Publications
1.
Wariri, Oghenebrume; Dotse-Gborgbortsi, Winfred; Agbla, Schadrac C; Jah, Hawanatu; Cham, Mamady; Jawara, Ba Foday; Bittaye, Mustapha; Nyassi, Momodou T; Marena, Musa; Sanneh, Sainey; Janneh, Mariama; Kampmann, Beate; Banke-Thomas, Aduragbemi; Lawn, Joy E; Okomo, Uduak
Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia Journal Article
In: BMJ Global Health, 2025.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia},
author = {Oghenebrume Wariri and Winfred Dotse-Gborgbortsi and Schadrac C Agbla and Hawanatu Jah and Mamady Cham and Ba Foday Jawara and Mustapha Bittaye and Momodou T Nyassi and Musa Marena and Sainey Sanneh and Mariama Janneh and Beate Kampmann and Aduragbemi Banke-Thomas and Joy E Lawn and Uduak Okomo },
url = {https://doi.org/10.1136/bmjgh-2024-016579},
year = {2025},
date = {2025-04-03},
journal = {BMJ Global Health},
abstract = {Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.
We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.
Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15–49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.
In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities—particularly those providing BEmONC services—are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.
We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.
Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15–49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.
In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities—particularly those providing BEmONC services—are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.
We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.
Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15–49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.
In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities—particularly those providing BEmONC services—are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.
2.
Sylla, El Hadji Malick; Fall, Ndeye Awa; Dotse-Gborgbortsi, Winfred; Sandie, Arsène Brunelle; Gueye, Barrel Sow; Senghor, Diarra Bousso; Cissé, Birane; Bocoum, Fadima Yaya; Sy, Ibrahima Ousmane; Faye, Cheikh
Beyond physical accessibility, bypassing health facilities offering caesarean section: insights from women in Dakar’s slums Journal Article
In: BMJ Open, vol. 15, 2025.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Beyond physical accessibility, bypassing health facilities offering caesarean section: insights from women in Dakar’s slums },
author = {El Hadji Malick Sylla and Ndeye Awa Fall and Winfred Dotse-Gborgbortsi and Arsène Brunelle Sandie and Barrel Sow Gueye and Diarra Bousso Senghor and Birane Cissé and Fadima Yaya Bocoum and Ibrahima Ousmane Sy and Cheikh Faye},
doi = {10.1136/bmjopen-2024-088606},
year = {2025},
date = {2025-02-14},
journal = {BMJ Open},
volume = {15},
abstract = {The study examines the geographic accessibility of Comprehensive Emergency Obstetric Care (CEmONC) among women residing in the slums of Dakar.
Design: The study is a cross-sectional geographic analysis of caesarean care utilisation in health facilities offering the service in Dakar.
Setting: The study was conducted in urban slum areas in Dakar.
Participants: 763 women living in urban slums who had undergone a caesarean section in six health facilities in Dakar between July and December 2022.
Outcome measures: The proportion of women bypassing the nearest health facility and travel time to health facilities.
Key findings: show that most women in Dakar’s urban slums live within 5min from a health facility offering caesarean services, with an average travel time of 6.3min. However, 44.3% bypassed nearby facilities, often travelling outside their district. Medical referral was the primary reason for bypassing (43.2%), followed by the search for higher quality care (13.5%) and reliance on family or social networks (14.9%). Only a small proportion (1.4%) cited more affordable treatment costs as a reason for bypassing.
Conclusion: Despite the good geographical accessibility of health facilities offering caesarean sections in Dakar, many women bypass nearby facilities due to medical referrals and the search for higher quality care, resulting in increased travel time and costs. Strengthening the quality and capacity of local health centres in urban slums is crucial to minimising unnecessary bypassing and ensuring timely access to essential obstetric services.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The study examines the geographic accessibility of Comprehensive Emergency Obstetric Care (CEmONC) among women residing in the slums of Dakar.
Design: The study is a cross-sectional geographic analysis of caesarean care utilisation in health facilities offering the service in Dakar.
Setting: The study was conducted in urban slum areas in Dakar.
Participants: 763 women living in urban slums who had undergone a caesarean section in six health facilities in Dakar between July and December 2022.
Outcome measures: The proportion of women bypassing the nearest health facility and travel time to health facilities.
Key findings: show that most women in Dakar’s urban slums live within 5min from a health facility offering caesarean services, with an average travel time of 6.3min. However, 44.3% bypassed nearby facilities, often travelling outside their district. Medical referral was the primary reason for bypassing (43.2%), followed by the search for higher quality care (13.5%) and reliance on family or social networks (14.9%). Only a small proportion (1.4%) cited more affordable treatment costs as a reason for bypassing.
Conclusion: Despite the good geographical accessibility of health facilities offering caesarean sections in Dakar, many women bypass nearby facilities due to medical referrals and the search for higher quality care, resulting in increased travel time and costs. Strengthening the quality and capacity of local health centres in urban slums is crucial to minimising unnecessary bypassing and ensuring timely access to essential obstetric services.
Design: The study is a cross-sectional geographic analysis of caesarean care utilisation in health facilities offering the service in Dakar.
Setting: The study was conducted in urban slum areas in Dakar.
Participants: 763 women living in urban slums who had undergone a caesarean section in six health facilities in Dakar between July and December 2022.
Outcome measures: The proportion of women bypassing the nearest health facility and travel time to health facilities.
Key findings: show that most women in Dakar’s urban slums live within 5min from a health facility offering caesarean services, with an average travel time of 6.3min. However, 44.3% bypassed nearby facilities, often travelling outside their district. Medical referral was the primary reason for bypassing (43.2%), followed by the search for higher quality care (13.5%) and reliance on family or social networks (14.9%). Only a small proportion (1.4%) cited more affordable treatment costs as a reason for bypassing.
Conclusion: Despite the good geographical accessibility of health facilities offering caesarean sections in Dakar, many women bypass nearby facilities due to medical referrals and the search for higher quality care, resulting in increased travel time and costs. Strengthening the quality and capacity of local health centres in urban slums is crucial to minimising unnecessary bypassing and ensuring timely access to essential obstetric services.
3.
Amouzou, Agbessi; Barros, Aluisio J D; Requejo, Jennifer; Faye, Cheikh; Akseer, Nadia; Bendavid, Eran; Blumenberg, Cauane; Borghi, Josephine; Baz, Sama El; Federspiel, Frederik; Ferreira, Leonardo Z; Hazel, Elizabeth; Heft-Neal, Sam; Hellwig, Franciele; Liu, Li; Maïga, Abdoulaye; Munos, Melinda; Pitt, Catherine; Shawar, Yusra Ribhi; Shiffman, Jeremy; Tam, Yvonne; Walker, Neff; Akilimali, Pierre; Alkema, Leontine; Behanzin, Paoli; Binyaruka, Peter; Bhutta, Zulfiqar; Blanchard, Andrea; Blencowe, Hannah; Bradley, Ellen; Brikci, Nouria; Caicedo-Velásquez, Beatriz; Costello, Anthony; Dotse-Gborgbortsi, Winfred; Arifeen, Shams El; Ezzati, Majid; Freedman, Lynn P; Guillot, Michel; Hanson, Claudia; Heidkamp, Rebecca; Huicho, Luis; Izugbara, Chimaraoke; Jiwani, Safia S; Kabiru, Caroline; Kiarie, Helen; Kinney, Mary; Kirakoya-Samadoulougou, Fati; Lawn, Joy; Madise, Nyovani; Mady, Gouda Roland Mesmer; Masquelier, Bruno; Melesse, Dessalegn; Nilsen, Kristine; Perin, Jamie; Ram, Usha; Romanello, Marina; Saad, Ghada E; Sharma, Sudha; Sidze, Estelle M; Spiegel, Paul; Tappis, Hannah; Tatem, Andrew J; and others,
The 2025 report of the Lancet Countdown to 2030 for women's, children's, and adolescents' health: tracking progress on health and nutrition Journal Article
In: The Lancet, vol. 405, iss. 10488, no. 10488, pp. 1505–1554, 2025.
Abstract | Links | BibTeX | Tags:
@article{amouzou20252025,
title = {The 2025 report of the Lancet Countdown to 2030 for women's, children's, and adolescents' health: tracking progress on health and nutrition},
author = {Agbessi Amouzou and Aluisio J D Barros and Jennifer Requejo and Cheikh Faye and Nadia Akseer and Eran Bendavid and Cauane Blumenberg and Josephine Borghi and Sama El Baz and Frederik Federspiel and Leonardo Z Ferreira and Elizabeth Hazel and Sam Heft-Neal and Franciele Hellwig and Li Liu and Abdoulaye Maïga and Melinda Munos and Catherine Pitt and Yusra Ribhi Shawar and Jeremy Shiffman and Yvonne Tam and Neff Walker and Pierre Akilimali and Leontine Alkema and Paoli Behanzin and Peter Binyaruka and Zulfiqar Bhutta and Andrea Blanchard and Hannah Blencowe and Ellen Bradley and Nouria Brikci and Beatriz Caicedo-Velásquez and Anthony Costello and Winfred Dotse-Gborgbortsi and Shams El Arifeen and Majid Ezzati and Lynn P Freedman and Michel Guillot and Claudia Hanson and Rebecca Heidkamp and Luis Huicho and Chimaraoke Izugbara and Safia S Jiwani and Caroline Kabiru and Helen Kiarie and Mary Kinney and Fati Kirakoya-Samadoulougou and Joy Lawn and Nyovani Madise and Gouda Roland Mesmer Mady and Bruno Masquelier and Dessalegn Melesse and Kristine Nilsen and Jamie Perin and Usha Ram and Marina Romanello and Ghada E Saad and Sudha Sharma and Estelle M Sidze and Paul Spiegel and Hannah Tappis and Andrew J Tatem and and others},
doi = {10.1016/S0140-6736(25)00151-5},
year = {2025},
date = {2025-01-01},
urldate = {2025-01-01},
journal = {The Lancet},
volume = {405},
number = {10488},
issue = {10488},
pages = {1505–1554},
publisher = {Elsevier},
abstract = {In line with previous progress reports by Countdown to 2030 for Women's, Children's, and Adolescents' Health, this report analyses global and regional trends and inequalities in health determinants, survival, nutritional status, intervention coverage, and quality of care in reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition, as well as country health systems, policies, financing, and prioritisation. The focus is on low-income and middle-income countries (LMICs) where 99% of maternal deaths and 98% of child and adolescent deaths (individuals aged 0–19 years) occur, with special attention to sub-Saharan Africa and South Asia.
Recognising the urgency of reaching the Sustainable Development Goal (SDG) for health, SDG 3, and health-related targets by 2030, the report assesses whether the momentum needed to reach these goals has been sustained, accelerated, stagnated, or regressed in comparison with the Millennium Development Goal (MDG) period (2000–15). Although most health and health-related indicators continue to show progress, there has been a notable slowdown in the rate of improvement after 2015, falling well short of the pace needed to achieve the 2030 SDG targets. This deceleration in pace contrasts sharply with the aspired grand convergence in health, characterised by drastic reductions in mortality and RMNCAH inequalities, which was expected to occur during the SDG period based on the assumption that the spectacular progress achieved during the MDG period would continue unabated. Multiple threats, external and internal to the RMNCAH health community, must be addressed to safeguard the gains in RMNCAH and nutrition and to accelerate progress. Furthermore, a large gap between sub-Saharan Africa, especially West and Central Africa, and other parts of the world persists for many indicators, necessitating further prioritisation of this region.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In line with previous progress reports by Countdown to 2030 for Women's, Children's, and Adolescents' Health, this report analyses global and regional trends and inequalities in health determinants, survival, nutritional status, intervention coverage, and quality of care in reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition, as well as country health systems, policies, financing, and prioritisation. The focus is on low-income and middle-income countries (LMICs) where 99% of maternal deaths and 98% of child and adolescent deaths (individuals aged 0–19 years) occur, with special attention to sub-Saharan Africa and South Asia.
Recognising the urgency of reaching the Sustainable Development Goal (SDG) for health, SDG 3, and health-related targets by 2030, the report assesses whether the momentum needed to reach these goals has been sustained, accelerated, stagnated, or regressed in comparison with the Millennium Development Goal (MDG) period (2000–15). Although most health and health-related indicators continue to show progress, there has been a notable slowdown in the rate of improvement after 2015, falling well short of the pace needed to achieve the 2030 SDG targets. This deceleration in pace contrasts sharply with the aspired grand convergence in health, characterised by drastic reductions in mortality and RMNCAH inequalities, which was expected to occur during the SDG period based on the assumption that the spectacular progress achieved during the MDG period would continue unabated. Multiple threats, external and internal to the RMNCAH health community, must be addressed to safeguard the gains in RMNCAH and nutrition and to accelerate progress. Furthermore, a large gap between sub-Saharan Africa, especially West and Central Africa, and other parts of the world persists for many indicators, necessitating further prioritisation of this region.
Recognising the urgency of reaching the Sustainable Development Goal (SDG) for health, SDG 3, and health-related targets by 2030, the report assesses whether the momentum needed to reach these goals has been sustained, accelerated, stagnated, or regressed in comparison with the Millennium Development Goal (MDG) period (2000–15). Although most health and health-related indicators continue to show progress, there has been a notable slowdown in the rate of improvement after 2015, falling well short of the pace needed to achieve the 2030 SDG targets. This deceleration in pace contrasts sharply with the aspired grand convergence in health, characterised by drastic reductions in mortality and RMNCAH inequalities, which was expected to occur during the SDG period based on the assumption that the spectacular progress achieved during the MDG period would continue unabated. Multiple threats, external and internal to the RMNCAH health community, must be addressed to safeguard the gains in RMNCAH and nutrition and to accelerate progress. Furthermore, a large gap between sub-Saharan Africa, especially West and Central Africa, and other parts of the world persists for many indicators, necessitating further prioritisation of this region.
4.
Wariri, Oghenebrume; Utazi, Chigozie Edson; Okomo, Uduak; Dotse-Gborgbortsi, Winfred; Sogur, Malick; Fofana, Sidat; Murray, Kris A.; Grundy, Chris; Kampmann, Beate
Multi-level determinants of timely routine childhood vaccinations in The Gambia: Findings from a nationwide analysis Journal Article
In: Vaccine, vol. 43, 2025.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Multi-level determinants of timely routine childhood vaccinations in The Gambia: Findings from a nationwide analysis},
author = {Oghenebrume Wariri and Chigozie Edson Utazi and Uduak Okomo and Winfred Dotse-Gborgbortsi and Malick Sogur and Sidat Fofana and Kris A. Murray and Chris Grundy and Beate Kampmann },
url = {https://doi.org/10.1016/j.vaccine.2024.126500},
year = {2025},
date = {2025-01-01},
journal = {Vaccine},
volume = {43},
abstract = {Achieving the ambitious goals of the Immunisation Agenda 2030 (IA2030) requires a deeper understanding of factors influencing under-vaccination, including timely vaccination. This study investigates the demand- and supply-side determinants influencing the timely uptake of key childhood vaccines scheduled throughout the first year of life in The Gambia.
We used two nationally-representative datasets: the 2019–20 Gambian Demographic and Health Survey and the 2019 national immunisation facility mapping. Using Bayesian multi-level binary logistic regression models, we identified key factors significantly associated with timely vaccination for five key vaccines: birth dose of hepatitis-B (HepB0), first, second, and third doses of the pentavalent vaccine (Penta1, Penta2, Penta3), and first-dose of measles-containing vaccine (MCV1) in children
We found that demand-side factors, such as ethnicity, household wealth status, maternal education, maternal parity, and the duration of the household's residency in its current location, were the most common drivers of timely childhood vaccination. However, supply-side factors such as travel time to the nearest immunisation clinic, availability of cold-storage and staffing numbers in the nearest immunisation clinic were also significant determinants. Furthermore, the determinants varied across specific vaccines and the timing of doses. For example, delivery in a health facility (aOR = 1.58, 95 %CI: 1.02–2.53), living less than 30 min (aOR = 2.11, 95 %CI: 1.2–8.84) and living between 30 and 60 min (aOR = 3.68, 95 %CI: 1.1–14.99) from a fixed-immunisation clinic was associated with timely HepB0, a time-sensitive vaccine that must be administered within 24 h of birth. On the other hand, children who received Penta1 and Penta2 on time were three- to five-fold more likely to receive subsequent doses on time (Penta2 and Penta3, respectively). Finally, proximity to an immunisation facility with functional vaccine cold-storage was a significant supply-side determinant of timely MCV1 (aOR = 1.4, 95 %CI: 1.09–1.99).
These findings provide valuable insights for programme managers and policymakers. By prioritising interventions and allocating scarce resources based on these identified determinants, they can maximize their impact and ensure children in The Gambia receive timely vaccinations throughout their first year of life, contributing to IA2030 goals.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Achieving the ambitious goals of the Immunisation Agenda 2030 (IA2030) requires a deeper understanding of factors influencing under-vaccination, including timely vaccination. This study investigates the demand- and supply-side determinants influencing the timely uptake of key childhood vaccines scheduled throughout the first year of life in The Gambia.
We used two nationally-representative datasets: the 2019–20 Gambian Demographic and Health Survey and the 2019 national immunisation facility mapping. Using Bayesian multi-level binary logistic regression models, we identified key factors significantly associated with timely vaccination for five key vaccines: birth dose of hepatitis-B (HepB0), first, second, and third doses of the pentavalent vaccine (Penta1, Penta2, Penta3), and first-dose of measles-containing vaccine (MCV1) in children
We found that demand-side factors, such as ethnicity, household wealth status, maternal education, maternal parity, and the duration of the household's residency in its current location, were the most common drivers of timely childhood vaccination. However, supply-side factors such as travel time to the nearest immunisation clinic, availability of cold-storage and staffing numbers in the nearest immunisation clinic were also significant determinants. Furthermore, the determinants varied across specific vaccines and the timing of doses. For example, delivery in a health facility (aOR = 1.58, 95 %CI: 1.02–2.53), living less than 30 min (aOR = 2.11, 95 %CI: 1.2–8.84) and living between 30 and 60 min (aOR = 3.68, 95 %CI: 1.1–14.99) from a fixed-immunisation clinic was associated with timely HepB0, a time-sensitive vaccine that must be administered within 24 h of birth. On the other hand, children who received Penta1 and Penta2 on time were three- to five-fold more likely to receive subsequent doses on time (Penta2 and Penta3, respectively). Finally, proximity to an immunisation facility with functional vaccine cold-storage was a significant supply-side determinant of timely MCV1 (aOR = 1.4, 95 %CI: 1.09–1.99).
These findings provide valuable insights for programme managers and policymakers. By prioritising interventions and allocating scarce resources based on these identified determinants, they can maximize their impact and ensure children in The Gambia receive timely vaccinations throughout their first year of life, contributing to IA2030 goals.
We used two nationally-representative datasets: the 2019–20 Gambian Demographic and Health Survey and the 2019 national immunisation facility mapping. Using Bayesian multi-level binary logistic regression models, we identified key factors significantly associated with timely vaccination for five key vaccines: birth dose of hepatitis-B (HepB0), first, second, and third doses of the pentavalent vaccine (Penta1, Penta2, Penta3), and first-dose of measles-containing vaccine (MCV1) in children
We found that demand-side factors, such as ethnicity, household wealth status, maternal education, maternal parity, and the duration of the household's residency in its current location, were the most common drivers of timely childhood vaccination. However, supply-side factors such as travel time to the nearest immunisation clinic, availability of cold-storage and staffing numbers in the nearest immunisation clinic were also significant determinants. Furthermore, the determinants varied across specific vaccines and the timing of doses. For example, delivery in a health facility (aOR = 1.58, 95 %CI: 1.02–2.53), living less than 30 min (aOR = 2.11, 95 %CI: 1.2–8.84) and living between 30 and 60 min (aOR = 3.68, 95 %CI: 1.1–14.99) from a fixed-immunisation clinic was associated with timely HepB0, a time-sensitive vaccine that must be administered within 24 h of birth. On the other hand, children who received Penta1 and Penta2 on time were three- to five-fold more likely to receive subsequent doses on time (Penta2 and Penta3, respectively). Finally, proximity to an immunisation facility with functional vaccine cold-storage was a significant supply-side determinant of timely MCV1 (aOR = 1.4, 95 %CI: 1.09–1.99).
These findings provide valuable insights for programme managers and policymakers. By prioritising interventions and allocating scarce resources based on these identified determinants, they can maximize their impact and ensure children in The Gambia receive timely vaccinations throughout their first year of life, contributing to IA2030 goals.
5.
Utazi, C. Edson; Olowe, Iyanuloluwa D.; Chan, H. M. Theophilus; Dotse-Gborgbortsi, Winfred; Wagai, John; Umar, Jamila A.; Etamesor, Sulaiman; Atuhaire, Brian; Fafunmi, Biyi; Crawford, Jessica; Adeniran, Adeyemi; Tatem, Andrew J.
In: Vaccines, vol. 12, no. 1299, 2024.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Geospatial Variation in Vaccination Coverage and Zero-Dose Prevalence at the District, Ward and Health Facility Levels Before and After a Measles Vaccination Campaign in Nigeria},
author = {C. Edson Utazi and Iyanuloluwa D. Olowe and H. M. Theophilus Chan and Winfred Dotse-Gborgbortsi and John Wagai and Jamila A. Umar and Sulaiman Etamesor and Brian Atuhaire and Biyi Fafunmi and Jessica Crawford and Adeyemi Adeniran and Andrew J. Tatem},
url = {https://doi.org/10.3390/vaccines12121299},
year = {2024},
date = {2024-11-21},
journal = {Vaccines},
volume = {12},
number = {1299},
abstract = {Many measles endemic countries with suboptimal coverage levels still rely on vaccination campaigns to fill immunity gaps and boost control efforts. Depending on local epidemiological patterns, national or targeted campaigns are implemented, following which post-campaign coverage surveys (PCCSs) are conducted to evaluate their performance, particularly in terms of reaching previously unvaccinated children. Due to limited resources, PCCS surveys are designed to be representative at coarse spatial scales, often masking important heterogeneities in coverage that could enhance the identification of areas of poor performance for follow-up via routine immunization strategies. Here, we undertake geospatial analyses of the 2021 measles PCCS in Nigeria to map indicators of coverage measuring the individual and combined performance of the campaign and routine immunization (RI) at 1 × 1 km resolution and the ward and district levels in 13 states. Using additional geospatial datasets, we also produced estimates of numbers of unvaccinated children during the campaign and numbers of measles-containing vaccine (MCV) zero-dose children before and after the campaign at these levels and within health facility catchment areas. Our study revealed that although the campaign reduced the numbers of MCV zero-dose children in all the districts, areas of suboptimal campaign and RI performance with considerable numbers of zero-dose children remained. Our analyses further identified wards and health facility catchment areas with higher numbers of unvaccinated children within these areas. Our outputs provide a robust evidence base to plan and implement follow-up RI strategies and to guide future campaigns at flexible and operationally relevant spatial scales.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Many measles endemic countries with suboptimal coverage levels still rely on vaccination campaigns to fill immunity gaps and boost control efforts. Depending on local epidemiological patterns, national or targeted campaigns are implemented, following which post-campaign coverage surveys (PCCSs) are conducted to evaluate their performance, particularly in terms of reaching previously unvaccinated children. Due to limited resources, PCCS surveys are designed to be representative at coarse spatial scales, often masking important heterogeneities in coverage that could enhance the identification of areas of poor performance for follow-up via routine immunization strategies. Here, we undertake geospatial analyses of the 2021 measles PCCS in Nigeria to map indicators of coverage measuring the individual and combined performance of the campaign and routine immunization (RI) at 1 × 1 km resolution and the ward and district levels in 13 states. Using additional geospatial datasets, we also produced estimates of numbers of unvaccinated children during the campaign and numbers of measles-containing vaccine (MCV) zero-dose children before and after the campaign at these levels and within health facility catchment areas. Our study revealed that although the campaign reduced the numbers of MCV zero-dose children in all the districts, areas of suboptimal campaign and RI performance with considerable numbers of zero-dose children remained. Our analyses further identified wards and health facility catchment areas with higher numbers of unvaccinated children within these areas. Our outputs provide a robust evidence base to plan and implement follow-up RI strategies and to guide future campaigns at flexible and operationally relevant spatial scales.
6.
Dwomoh, Duah; Iddi, Samuel; Afagbedzi, Seth Kwaku; Tejedor-Garavito, Natalia; Dotse-Gborgbortsi, Winfred; Wright, Jim; Tatem, Andrew J; Nilsen, Kristine
In: Journal of Urban Health, 2023.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021},
author = {Duah Dwomoh and Samuel Iddi and Seth Kwaku Afagbedzi and Natalia Tejedor-Garavito and Winfred Dotse-Gborgbortsi and Jim Wright and Andrew J Tatem and Kristine Nilsen },
url = {https://doi.org/10.1007/s11524-023-00812-0
},
doi = {10.1007/s11524-023-00812-0},
year = {2023},
date = {2023-11-16},
journal = {Journal of Urban Health},
abstract = {Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs’ targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs’ targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.
7.
Gausman, Jewel; Pingray, Verónica; Adanu, Richard; Berrueta, Delia A. B. Bandohand Mabel; Blossom, Jeff; Chakraborty, Suchandrima; Dotse-Gborgbortsi, Winfred; Kenu, Ernest; Khan, Nizamuddin; Langer, Ana; Nigri, Carolina; Odikro, Magdalene A.; Ramesh, Sowmya; Saggurti, Niranjan; Vázquez, Paula; Williams, Caitlin R.; Jolivet, R. Rima
In: PLOS one, 2023.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data},
author = {Jewel Gausman and Verónica Pingray and Richard Adanu and Delia A. B. Bandohand Mabel Berrueta and Jeff Blossom and Suchandrima Chakraborty and Winfred Dotse-Gborgbortsi and Ernest Kenu and Nizamuddin Khan and Ana Langer and Carolina Nigri and Magdalene A. Odikro and Sowmya Ramesh and Niranjan Saggurti and Paula Vázquez and Caitlin R. Williams and R. Rima Jolivet},
url = {https://doi.org/10.1371/journal.pone.0287904
},
doi = {10.1371/journal.pone.0287904},
year = {2023},
date = {2023-09-14},
journal = {PLOS one},
abstract = {Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization’s indicator “Availability of EmONC facilities” was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate “Availability of EmONC” by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator’s value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator’s validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization’s indicator “Availability of EmONC facilities” was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate “Availability of EmONC” by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator’s value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator’s validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.
8.
Kantamah, Abdul Ganiyu; Dwomoh, Duah; Amuasi, Susan Ama; Dotse-Gborgbortsi, Winfred; Kubio, Chrysantus; Apraku, Edward Anane; Timbire, Jonas Kolong; Nonvignon, Justice
Impact of mobile health on maternal and child health service utilization and continuum of care in Northern Ghana Journal Article
In: Scientific Reports, vol. 13, no. 3004, 2023.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Impact of mobile health on maternal and child health service utilization and continuum of care in Northern Ghana},
author = {Abdul Ganiyu Kantamah and Duah Dwomoh and Susan Ama Amuasi and Winfred Dotse-Gborgbortsi and Chrysantus Kubio and Edward Anane Apraku and Jonas Kolong Timbire and Justice Nonvignon},
url = {https://doi.org/10.1038/s41598-023-29683-w
},
doi = {10.1038/s41598-023-29683-w},
year = {2023},
date = {2023-02-21},
journal = {Scientific Reports},
volume = {13},
number = {3004},
abstract = {Maternal and child mortality are of public health concern. Most of these deaths occur in rural communities of developing countries. Technology for maternal and child health (T4MCH) is an intervention introduced to increase Maternal and Child Health (MCH) services utilization and continuum of care in some health facilities across Ghana. The objective of this study is to assess the impact of T4MCH intervention on MCH services utilization and continuum of care in the Sawla-Tuna-Kalba District in the Savannah Region of Ghana. This is a quasi-experimental study with a retrospective review of records of MCH services of women who attended antenatal services in some selected health centers in the Bole (comparison district) and Sawla-Tuna-Kalba (intervention district) of the Savannah region, Ghana. A total of 469 records were reviewed, 263 in Bole and 206 in Sawla-Tuna-Kalba. A multivariable modified Poisson and logistic regression models with augmented inverse-probability weighted regression adjustment based on propensity scores were used to quantify the impact of the intervention on service utilization and continuum of care. The implementation of T4MCH intervention increased antenatal care attendance, facility delivery, postnatal care and continuum of care by 18 percentage points (ppts) [95% CI - 17.0, 52.0], 14 ppts [95% CI 6.0%, 21.0%], 27 ppts [95% CI 15.0, 26.0] and 15.0 ppts [95% CI 8.0, 23.0] respectively compared to the control districts. The study showed that T4MCH intervention improved antenatal care, skilled delivery, postnatal services utilization, and continuum of care in health facilities in the intervention district. The intervention is recommended for a scale-up in other rural areas of Northern Ghana and the West-African sub-region.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Maternal and child mortality are of public health concern. Most of these deaths occur in rural communities of developing countries. Technology for maternal and child health (T4MCH) is an intervention introduced to increase Maternal and Child Health (MCH) services utilization and continuum of care in some health facilities across Ghana. The objective of this study is to assess the impact of T4MCH intervention on MCH services utilization and continuum of care in the Sawla-Tuna-Kalba District in the Savannah Region of Ghana. This is a quasi-experimental study with a retrospective review of records of MCH services of women who attended antenatal services in some selected health centers in the Bole (comparison district) and Sawla-Tuna-Kalba (intervention district) of the Savannah region, Ghana. A total of 469 records were reviewed, 263 in Bole and 206 in Sawla-Tuna-Kalba. A multivariable modified Poisson and logistic regression models with augmented inverse-probability weighted regression adjustment based on propensity scores were used to quantify the impact of the intervention on service utilization and continuum of care. The implementation of T4MCH intervention increased antenatal care attendance, facility delivery, postnatal care and continuum of care by 18 percentage points (ppts) [95% CI - 17.0, 52.0], 14 ppts [95% CI 6.0%, 21.0%], 27 ppts [95% CI 15.0, 26.0] and 15.0 ppts [95% CI 8.0, 23.0] respectively compared to the control districts. The study showed that T4MCH intervention improved antenatal care, skilled delivery, postnatal services utilization, and continuum of care in health facilities in the intervention district. The intervention is recommended for a scale-up in other rural areas of Northern Ghana and the West-African sub-region.
9.
Dotse-Gborgbortsi, Winfred; Tatem, Andrew J; Matthews, Zoe; Alegana, Victor A; Ofosu, Anthony; Wright, Jim A
In: BMJ Open, vol. 13, iss. 1, 2023.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data},
author = {Winfred Dotse-Gborgbortsi and Andrew J Tatem and Zoe Matthews and Victor A Alegana and Anthony Ofosu and Jim A Wright},
url = {http://dx.doi.org/10.1136/bmjopen-2022-066792},
doi = {10.1136/bmjopen-2022-066792},
year = {2023},
date = {2023-01-18},
journal = {BMJ Open},
volume = {13},
issue = {1},
abstract = {Objectives: To investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.
Design: The study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.
Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.
Participants: Women who gave birth in health facilities in the Eastern Region, Ghana in 2017.
Outcome measures: The count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.
Results: As travel time from women’s place of residence to the health facility increased up to two (2) hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.
Conclusions: To increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objectives: To investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.
Design: The study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.
Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.
Participants: Women who gave birth in health facilities in the Eastern Region, Ghana in 2017.
Outcome measures: The count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.
Results: As travel time from women’s place of residence to the health facility increased up to two (2) hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.
Conclusions: To increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
Design: The study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.
Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.
Participants: Women who gave birth in health facilities in the Eastern Region, Ghana in 2017.
Outcome measures: The count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.
Results: As travel time from women’s place of residence to the health facility increased up to two (2) hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.
Conclusions: To increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
10.
Dotse-Gborgbortsi, Winfred; Nilsen, Kristine; Ofosu, Anthony; Matthews, Zoe; Tejedor-Garavito, Natalia; Wright, Jim; Tatem, Andrew J
Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana Journal Article
In: BMC Pregnancy and Childbirth, vol. 22, no. 672, 2022.
Abstract | Links | BibTeX | Tags: Ghana, maternal health, travel time
@article{nokey,
title = {Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana},
author = {Dotse-Gborgbortsi, Winfred and Nilsen, Kristine and Ofosu, Anthony and Matthews, Zoe and Tejedor-Garavito, Natalia and Wright, Jim and Tatem, Andrew J},
doi = {10.1186/s12884-022-04998-0},
year = {2022},
date = {2022-08-31},
urldate = {2022-08-31},
journal = {BMC Pregnancy and Childbirth},
volume = {22},
number = {672},
abstract = {Geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.
Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.
Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.
Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.},
keywords = {Ghana, maternal health, travel time},
pubstate = {published},
tppubtype = {article}
}
Geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.
Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.
Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.
Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.
Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.
Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.
Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.
11.
Dotse-Gborgbortsi, Winfred; Tatem, Andrew J.; Matthews, Zoë; Alegana, Victor; Ofosu, Anthony; Wright, Jim
Delineating natural catchment health districts with routinely collected health data from women’s travel to give birth in Ghana Journal Article
In: BMC Health Services Research, vol. 22, no. 772, 2022.
Abstract | Links | BibTeX | Tags: Ghana, Health, maternal health, Public health
@article{nokey,
title = {Delineating natural catchment health districts with routinely collected health data from women’s travel to give birth in Ghana},
author = {Winfred Dotse-Gborgbortsi and Andrew J. Tatem and Zoë Matthews and Victor Alegana and Anthony Ofosu and Jim Wright },
doi = {10.1186/s12913-022-08125-9},
year = {2022},
date = {2022-06-13},
urldate = {2022-06-13},
journal = {BMC Health Services Research},
volume = {22},
number = {772},
abstract = {Health service areas are essential for planning, policy and managing public health interventions. In this study, we delineate health service areas from routinely collected health data as a robust geographic basis for presenting access to maternal care indicators.
Methods
A zone design algorithm was adapted to delineate health service areas through a cross-sectional, ecological study design. Health sub-districts were merged into health service areas such that patient flows across boundaries were minimised. Delineated zones and existing administrative boundaries were used to provide estimates of access to maternal health services. We analysed secondary data comprising routinely collected health records from 32,921 women attending 27 hospitals to give birth, spatial demographic data, a service provision assessment on the quality of maternal healthcare and health sub-district boundaries from Eastern Region, Ghana.
Results
Clear patterns of cross border movement to give birth emerged from the analysis, but more women originated closer to the hospitals. After merging the 250 sub-districts in 33 districts, 11 health service areas were created. The minimum percent of internal flows of women giving birth within any health service area was 97.4%. Because the newly delineated boundaries are more “natural” and sensitive to observed flow patterns, when we calculated areal indicator estimates, they showed a marked improvement over the existing administrative boundaries, with the inclusion of a hospital in every health service area.
Conclusion
Health planning can be improved by using routine health data to delineate natural catchment health districts. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.},
keywords = {Ghana, Health, maternal health, Public health},
pubstate = {published},
tppubtype = {article}
}
Health service areas are essential for planning, policy and managing public health interventions. In this study, we delineate health service areas from routinely collected health data as a robust geographic basis for presenting access to maternal care indicators.
Methods
A zone design algorithm was adapted to delineate health service areas through a cross-sectional, ecological study design. Health sub-districts were merged into health service areas such that patient flows across boundaries were minimised. Delineated zones and existing administrative boundaries were used to provide estimates of access to maternal health services. We analysed secondary data comprising routinely collected health records from 32,921 women attending 27 hospitals to give birth, spatial demographic data, a service provision assessment on the quality of maternal healthcare and health sub-district boundaries from Eastern Region, Ghana.
Results
Clear patterns of cross border movement to give birth emerged from the analysis, but more women originated closer to the hospitals. After merging the 250 sub-districts in 33 districts, 11 health service areas were created. The minimum percent of internal flows of women giving birth within any health service area was 97.4%. Because the newly delineated boundaries are more “natural” and sensitive to observed flow patterns, when we calculated areal indicator estimates, they showed a marked improvement over the existing administrative boundaries, with the inclusion of a hospital in every health service area.
Conclusion
Health planning can be improved by using routine health data to delineate natural catchment health districts. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.
Methods
A zone design algorithm was adapted to delineate health service areas through a cross-sectional, ecological study design. Health sub-districts were merged into health service areas such that patient flows across boundaries were minimised. Delineated zones and existing administrative boundaries were used to provide estimates of access to maternal health services. We analysed secondary data comprising routinely collected health records from 32,921 women attending 27 hospitals to give birth, spatial demographic data, a service provision assessment on the quality of maternal healthcare and health sub-district boundaries from Eastern Region, Ghana.
Results
Clear patterns of cross border movement to give birth emerged from the analysis, but more women originated closer to the hospitals. After merging the 250 sub-districts in 33 districts, 11 health service areas were created. The minimum percent of internal flows of women giving birth within any health service area was 97.4%. Because the newly delineated boundaries are more “natural” and sensitive to observed flow patterns, when we calculated areal indicator estimates, they showed a marked improvement over the existing administrative boundaries, with the inclusion of a hospital in every health service area.
Conclusion
Health planning can be improved by using routine health data to delineate natural catchment health districts. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.
12.
Aheto, Justice M. K.; Pannell, Oliver; Dotse-Gborgbortsi, Winfred; Trimner, Mary K.; Tatem, Andrew J.; Rhoda, Dale A.; Cutts, Felicity T.; Utazi, C Edson
Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria Journal Article
In: PLoS ONE, vol. 15, no. 5, pp. e0269066, 2022.
Abstract | Links | BibTeX | Tags: Nigeria, Predictive clustering, vaccination
@article{nokey,
title = {Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria},
author = {Justice M. K. Aheto and Oliver Pannell and Winfred Dotse-Gborgbortsi and Mary K. Trimner and Andrew J. Tatem and Dale A. Rhoda and Felicity T. Cutts and C Edson Utazi},
doi = {https://doi.org/10.1371/journal.pone.0269066},
year = {2022},
date = {2022-05-25},
urldate = {2022-05-25},
journal = {PLoS ONE},
volume = {15},
number = {5},
pages = {e0269066},
abstract = {Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed.
Methods
Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months.
Results
Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome.
Conclusion
Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.},
keywords = {Nigeria, Predictive clustering, vaccination},
pubstate = {published},
tppubtype = {article}
}
Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed.
Methods
Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months.
Results
Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome.
Conclusion
Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.
Methods
Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months.
Results
Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome.
Conclusion
Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.
13.
Yu, Weiyu; Bain, Robert E. S.; Yu, Jie; Alegana, Victor; Dotse-Gborgbortsi, Winfred; Lin, Yi; and Jim A. Wright,
Mapping access to basic hygiene services in low- and middle-income countries: A cross-sectional case study of geospatial disparities Journal Article
In: Applied Geography, vol. 135, 2021, ISSN: 0143-6228.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Mapping access to basic hygiene services in low- and middle-income countries: A cross-sectional case study of geospatial disparities},
author = {Weiyu Yu and Robert E.S. Bain and Jie Yu and Victor Alegana and Winfred Dotse-Gborgbortsi and Yi Lin and and Jim A. Wright},
doi = {https://doi.org/10.1016/j.apgeog.2021.102549},
issn = {0143-6228},
year = {2021},
date = {2021-09-07},
journal = {Applied Geography},
volume = {135},
abstract = {Handwashing with water and soap is among the most a cost-effective interventions to improve public health. Yet billions of people globally lacking handwashing facilities with water and soap on premises, with gaps particularly found in low- and middle-income countries. Targeted efforts to expand access to basic hygiene services require data at geospatially explicit scales. Drawing on country-specific cross-sectional Demographic and Health Surveys with georeferenced hygiene data, we developed an ensemble machine learning model to predict the prevalence of basic hygiene facilities in Malawi, Nepal, Nigeria, Pakistan and Uganda. The ensemble model was based on a multiple-level stacking structure, where four predictive modelling algorithms were used to produce sub-models, and a random forest model was used to generalise the final predictions. An inverse distance weighted interpolation was incorporated in the random forest model to account for spatial autocorrelation. Local coverage and a local dissimilarity index were calculated to examine the geographic disparities in access. Our methodology produced robust outputs, as evidenced by performance evaluations (all R2 were above 0.8). Among the five study countries, Pakistan had the highest overall coverage, whilst Malawi had the poorest coverage. Apparent disparities in basic hygiene services measured by local coverage were found across geographic locations and between urban and rural settings. Nigeria had the highest level of inequalities in basic hygiene services measured by a dissimilarity index, whilst Malawi showed the least segregation between populations with and without basic hygiene services. Both educational attainment and wealth were important predictors of the geospatial distribution of basic hygiene services. By producing geospatially explicit estimates of the prevalence of handwashing facilities with water and soap, this study provides a means of identifying geographical disparities in basic hygiene services. The method and outputs can be useful tools to identify areas of low coverage and to support efficient and precise targeting of efforts to scale up access to handwashing facilities and shift social and cultural norms on handwashing.}},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Handwashing with water and soap is among the most a cost-effective interventions to improve public health. Yet billions of people globally lacking handwashing facilities with water and soap on premises, with gaps particularly found in low- and middle-income countries. Targeted efforts to expand access to basic hygiene services require data at geospatially explicit scales. Drawing on country-specific cross-sectional Demographic and Health Surveys with georeferenced hygiene data, we developed an ensemble machine learning model to predict the prevalence of basic hygiene facilities in Malawi, Nepal, Nigeria, Pakistan and Uganda. The ensemble model was based on a multiple-level stacking structure, where four predictive modelling algorithms were used to produce sub-models, and a random forest model was used to generalise the final predictions. An inverse distance weighted interpolation was incorporated in the random forest model to account for spatial autocorrelation. Local coverage and a local dissimilarity index were calculated to examine the geographic disparities in access. Our methodology produced robust outputs, as evidenced by performance evaluations (all R2 were above 0.8). Among the five study countries, Pakistan had the highest overall coverage, whilst Malawi had the poorest coverage. Apparent disparities in basic hygiene services measured by local coverage were found across geographic locations and between urban and rural settings. Nigeria had the highest level of inequalities in basic hygiene services measured by a dissimilarity index, whilst Malawi showed the least segregation between populations with and without basic hygiene services. Both educational attainment and wealth were important predictors of the geospatial distribution of basic hygiene services. By producing geospatially explicit estimates of the prevalence of handwashing facilities with water and soap, this study provides a means of identifying geographical disparities in basic hygiene services. The method and outputs can be useful tools to identify areas of low coverage and to support efficient and precise targeting of efforts to scale up access to handwashing facilities and shift social and cultural norms on handwashing.}
14.
Simo, Larissa Pone; Agbor, Valirie Ndip; Temgoua, Francine Zeuga; Fozeu, Leo Cedric Fosso; Bonghaseh, Divine Tim; Mbonda, Aimé Gilbert Noula; Yurika, Raymond; Dotse-Gborgbortsi, Winfred; Mbanya, Dora
In: BMC Public Health, vol. 21, iss. 1, 2021.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Prevalence and factors associated with overweight and obesity in selected health areas in a rural health district in Cameroon: a cross-sectional analysis},
author = {Simo, Larissa Pone and Agbor, Valirie Ndip and Temgoua, Francine Zeuga and Fozeu, Leo Cedric Fosso and Bonghaseh, Divine Tim and Mbonda, Aimé Gilbert Noula and Yurika, Raymond and Dotse-Gborgbortsi, Winfred and Mbanya, Dora},
doi = {https://doi.org/10.1186/s12889-021-10403-w},
year = {2021},
date = {2021-03-10},
urldate = {2023-03-10},
journal = {BMC Public Health},
volume = {21},
issue = {1},
abstract = {Overweight and obesity are major public health problems worldwide, with projections suggesting a proportional increase in the number of affected individuals in developing countries by the year 2030. Evidence-based preventive strategies are needed to reduce the burden of overweight and obesity in developing countries. We assessed the prevalence of, and factors associated with overweight and obesity in selected health areas in West Cameroon.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Overweight and obesity are major public health problems worldwide, with projections suggesting a proportional increase in the number of affected individuals in developing countries by the year 2030. Evidence-based preventive strategies are needed to reduce the burden of overweight and obesity in developing countries. We assessed the prevalence of, and factors associated with overweight and obesity in selected health areas in West Cameroon.
15.
Rice, Benjamin L.; Annapragada, Akshaya; Baker, Rachel E.; Bruijning, Marjolein; Dotse-Gborgbortsi, Winfred; Mensah, Keitly; Miller, Ian F.; Motaze, Nkengafac Villyen; Raherinandrasana, Antso; Rajeev, Malavika; Rakotonirina, Julio; Ramiadantsoa, Tanjona; Rasambainarivo, Fidisoa; Yu, Weiyu; Grenfell, Bryan T.; Tatem, Andrew J.; Metcalf, C. Jessica E.
Variation in SARS-CoV-2 outbreaks across sub-Saharan Africa Journal Article
In: Nature Medicine, vol. 27, no. 3, pp. 447-453, 2021, ISSN: 1546-170X.
Abstract | Links | BibTeX | Tags:
@article{Rice2021,
title = {Variation in SARS-CoV-2 outbreaks across sub-Saharan Africa},
author = {Benjamin L. Rice and Akshaya Annapragada and Rachel E. Baker and Marjolein Bruijning and Winfred Dotse-Gborgbortsi and Keitly Mensah and Ian F. Miller and Nkengafac Villyen Motaze and Antso Raherinandrasana and Malavika Rajeev and Julio Rakotonirina and Tanjona Ramiadantsoa and Fidisoa Rasambainarivo and Weiyu Yu and Bryan T. Grenfell and Andrew J. Tatem and C. Jessica E. Metcalf},
url = {https://doi.org/10.1038/s41591-021-01234-8},
doi = {10.1038/s41591-021-01234-8},
issn = {1546-170X},
year = {2021},
date = {2021-03-01},
journal = {Nature Medicine},
volume = {27},
number = {3},
pages = {447-453},
abstract = {A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (for example, warmer environments1, younger populations2--4) have yet to be framed within a comprehensive analysis. We synthesized factors hypothesized to drive the pace and burden of this pandemic in SSA during the period from 25 February to 20 December 2020, encompassing demographic, comorbidity, climatic, healthcare capacity, intervention efforts and human mobility dimensions. Large diversity in the probable drivers indicates a need for caution in interpreting analyses that aggregate data across low- and middle-income settings. Our simulation shows that climatic variation between SSA population centers has little effect on early outbreak trajectories; however, heterogeneity in connectivity, although rarely considered, is likely an important contributor to variance in the pace of viral spread across SSA. Our synthesis points to the potential benefits of context-specific adaptation of surveillance systems during the ongoing pandemic. In particular, characterizing patterns of severity over age will be a priority in settings with high comorbidity burdens and poor access to care. Understanding the spatial extent of outbreaks warrants emphasis in settings where low connectivity could drive prolonged, asynchronous outbreaks resulting in extended stress to health systems.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (for example, warmer environments1, younger populations2--4) have yet to be framed within a comprehensive analysis. We synthesized factors hypothesized to drive the pace and burden of this pandemic in SSA during the period from 25 February to 20 December 2020, encompassing demographic, comorbidity, climatic, healthcare capacity, intervention efforts and human mobility dimensions. Large diversity in the probable drivers indicates a need for caution in interpreting analyses that aggregate data across low- and middle-income settings. Our simulation shows that climatic variation between SSA population centers has little effect on early outbreak trajectories; however, heterogeneity in connectivity, although rarely considered, is likely an important contributor to variance in the pace of viral spread across SSA. Our synthesis points to the potential benefits of context-specific adaptation of surveillance systems during the ongoing pandemic. In particular, characterizing patterns of severity over age will be a priority in settings with high comorbidity burdens and poor access to care. Understanding the spatial extent of outbreaks warrants emphasis in settings where low connectivity could drive prolonged, asynchronous outbreaks resulting in extended stress to health systems.
16.
Utazi, C. Edson; Nilsen, Kristine; Pannell, Oliver; Dotse-Gborgbortsi, Winfred; Tatem, Andrew J.
District-level estimation of vaccination coverage: Discrete vs continuous spatial models Journal Article
In: Statistics in Medicine, vol. 40, no. 9, pp. 2197-2211, 2021.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {District-level estimation of vaccination coverage: Discrete vs continuous spatial models},
author = {Utazi, C. Edson and Nilsen, Kristine and Pannell, Oliver and Dotse-Gborgbortsi, Winfred and Tatem, Andrew J.},
doi = {https://doi.org/10.1002/sim.8897},
year = {2021},
date = {2021-02-04},
journal = {Statistics in Medicine},
volume = {40},
number = {9},
pages = {2197-2211},
abstract = {Health and development indicators (HDIs) such as vaccination coverage are regularly measured in many low- and middle-income countries using household surveys, often due to the unreliability or incompleteness of routine data collection systems. Recently, the development of model-based approaches for producing subnational estimates of HDIs using survey data, particularly cluster-level data, has been an active area of research. This is mostly driven by the increasing demand for estimates at certain administrative levels, for example, districts, at which many development goals are set and evaluated. In this study, we explore spatial modeling approaches for producing district-level estimates of vaccination coverage. Specifically, we compare discrete spatial smoothing models which directly model district-level data with continuous Gaussian process (GP) models that utilize geolocated cluster-level data. We adopt a fully Bayesian framework, implemented using the INLA and SPDE approaches. We compare the predictive performance of the models by analyzing vaccination coverage using data from two Demographic and Health Surveys (DHS), namely the 2014 Kenya DHS and the 2015-16 Malawi DHS. We find that the continuous GP models performed well, offering a credible alternative to traditional discrete spatial smoothing models. Our analysis also revealed that accounting for between-cluster variation in the continuous GP models did not have any real effect on the district-level estimates. Our results provide guidance to practitioners on the reliability of these model-based approaches for producing estimates of vaccination coverage and other HDIs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Health and development indicators (HDIs) such as vaccination coverage are regularly measured in many low- and middle-income countries using household surveys, often due to the unreliability or incompleteness of routine data collection systems. Recently, the development of model-based approaches for producing subnational estimates of HDIs using survey data, particularly cluster-level data, has been an active area of research. This is mostly driven by the increasing demand for estimates at certain administrative levels, for example, districts, at which many development goals are set and evaluated. In this study, we explore spatial modeling approaches for producing district-level estimates of vaccination coverage. Specifically, we compare discrete spatial smoothing models which directly model district-level data with continuous Gaussian process (GP) models that utilize geolocated cluster-level data. We adopt a fully Bayesian framework, implemented using the INLA and SPDE approaches. We compare the predictive performance of the models by analyzing vaccination coverage using data from two Demographic and Health Surveys (DHS), namely the 2014 Kenya DHS and the 2015-16 Malawi DHS. We find that the continuous GP models performed well, offering a credible alternative to traditional discrete spatial smoothing models. Our analysis also revealed that accounting for between-cluster variation in the continuous GP models did not have any real effect on the district-level estimates. Our results provide guidance to practitioners on the reliability of these model-based approaches for producing estimates of vaccination coverage and other HDIs.
17.
Wariri, Oghenebrume; Onuwabuchi, Egwu; Alhassan, Jacob Albin Korem; Dase, Eseoghene; Jalo, Iliya; Laima, Christopher Hassan; Farouk, Halima Usman; El-Nafaty, Aliyu U.; Okomo, Uduak; Dotse-Gborgbortsi, Winfred
The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria Journal Article
In: PLOS ONE, vol. 16, no. 1, pp. 1-18, 2021.
Abstract | Links | BibTeX | Tags:
@article{10.1371/journal.pone.0245297,
title = {The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria},
author = {Oghenebrume Wariri and Egwu Onuwabuchi and Jacob Albin Korem Alhassan and Eseoghene Dase and Iliya Jalo and Christopher Hassan Laima and Halima Usman Farouk and Aliyu U. El-Nafaty and Uduak Okomo and Winfred Dotse-Gborgbortsi},
url = {https://doi.org/10.1371/journal.pone.0245297},
doi = {10.1371/journal.pone.0245297},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {PLOS ONE},
volume = {16},
number = {1},
pages = {1-18},
publisher = {Public Library of Science},
abstract = {Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively
18.
Dotse-Gborgbortsi, Winfred; Tatem, Andrew J.; Alegana, Victor; Utazi, C. Edson; Ruktanonchai, Corrine Warren; Wright, Jim
In: Tropical Medicine & International Health, vol. 25, no. 9, pp. 1044-1054, 2020.
Abstract | Links | BibTeX | Tags: accouchement qualifié, EmONC, financement EmONC, GIS, maternal health, quality care, santé maternelle, skilled birth attendance, soins de qualité, temps de trajet, travel time
@article{https://doi.org/10.1111/tmi.13460,
title = {Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data},
author = {Winfred Dotse-Gborgbortsi and Andrew J. Tatem and Victor Alegana and C. Edson Utazi and Corrine Warren Ruktanonchai and Jim Wright},
url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13460},
doi = {https://doi.org/10.1111/tmi.13460},
year = {2020},
date = {2020-01-01},
journal = {Tropical Medicine & International Health},
volume = {25},
number = {9},
pages = {1044-1054},
abstract = {Abstract Objective This study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility. Methods Through a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA and then applied model estimates to spatial layers to assess the probability of SBA at high-spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates and modelled travel time to health facilities. Results Within an hour's travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services, and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high-quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions. Conclusion Given the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.},
keywords = {accouchement qualifié, EmONC, financement EmONC, GIS, maternal health, quality care, santé maternelle, skilled birth attendance, soins de qualité, temps de trajet, travel time},
pubstate = {published},
tppubtype = {article}
}
Abstract Objective This study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility. Methods Through a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA and then applied model estimates to spatial layers to assess the probability of SBA at high-spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates and modelled travel time to health facilities. Results Within an hour's travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services, and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high-quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions. Conclusion Given the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.
19.
Rice, Benjamin L.; Annapragada, Akshaya; Baker, Rachel E.; Bruijning, Marjolein; Dotse-Gborgbortsi, Winfred; Mensah, Keitly; Miller, Ian F.; Motaze, Nkengafac Villyen; Raherinandrasana, Antso; Rajeev, Malavika; Rakotonirina, Julio; Ramiadantsoa, Tanjona; Rasambainarivo, Fidisoa; Yu, Weiyu; Grenfell, Bryan T.; Tatem, Andrew J.; Metcalf, C. Jessica E.
High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa Journal Article
In: medRxiv, 2020.
Abstract | Links | BibTeX | Tags:
@article{Rice2020.07.23.20161208,
title = {High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa},
author = {Benjamin L. Rice and Akshaya Annapragada and Rachel E. Baker and Marjolein Bruijning and Winfred Dotse-Gborgbortsi and Keitly Mensah and Ian F. Miller and Nkengafac Villyen Motaze and Antso Raherinandrasana and Malavika Rajeev and Julio Rakotonirina and Tanjona Ramiadantsoa and Fidisoa Rasambainarivo and Weiyu Yu and Bryan T. Grenfell and Andrew J. Tatem and C. Jessica E. Metcalf},
url = {https://www.medrxiv.org/content/early/2020/07/29/2020.07.23.20161208},
doi = {10.1101/2020.07.23.20161208},
year = {2020},
date = {2020-01-01},
journal = {medRxiv},
publisher = {Cold Spring Harbor Laboratory Press},
abstract = {A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments1, younger populations2–4) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ‘slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.Competing Interest StatementThe authors have declared no competing interest.Funding StatementREB is supported by the Cooperative Institute for Modeling the Earth System (CIMES). AA acknowledges support from the NIH Medical Scientist Training Program 1T32GM136577. AJT is funded by the BMGF (OPP1182425, OPP1134076 and INV-002697). MB is funded by NWO Rubicon grant 019.192EN.017.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:NAAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData and code have been deposited into a publicly available GitHub repository: https://github.com/labmetcalf/SSA-SARS-CoV-2 High resolution maps and further visualizations of the risk indicators and simulations studied here can be accessed online through an interactive tool: https://labmetcalf.shinyapps.io/covid19-burden-africa/ https://labmetcalf.shinyapps.io/covid19-burden-africa/},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments1, younger populations2–4) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ‘slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.Competing Interest StatementThe authors have declared no competing interest.Funding StatementREB is supported by the Cooperative Institute for Modeling the Earth System (CIMES). AA acknowledges support from the NIH Medical Scientist Training Program 1T32GM136577. AJT is funded by the BMGF (OPP1182425, OPP1134076 and INV-002697). MB is funded by NWO Rubicon grant 019.192EN.017.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:NAAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData and code have been deposited into a publicly available GitHub repository: https://github.com/labmetcalf/SSA-SARS-CoV-2 High resolution maps and further visualizations of the risk indicators and simulations studied here can be accessed online through an interactive tool: https://labmetcalf.shinyapps.io/covid19-burden-africa/ https://labmetcalf.shinyapps.io/covid19-burden-africa/
20.
Dotse-Gborgbortsi, Winfred; Dwomoh, Duah; Alegana, Victor; Hill, Allan; Tatem, Andrew J; Wright, Jim
The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana Journal Article
In: BMJ Global Health, vol. 4, no. Suppl 5, 2020.
Abstract | Links | BibTeX | Tags:
@article{Dotse-Gborgbortsie002020,
title = {The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana},
author = {Winfred Dotse-Gborgbortsi and Duah Dwomoh and Victor Alegana and Allan Hill and Andrew J Tatem and Jim Wright},
url = {https://gh.bmj.com/content/4/Suppl_5/e002020},
doi = {10.1136/bmjgh-2019-002020},
year = {2020},
date = {2020-01-01},
journal = {BMJ Global Health},
volume = {4},
number = {Suppl 5},
publisher = {BMJ Specialist Journals},
abstract = {Objectives Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.Methods We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.Results A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.Conclusion This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence-based information for improving maternal health service provision by targeting specific communities and health facilities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objectives Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.Methods We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.Results A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.Conclusion This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence-based information for improving maternal health service provision by targeting specific communities and health facilities.
