Geospatial estimation of reproductive, maternal, newborn and child health indicators: a systematic review of methodological aspects of studies based on household surveys

Ferreira, Leonardo Zanini; Blumenberg, Cauane; Utazi, C. Edson; Nilsen, Kristine; Hartwig, Fernando Pires; Tatem, Andrew J.; Barros, Aluísio J. D.

doi:10.1186/s12942-020-00239-9

Cited by 12 publications

(12 citation statements)

References 113 publications

(150 reference statements)

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“…The DHS Program is United States Agency for International Development (USAID) funded nationally representative survey on fertility, family planning, maternal and child health, gender, HIV/AIDS, malaria, and nutrition for over 90 developing countries [ 70 ]. The finding that most of the reviewed studies use DHS as a data source is comparable with the finding of other reviews conducted on different study populations [ 71 ] and study areas [ 72 ]. Despite the large sample size and availability in regular five-year intervals, DHS only contains data aggregated at the survey cluster level [ 70 ].…”

Section: Discussionsupporting

confidence: 82%

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

et al. 2022

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Background Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA. Methods A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review. Results We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data. Conclusions The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully.

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Section: Discussionsupporting

confidence: 82%

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

et al. 2022

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“…The merit of using geo-spatial techniques lies in the fact that policies can be planned at the micro-level. Furthermore, literary evidences indicate that application of spatial techniques provide policymakers with the capability to identify high priority areas that require more maternal health services which helps in improvement of maternal health [ 63 , 64 ] along with producing fine spatial scale estimates of reproductive and maternal indicators in low- and middle-income countries [ 65 ]. Since India exhibits a wide regional variation of maternal mortality ratio and limited use of SBAs for deliveries, therefore, the present study attempts to understand the spatial distribution of deliveries by SBAs across 640 districts in India as well as to identify the background characteristics that affect its utilization.…”

Section: Discussionmentioning

confidence: 99%

Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach

et al. 2022

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Background Despite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - particularly across states and regions. Therefore, this study applies the spatial-regression model to examine the spatial distribution of SBA across districts of India. Furthermore, the study tries to understand the spatially associated population characteristics that influence the low coverage of SBA across districts of India and its regions. Methods The study used national representative cross-sectional survey data obtained from the fourth round of National Family Health Survey, conducted in 2015-16. The effective sample size was 259,469 for the analysis. Moran’s I statistics and bivariate Local Indicator for Spatial Association maps were used to understand spatial dependence and clustering of deliveries conducted by SBA coverage in districts of India. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of deliveries conducted by SBA. Results Moran’s I value for SBA among women was 0.54, which represents a high spatial auto-correlation of deliveries conducted by SBA over 640 districts of India. There were 145 hotspots for deliveries conducted by SBA among women in India, which includes almost the entire southern part of India. The spatial error model revealed that with a 10% increase in exposure to mass media in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Interestingly, also with the 10% increase in the four or more antenatal care (ANC) in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Again, if there was a 10% increase of women with first birth order in a particular district, then the deliveries conducted by SBA significantly increased by 6.1%. If the district experienced an increase of 10% household as female-headed, then the deliveries conducted by SBA significantly increased by 1.4%. Conclusion The present study highlights the important role of ANC visits, mass media exposure, education, female household headship that augment the use of an SBA for delivery. Attention should be given in promoting regular ANC visits and strengthening women’s education.

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“…Model-based geostatistics (MBG)(31) offers a principled likelihood-based approach to problems concerning the modeling of the spatial variation of a phenomenon of scienti c interest such as ANC4 + and robustly assesses attainment of target coverage. It has been applied widely across public health problems where the goal is to make inferences using spatially discrete cross-sectional survey data, especially in low resource settings where disease registries are incomplete or non-existent (32)(33)(34). In this study, we aimed to model ANC4 + coverage, likelihood of achieving target coverage and number of women who need to be reached disaggregated by three equity strati ers (household wealth, woman's education, and travel time to nearest health facility) using data from household surveys in Kenya, Uganda, and mainland Tanzania.…”

Section: Introductionmentioning

confidence: 99%

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

Macharia

Joseph

Nalwadda

et al. 2022

Preprint

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Background: Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. Methods: We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were then computed. Prediction was at 3 km spatial resolution and aggregated at national- and district-level for sub-national planning. Results: About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had less than ANC4+ visits. The majority of the 366 districts in the three countries had ANC4+ coverage of 50-70%. In Kenya, 13% of districts had <70% coverage, compared to 10% and 27% of the districts in Uganda and mainland Tanzania, respectively. Only one district in Kenya and ten districts in mainland Tanzania likely met the target coverage. Six percent, 38%, and 50% of the districts had at most 5,000 women with <ANC4+ visits in Kenya, Uganda, and mainland Tanzania, respectively, while districts with >20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare. Conclusions: These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.

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Geospatial estimation of reproductive, maternal, newborn and child health indicators: a systematic review of methodological aspects of studies based on household surveys

Cited by 12 publications

References 113 publications

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

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