Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study

Abstract

Background Antenatal care and skilled childbirth services are important interventions to improve maternal health and lower the risk of poor pregnancy outcomes and mortality. A growing body of literature has shown that geographic distance to clinics can be a disincentive towards seeking care during pregnancy. On the Thailand-Myanmar border antenatal clinics serving migrant populations have found high rates of loss to follow-up of 17.4%, but decades of civil conflict have made the underlying factors difficult to investigate. Here we perform a comprehensive study examining the geographic, demographic, and health-related factors contributing to loss to follow-up. Methods Using patient records we conducted a spatial and epidemiological analysis looking for predictors of loss to follow-up and pregnancy outcomes between 2007 and 2015. We used multivariable negative binomial regressions to assess for associations between distance travelled to the clinic and birth outcomes (loss to follow-up, pregnancy complications, and time of first presentation for antenatal care.) Results We found distance travelled to clinic strongly predicts loss to follow-up, miscarriage, malaria infections in pregnancy, and presentation for antenatal care after the first trimester. People lost to follow-up travelled 50% farther than people who had a normal singleton childbirth (a ratio of distances (DR) 1.5; 95% confidence interval (CI): 1.4 – 1.5). People with pregnancies complicated by miscarriage travelled 20% farther than those who did not have miscarriages (DR: 1.2; CI 1.1–1.3), and those with Plasmodium falciparum malaria in pregnancy travelled 60% farther than those without P. falciparum (DR: 1.6; CI: 1.6 – 1.8). People who delayed antenatal care until the third trimester travelled 50% farther compared to people who attended in the first trimester (DR: 1.5; CI: 1.4 – 1.5). Conclusions This analysis provides the first evidence of the complex impact of geography on access to antenatal services and pregnancy outcomes in the rural, remote, and politically complex Thailand-Myanmar border region. These findings can be used to help guide evidence-based interventions to increase uptake of maternal healthcare both in the Thailand-Myanmar region and in other rural, remote, and politically complicated environments.

Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh: analysis of linked data

“…However, we found that the increase in distance of mothers' homes to the nearest healthcare facility reduces women's ANC services uptake, especially in the rural areas. Our ndings corroborates with the ndings from other LMICs settings [31,32,[34][35][36][37][50][51][52][53][54]. There are several possible explanations for this in uence.…”

Contribution of genetic factors to high rates of neonatal hyperbilirubinaemia on the Thailand-Myanmar border

“…Increased risk of NH in UGT1A1 � 6 was first reported in Japan over 20 years ago [29] and has been observed elsewhere in East Asian countries (Taiwan [30]; Malaysia [31]; Thailand [32]), although in certain contexts the increased risk in neonates with the mutation was only observed in association with large neonatal body weight loss [33]. NH which develops after discharge from birth centres in newborns with higher EGA and no obvious risk factors represents a clinical challenge in low resource settings and, in particular, in migrant populations where access and medical followup cannot be provided easily [34]. Levels of TSB observed in neonates homozygous for UGT1A1 � 6 at 48h (i.e.…”

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

“…Given the experience of the nurses and medics who have been working in SMRU SCBUs since their establishment, their reflections captured in FGDs lend a historical perspective to the qualitative findings. The narratives from women receiving SCBU care may be limited due to when they were collected, but they align with many of the issues related to coverage, acceptability, adoption, feasibility, and fidelity for maternal, neonatal, and infant care documented previously in this setting ( 23 , 46 , 76 , 78 ). Given that the original mixed methods design was intended to inform best SCBU practices for this setting, the qualitative findings have been kept as a valuable contribution to the continuous improvement process for SCBU care.…”

“…These communities provided readily accessible, unskilled labor to help fuel Thailand's local border economy and further its affluence relative to its western neighbor. This narrative contextualizes this study's findings, contrasting a refugee yet reachable population with a mobile, migrant one—both constrained by overlapping and nuanced externalities ( 40 , 41 , 52 , 54 , 75 ) that inform the adaptation, maintenance, and improvement of evidence-based provision of newborn care ( 12 , 21 , 25 , 39 , 42 , 44 , 46 , 51 , 76 – 78 ). Although a very specific setting, this study may provide insights to researchers, clinicians, and program managers promoting newborn health that are applicable to their context.…”