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

Abstract

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

Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia

“…Additionally, it is assumed that emergency 4WD vehicles are present and immediately able to make emergency referrals. Whilst a common assumption, in reality, these vehicles are often unavailable in many parts of sub-Saharan Africa due to their upkeep and fuelling expenses, and they are often utilised in other tasks [ 19 , 133 ]. The model also assumes that all facilities have operational communications equipment with which to communicate referrals with [ 46 , 134 ].…”

“…These models can account for the impact of geographical barriers on health access when calculating population travel times and distances to health services. This approach is commonplace in maternal health research as geographic health access models are able to identify underserved populations, provide evidence to support interventions on improving accessibility, and identify the most influential geographical barriers to access [ 16 – 19 ]. For example, Ruktanonchai et al [ 1 ] used cost-distance analysis as part of their study investigating maternal healthcare utilisation, and found that increased geographical inaccessibility had the strongest association with reducing maternal care usage in five East African countries.…”

Developing policy-ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub-Saharan Africa

“…Ultimately, for such modelling features to work, there is a need to ensure that the dashboard is interlinked with other databases [41]. A feature allowing modelling various provision scenarios such as HRH, cost of service provision, or service outcomes could extend the utility of the dashboard for service planning and allow it to be more informative for policymakers in their efforts to identify areas of inequalities in healthcare utilisation, achieve cost-efficiency in provision of maternal and newborn health services and reduce maternal and neonatal morbidity and mortality [42,43]. There are also other potential gains of a dashboard like this in SSA countries, including improving the routine health management information systems and enhancing accountability/ stewardship of health systems and policymakers toward the population, as was the case with the routine immunisation dashboard implemented in Nigeria [21].…”

Exploring spatiotemporal trends and impacts of health resources and services on under-5 mortality in West African countries, 2010–2019: a spatial data analysis

“…Analyzing the spatiotemporal characteristics of U5MR and the spatial spillover effect of health resources and services can comprehensively explain the long-term trend of health inequality in different countries in this region. It is of great significance to guide regional health planning and formulate regional health policies in West Africa, conducive to reducing child health inequality between and within countries ( 19 ). Hence, the present study aimed to describe the spatiotemporal characteristics of U5MR in 15 West African countries from 2010 to 2019 by combining the ecological design of geographic information systems and explore the spatial spillover effects of health resources and services on U5MR from the perspective of spatiotemporal correlation.…”