figure - uploaded by Aduragbemi Banke-Thomas
Content may be subject to copyright.
Bivariate analysis for maternal outcomes

Bivariate analysis for maternal outcomes

Source publication
Article
Full-text available
Introduction Prompt access to emergency obstetrical care (EmOC) reduces the risk of maternal mortality. We assessed institutional maternal mortality by distance and travel time for pregnant women with obstetrical emergencies in Lagos State, Nigeria. Methods We conducted a facility-based retrospective cohort study across 24 public hospitals in Lago...

Context in source publication

Context 1
... marital status, a complication in a previous pregnancy, number of gestations, booking status, maternal complications, distance and time from home directly to a hospital, total travel time, mode of delivery and principal settlement served by the hospital were statistically significant from the bivariate analysis (table 3). In Model 1, factors that were significantly associated with maternal death were having an obstetrical complication in a previous pregnancy (0.41, 95% CI 0.22 to 0.77), being booked (0.21, 95% CI 0.11 to 0.42), travelling 10-15 km (2.53, 95% CI 1.27 to 5.03) and travelling to a hospital that principally serves suburban (3.60, 95% CI 1.59 to 8.18) and rural areas (2.51, 95% CI 1.01 to 6.29) and delivering via assisted vaginal birth (3.37, 95% CI 1.76 to 6.46) or by caesarean section (0.39, 95% CI 0.22 to 0.71) (table 4). ...

Citations

... 6 Travel time and distance to care may lead to maternal or perinatal deaths. [7][8][9][10] There is a global consensus that understanding the reasons underpinning the death of a pregnant woman or her unborn child is an important first step in forestalling future similar deaths. To reach this understanding, in addition to being able to label the obstetric complication that led to the death(s), it is crucial to capture the pregnant woman's personal story to care and the precise circumstances around her death or that of her unborn child. ...
Article
Background: The Maternal and Perinatal Death Surveillance and Response (MPDSR) proposed by the World Health Organization recognises the importance for health systems to understand the reasons underpinning the death of a pregnant woman or her newborn as an essential first step in preventing future similar deaths. Data for the surveillance component of the MPDSR process are typically collected from health facility sources and post-mortem interviews with affected families, though it may be traumatising to them. This brief report aimed to assess the potential utility of an augmented data collection method for mapping journeys of maternal and perinatal deaths, which does not require sourcing additional information from grieving family members. Methods: A descriptive analysis of maternal and perinatal deaths that occurred across 24 public hospitals in Lagos State, Nigeria, between 1 st November 2018 and 30 th October 2019 was conducted. Data on their demographic, obstetric history and complication at presentation, travel to the hospital, and mode of birth were extracted from their hospital records. The extracted travel data was exported to Google Maps, where driving distance and travel time to the hospital for the period of the day of travel were also extracted. Results: Of the 182 maternal deaths, most presented during the week (80.8%), travelled 5-10 km (30.6%) and 10-29 minutes (46.9%), and travelled to the nearest hospital to their places of residence (70.9%). Of the 442 pregnant women who had perinatal deaths, most presented during the week (78.5%), travelled <5 km (26.9%) and 10-29 minutes (38.0%). For both, the least reported travel data was the mode of travel used to care (>90.0%) and the period of the day they travelled (approximately 30.0%). Conclusion: An augmented data collection approach that includes accurate and complete travel data and closer-to-reality estimates of travel time and distance can be beneficial for MPDSR purposes.
... 6 Travel time and distance to care may lead to maternal or perinatal deaths. [7][8][9][10] There is a global consensus that understanding the reasons underpinning the death of a pregnant woman or her unborn child is an important first step in forestalling future similar deaths. To reach this understanding, in addition to being able to label the obstetric complication that led to the death(s), it is crucial to capture the pregnant woman's personal story to care and the precise circumstances around her death or that of her unborn child. ...
Article
Background: The Maternal and Perinatal Death Surveillance and Response (MPDSR) proposed by the World Health Organization recognises the importance for health systems to understand the reasons underpinning the death of a pregnant woman or her newborn as an essential first step in preventing future similar deaths. Data for the surveillance component of the MPDSR process are typically collected from health facility sources and post-mortem interviews with affected families, though it may be traumatising to them. This brief report aimed to assess the potential utility of an augmented data collection method for mapping journeys of maternal and perinatal deaths, which does not require sourcing additional information from grieving family members. Methods: A descriptive analysis of maternal and perinatal deaths that occurred across all 24 public hospitals in Lagos State, Nigeria, between 1 st November 2018 and 30 th October 2019 was conducted. Data on their demographic, obstetric history and complication at presentation, travel to the hospital, and mode of birth were extracted from their hospital records. The extracted travel data was exported to Google Maps, where driving distance and travel time to the hospital for the period of the day of travel were also extracted. Results: Of the 182 maternal deaths, most presented during the week (80.8%), travelled 5-10 km (30.6%) and 10-29 minutes (46.9%), and travelled to the nearest hospital to their places of residence (70.9%). Of the 442 pregnant women who had perinatal deaths, most presented during the week (78.5%), travelled <5 km (26.9%) and 10-29 minutes (38.0%). For both, the least reported travel data was the mode of travel used to care (>90.0%) and the period of the day they travelled (approximately 30.0%). Conclusion: An augmented data collection approach that includes accurate and complete travel data and closer-to-reality estimates of travel time and distance can be beneficial for MPDSR purposes.
... Women living in urban areas have been assumed to have better physical access EmOC compared to their rural counterparts due to relatively shorter travel distances to health facilities (11). However, emerging evidence shows that this so called "urban advantage" is shrinking and, in some LMIC settings, almost non-existent partly because while travel distances might be shorter, travel time can get longer (9,12,13). In urban LMIC settings, typically characterized by poor spatial planning, haphazardly built environments, growing informal settlements, poor road infrastructure, and extreme traffic congestion prolong travel time, delay care-seeking, and aggravate the risk of long-term morbidity and mortality for women and their babies. ...
Article
Full-text available
Maternal and perinatal mortality remain huge challenges globally, particularly in low- and middle-income countries (LMICs) where >98% of these deaths occur. Emergency obstetric care (EmOC) provided by skilled health personnel is an evidence-based package of interventions effective in reducing these deaths associated with pregnancy and childbirth. Until recently, pregnant women residing in urban areas have been considered to have good access to care, including EmOC. However, emerging evidence shows that due to rapid urbanization, this so called “urban advantage” is shrinking and in some LMIC settings, it is almost non-existent. This poses a complex challenge for structuring an effective health service delivery system, which tend to have poor spatial planning especially in LMIC settings. To optimize access to EmOC and ultimately reduce preventable maternal deaths within the context of urbanization, it is imperative to accurately locate areas and population groups that are geographically marginalized. Underpinning such assessments is accurately estimating travel time to health facilities that provide EmOC. In this perspective, we discuss strengths and weaknesses of approaches commonly used to estimate travel times to EmOC in LMICs, broadly grouped as reported and modeled approaches, while contextualizing our discussion in urban areas. We then introduce the novel OnTIME project, which seeks to address some of the key limitations in these commonly used approaches by leveraging big data. The perspective concludes with a discussion on anticipated outcomes and potential policy applications of the OnTIME project.
... 6 Travel time and distance to care may lead to maternal or perinatal deaths. [7][8][9][10] There is a global consensus that understanding the reasons underpinning the death of a pregnant woman or her unborn child is an important first step in forestalling future similar deaths. To reach this understanding, in addition to being able to label the obstetric complication that led to the death(s), it is crucial to capture the pregnant woman's personal story to care and the precise circumstances around her death or that of her unborn child. ...
Article
Full-text available
Background: The Maternal and Perinatal Death Surveillance and Response (MPDSR) proposed by the World Health Organization recognises the importance for health systems to understand the reasons underpinning the death of a pregnant woman or her newborn as an essential first step in preventing future similar deaths. Data for the surveillance component of the MPDSR process are typically collected from health facility sources and post-mortem interviews with affected families, though it may be traumatising to them. This brief report aimed to assess the potential utility of an augmented data collection method for mapping journeys of maternal and perinatal deaths, which does not require sourcing additional information from grieving family members. Methods: A descriptive analysis of maternal and perinatal deaths that occurred across all 24 public hospitals in Lagos State, Nigeria, between 1 st November 2018 and 30 th October 2019 was conducted. Data on their demographic, obstetric history and complication at presentation, travel to the hospital, and mode of birth were extracted from their hospital records. The extracted travel data was exported to Google Maps, where driving distance and travel time to the hospital for the period of the day of travel were also extracted. Results: Of the 182 maternal deaths, most presented during the week (80.8%), travelled 5-10 km (30.6%) and 10-29 minutes (46.9%), and travelled to the nearest hospital to their places of residence (70.9%). Of the 442 pregnant women who had perinatal deaths, most presented during the week (78.5%), travelled <5 km (26.9%) and 10-29 minutes (38.0%). For both, the least reported travel data was the mode of travel used to care (>90.0%) and the period of the day they travelled (approximately 30.0%). Conclusion: An augmented data collection approach that includes accurate and complete travel data and closer-to-reality estimates of travel time and distance can be beneficial for MPDSR purposes.
Article
Full-text available
In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15–49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women’s socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90–41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55–3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.