Geospatial mapping of timely access to inpatient neonatal care and its relationship to neonatal mortality in Kenya

Abstract

Globally, 2.4 million newborns die in the first month of life, with neonatal mortality rates (NMR) per 1,000 livebirths being highest in sub-Saharan Africa. Improving access to inpatient newborn care is necessary for reduction of neonatal deaths in the region. We explore the relationship between distance to inpatient hospital newborn care and neonatal mortality in Kenya. Data on service availability from numerous sources were used to map hospitals that care for newborns with very low birth weight (VLBW). Estimates of livebirths needing VLBW services were mapped from population census data at 100 m spatial resolution using a random forest algorithm and adjustments using a systematic review of livebirths needing these services. A cost distance algorithm that adjusted for proximity to roads, road speeds, land use and protected areas was used to define geographic access to hospitals offering VLBW services. County-level access metrics were then regressed against estimates of NMR to assess the contribution of geographic access to VLBW services on newborn deaths while controlling for wealth, maternal education and health workforce. 228 VLBW hospitals were mapped, with 29,729 births predicted as requiring VLBW services in 2019. Approximately 80.3% of these births were within 2 hours of the nearest VLBW hospital. Geographic access to these hospitals, ranged from less than 30% in Wajir and Turkana to as high as 80% in six counties. Regression analysis showed that a one percent increase in population within 2 hours of a VLBW hospital was associated with a reduction of NMR by 0.24. Despite access in the country being above the 80% threshold, 17/47 counties do not achieve this benchmark. To reduce inequities in NMR in Kenya, policies to improve care must reduce geographic barriers to access and progressively improve facilities’ capacity to provide quality care for VLBW newborns.

Advancing the frontiers of geographic accessibility to healthcare services

“…The Sustainable Development Goal target 3.8 aims to ensure comprehensive and quality health services to individuals without financial burden and underpins the global commitment to achieve UHC 3 . Evidence shows that better access to healthcare is associated with improved health outcomes, including morbidity and mortality 4 , 5 . Therefore, it is essential to periodically evaluate a population’s healthcare access to identify those left behind to ensure their prioritization during decision-making and future resource allocation.…”

“…The choice of either potential or revealed as a measure of spatial accessibility is a function of the research question, technical expertise and ease of implementing a certain method, area (rural or urban), size of the geographical area and its features (topography), context (socio-economic status, ethnic composition, and cultural diversity) and data availability. Advances in geospatial technologies such as global navigation satellite systems, geographical information systems and earth observation have led to a proliferation of studies on potential access 4 , 11 – 15 .…”

Geographic accessibility and hospital competition for emergency blood transfusion services in Bungoma, Western Kenya

“…Travel time has been investigated in several settings in sub Saharan Africa for severe conditions requiring timely hospital access, including obstetrics [ 15 – 19 ], very low-birth-weight infants [ 20 ], surgery [ 8 ], severe malaria [ 21 ] and other severe paediatric conditions [ 22 ]. These studies have largely focused on access to broad hospital, in-patient care but have not accounted for services available for specific conditions, including BT services.…”