Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis

Abstract

Background Persisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia. Methods Cross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women’s proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality. Results Significant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women’s decision-making involvement (p = 0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale. Conclusions Spatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations.

Contributing factors for reduction in maternal mortality ratio in India

“…Sufficient studies leverage spatial and spatio-temporal methods as indispensable tool for identifying inequalities in access for maternal health services and disparities in utilization 31 . Classical statistical algorithms such as Spatial autocorrelation 32 , Geographically weighted regression 33 , Local Indicators of Spatial Autocorrelation 34 have been employed frequently for understanding maternal health and MMR integrated through panel data models in China, Ethiopia and fifty four (54) African countries respectively. Inverse distance weighted method of interpolation method has been used to assess spatial patterns of maternal mortality in Tanzania 35 .…”

Exploration of spatial clustering in maternal health continuum of care across districts of India: A geospatial analysis of demographic and health survey data

“…Similarly, a study on the determinants of antenatal care utilization in India found spatial dissimilarities in ANC utilization by women and a moderate spatial autocorrelation (Moran’s I = 0.6210) confirmed the spatial dependence of ANC [ 21 ]. A few other studies have also observed significant spatial heterogeneity in ANC [ 22 , 23 ], institutional delivery [ 24 ], and PNC [ 25 – 27 ]. Studies have also observed that home delivery after ANC was spatially clustered [ 28 , 29 ].…”