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

Jia Wang — 2023-01-01T00:00:00Z

Title: Developing policy‑ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub‑Saharan Africa Authors: Jia Wang; Kerry L. M. Wong; Tope Olubodun; Uchenna Gwacham‑Anisiobi; Olakunmi Ogunyemi; Bosede B. Afolabi; Peter M. Macharia; Prestige Tatenda Makanga; Ibukun‑Oluwa Omolade Abejirinde; Lenka Beňová; Aduragbemi Banke‑Thomas Abstract: Background Dashboards are increasingly being used in sub-Saharan Africa (SSA) to support health policymaking and governance. However, their use has been mostly limited to routine care, not emergency services like emergency obstetric care (EmOC). To ensure a fit-for-purpose dashboard, we conducted an online survey with policymakers and researchers to understand key considerations needed for developing a policy-ready dashboard of geospatial access to EmOC in SSA. Methods Questionnaires targeting both stakeholder groups were pre-tested and disseminated in English, French, and Portuguese across SSA. We collected data on participants’ awareness of concern areas for geographic accessibility of EmOC and existing technological resources used for planning of EmOC services, the dynamic dashboard features preferences, and the dashboard's potential to tackle lack of geographic access to EmOC. Questions were asked as multiple-choice, Likert-scale, or open-ended. Descriptive statistics were used to summarise findings using frequencies or proportions. Free-text responses were recoded into themes where applicable. Results Among the 206 participants (88 policymakers and 118 researchers), 90% reported that rural areas and 23% that urban areas in their countries were affected by issues of geographic accessibility to EmOC. Five percent of policymakers and 38% of researchers were aware of the use of maps of EmOC facilities to guide planning of EmOC facility location. Regarding dashboard design, most visual components such as location of EmOC facilities had almost universal desirability; however, there were some exceptions. Nearly 70% of policymakers considered the socio-economic status of the population and households relevant to the dashboard. The desirability for a heatmap showing travel time to care was lower among policymakers (53%) than researchers (72%). Nearly 90% of participants considered three to four data updates per year or less frequent updates adequate for the dashboard. The potential usability of a dynamic dashboard was high amongst both policymakers (60%) and researchers (82%). Conclusion This study provides key considerations for developing a policy-ready dashboard for EmOC geographical accessibility in SSA. Efforts should now be targeted at establishing robust estimation of geographical accessibility metrics, integrated with existing health system data, and developing and maintaining the dashboard with up-to-date data to maximise impact in these settings.

Measuring geographic access to emergency obstetric care: a comparison of travel time estimates modelled using Google Maps Directions API and AccessMod in three Nigerian conurbations

Peter M. Macharia — 2024-05-27T00:00:00Z

Title: Measuring geographic access to emergency obstetric care: a comparison of travel time estimates modelled using Google Maps Directions API and AccessMod in three Nigerian conurbations Authors: Peter M. Macharia; Kerry L.M. Wong; Lenka Beňová; Jia Wang; Prestige Tatenda Makanga; Nicolas Ray; Aduragbemi Banke-Thomas Abstract: Google Maps Directions Application Programming Interface (the API) and AccessMod tools are increasingly being used to estimate travel time to healthcare. However, no formal comparison of estimates from the tools has been conducted. We modelled and compared median travel time (MTT) to comprehensive emergency obstetric care (CEmOC) using both tools in three Nigerian conurbations (Kano, Port-Harcourt, and Lagos). We compiled spatial layers of CEmOC healthcare facilities, road network, elevation, and land cover and used a least-cost path algorithm within AccessMod to estimate MTT to the nearest CEmOC facility. Comparable MTT estimates were extracted using the API for peak and non-peak travel scenarios. We investigated the relationship between MTT estimates generated by both tools at raster celllevel (0.6 km resolution). We also aggregated the raster cell estimates to generate administratively relevant ward-level MTT. We compared ward-level estimates and identified wards within the same conurbation falling into different 15-minute incremental categories (<15/15-30/30-45/45-60/+60). Of the 189, 101 and 375 wards, 72.0%, 72.3% and 90.1% were categorised in the same 15- minute category in Kano, Port-Harcourt, and Lagos, respectively. Concordance decreased in wards with longer MTT. AccessMod MTT were longer than the API’s in areas with ≥45min. At the raster cell-level, MTT had a strong positive correlation (≥0.8) in all conurbations. Adjusted R2 from a linear model (0.624-0.723) was high, increasing marginally in a piecewise linear model (0.677-0.807). In conclusion, at <45-minutes, ward-level estimates from the API and AccessMod are marginally different, however, at longer travel times substantial differences exist, which are amenable to conversion factors.

Protocol of an individual participant data meta-analysis to quantify the impact of high ambient temperatures on maternal and child health in Africa (HE2AT IPD)

Darshnika Pemi Lakhoo — 2024-01-01T00:00:00Z

Title: Protocol of an individual participant data meta-analysis to quantify the impact of high ambient temperatures on maternal and child health in Africa (HE2AT IPD) Authors: Darshnika Pemi Lakhoo; Matthew Francis Chersich; Chris Jack; Gloria Maimela; Guéladio Cissé; Ijeoma Solarin; Kristie L Ebi; Kshama S Chande; Cherlynn Dumbura; Prestige Tatenda Makanga; Lisa van Aardenne; Bonnie R Joubert; Kimberly A McAllister; Maliha Ilias; Sibusisiwe Makhanya; Stanley Luchters; HE2AT Center IPD Study Group Abstract: Introduction Globally, recognition is growing of the harmful impacts of high ambient temperatures (heat) on health in pregnant women and children. There remain, however, major evidence gaps on the extent to which heat increases the risks for adverse health outcomes, and how this varies between settings. Evidence gaps are especially large in Africa. We will conduct an individual participant data (IPD) meta-analysis to quantify the impacts of heat on maternal and child health in sub-Saharan Africa. A detailed understanding and quantification of linkages between heat, and maternal and child health is essential for developing solutions to this critical research and policy area. Methods and analysis We will use IPD from existing, large, longitudinal trial and cohort studies, on pregnant women and children from sub-Saharan Africa. We will systematically identify eligible studies through a mapping review, searching data repositories, and suggestions from experts. IPD will be acquired from data repositories, or through collaboration with data providers. Existing satellite imagery, climate reanalysis data, and station-based weather observations will be used to quantify weather and environmental exposures. IPD will be recoded and harmonised before being linked with climate, environmental, and socioeconomic data by location and time. Adopting a one-stage and two- stage meta-analysis method, analytical models such as time-to-event analysis, generalised additive models, and machine learning approaches will be employed to quantify associations between exposure to heat and adverse maternal and child health outcomes. Ethics and dissemination The study has been approved by ethics committees. There is minimal risk to study participants. Participant privacy is protected through the anonymisation of data for analysis, secure data transfer and restricted access. Findings will be disseminated through conferences, journal publications, related policy and research fora, and data may be shared in accordance with data sharing policies of the National Institutes of Health.