Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach.

Núbia Cristina Da Silva,Catherine Staton,Pedro Vasconcelos Amaral,Luiz Augusto Facchini,João Ricardo Nickenig Vissoci,Erika Bárbara Abreu Fonseca Thomaz,Rejane Christine De Sousa Queiroz,Elaine Thumé,Thiago Augusto Hernandes Rocha,Cyrus Elahi,Georg M Schmölzer

doi:10.1371/journal.pone.0235954

Abstract

The objective of this study was to better understand how the lack of emergency child and obstetric care can be related to maternal and neonatal mortality levels. We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends. From 2000 to 2015 Brazil the overall neonatal mortality rate varied from 11,42 to 11,71 by 1000 live births. The maternal mortality presented a slightly decrease from 2,98 to 2,88 by 100 thousand inhabitants. For neonatal mortality the Northeast and North regions presented the highest percentage of up trending. For maternal mortality the North region exhibited the higher volume of up trending. The accessibility index obtained highlighted large portions of the rural areas of the country without any coverage of obstetric or neonatal beds. The analyses highlighted regions with problems of mortality and access to maternal and newborn emergency services. This sequence of steps can be applied to other low and medium income countries as health situation analysis tool. Low and middle income countries have greater disparities in access to emergency child and obstetric care. There is a lack of approaches capable to support analysis considering a spatiotemporal perspective for emergency care. Studies using Geographic Information System analysis for maternal and child care, are increasing in frequency. This approach can identify emergency child and obstetric care saturated or deprived regions. The sequence of steps designed here can help researchers, and policy makers to better design strategies aiming to improve emergency child and obstetric care.

Highlights

Despite a global reduction of 44% in maternal deaths from 1990 to 2015, the current global maternal mortality rate of 216 per 100,000 is far from international targets [1, 2]
The challenges to address the maternal and neonatal mortality is different across low (LICs) and middle income countries (MICs)
While low income countries (LICs) suffer from limited capacity and resource shortages, the challenge for MICs is partly an issue of coordinating the network of obstetrical services [3]

Summary

Methods

We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends

Results

Significance statement

Introduction

Study design and setting