An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria.

Aduragbemi Banke-Thomas,Abimbola Olaniran,Akin Abayomi,Bosede Bukola Afolabi,Mobolanle Balogun,Lenka Benova,Kerry L M Wong,Babatunde Ajayi,Ololade Wright,Lindsey Collins,Opeyemi Babajide

doi:10.1093/heapol/czab099

Abstract

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.

Highlights

Maternal mortality remains a huge challenge for many health systems globally, despite a 38% reduction in global maternal mortality between 2000 and 2017
Pregnant women who travelled to a facility in the afternoon, morning and evening were about three, two and two times more likely to travel >60 minutes to reach a public comprehensive emergency obstetric care (CEmOC) facility that provided care to them compared to those who travelled at night
Records of 4181 pregnant women who presented in public CEmOC facilities in Lagos state with obstetric emergencies were included in this study

Summary

Introduction

Maternal mortality remains a huge challenge for many health systems globally, despite a 38% reduction in global maternal mortality between 2000 and 2017. Provision of emergency obstetric care (EmOC), which consist of nine clinical and surgical evidence-based interventions, is effective in managing these complications (Paxton et al, 2005). Within the Lagos suburbs, there were three hotspots from which pregnant women needed longer than 60 minutes to travel directly to CEmOC facilities. These areas were Alimosho/Ifako-Ijaiye (Cluster A), Eti-Osa (Cluster B) and Ijanikin/Morogbo (Cluster C). We found that there were larger hotspots in the three suburbs from which pregnant women needed longer than 60 minutes to travel directly, i.e. Cluster A, B and C and an additional, small cluster north of Ikorodu (Cluster D) (Figure 2 and Supplementary Figures S1 and S2)

Objectives

Methods

Results

Discussion

Conclusion