Dataset Information

Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh.

ABSTRACT:

Background

A spatial and temporal study of the distribution of facility-based deliveries can identify areas of low and high facility usage and help devise more targeted interventions to improve delivery outcomes. Developing countries like Bangladesh face considerable challenges in reducing the maternal mortality ratio to the targets set by the Sustainable Development Goals. Recent studies have already identified that the progress of reducing maternal mortality has stalled. Giving birth in a health facility is one way to reduce maternal mortality.

Methods

Facility delivery data from a demographic surveillance site was analyzed at both village and Bari (comprising several households with same paternal origins) level to understand spatial and temporal heterogeneity. Global spatial autocorrelation was detected using Moran's I index while local spatial clusters were detected using the local Getis G _i * statistics. In addition, space-time scanning using a discrete Poisson approach facilitated the identification of space-time clusters. The likelihood of delivering at a facility when located inside a cluster was calculated using log-likelihood ratios.

Results

The three cluster detection approaches detected significant spatial and temporal heterogeneity in the distribution of facility deliveries in the study area. The hot and cold spots indicated contiguous and relocation type diffusion and increased in number over the years. Space-time scanning revealed that when a parturient woman is located in a Bari inside the cluster, the likelihood of delivering at a health facility increases by twenty-seven times.

Conclusions

Spatiotemporal studies to understand delivery patterns are quite rare. However, in resource constraint countries like Bangladesh, detecting hot and cold spot areas can aid in the detection of diffusion centers, which can be targeted to expand regions with high facility deliveries. Places and periods with reduced health facility usages can be identified using various cluster detection techniques, to assess the barriers and facilitators in promoting health facility deliveries.

SUBMITTER: Chowdhury AI

PROVIDER: S-EPMC6636060 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh.

Chowdhury Atique Iqbal AI Abdullah Abu Yousuf Md AYM Haider Rafiqul R Alam Asraful A Billah Sk Masum SM Bari Sanwarul S Rahman Qazi Sadeq-Ur QS Jochem Warren Christopher WC Dewan Ashraf A El Arifeen Shams S

Tropical medicine and health 20190716

<h4>Background</h4>A spatial and temporal study of the distribution of facility-based deliveries can identify areas of low and high facility usage and help devise more targeted interventions to improve delivery outcomes. Developing countries like Bangladesh face considerable challenges in reducing the maternal mortality ratio to the targets set by the Sustainable Development Goals. Recent studies have already identified that the progress of reducing maternal mortality has stalled. Giving birth i ...[more]

PMID: 31346313

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Project description:BACKGROUND:In Nigeria, the provision of public and private healthcare vary geographically, contributing to variations in one's healthcare surroundings across space. Facility-based delivery (FBD) is also spatially heterogeneous. Levels of FBD and private FBD are significantly lower for women in certain south-eastern and northern regions. The potential influence of childbirth services frequented by the community on individual's barriers to healthcare utilization is under-studied, possibly due to the lack of suitable data. Using individual-level data, we present a novel analytical approach to examine the relationship between women's reasons for homebirth and community-level, health-seeking surroundings. We aim to assess the extent to which cost or finance acts as a barrier for FBD across geographic areas with varying levels of private FBD in Nigeria. METHOD:The most recent live births of 20,467 women were georeferenced to 889 locations in the 2013 Nigeria Demographic and Health Survey. Using these locations as the analytical unit, spatial clusters of high/low private FBD were detected with Kulldorff statistics in the SatScan software package. We then obtained the predicted percentages of women who self-reported financial reasons for homebirth from an adjusted generalized linear model for these clusters. RESULTS:Overall private FBD was 13.6% (95%CI?=?11.9,15.5). We found ten clusters of low private FBD (average level: 0.8, 95%CI?=?0.8,0.8) and seven clusters of high private FBD (average level: 37.9, 95%CI?=?37.6,38.2). Clusters of low private FBD were primarily located in the north, and the Bayelsa and Cross River States. Financial barrier was associated with high private FBD at the cluster level - 10% increase in private FBD was associated with +?1.94% (95%CI?=?1.69,2.18) in nonusers citing cost as a reason for homebirth. CONCLUSIONS:In communities where private FBD is common, women who stay home for childbirth might have mild increased difficulties in gaining effective access to public care, or face an overriding preference to use private services, among other potential factors. The analytical approach presented in this study enables further research of the differentials in individuals' reasons for service non-uptake across varying contexts of healthcare surroundings. This will help better devise context-specific strategies to improve health service utilization in resource-scarce settings.

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Dataset Information

Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh.

Background

Methods

Results

Conclusions

Publications

Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh.

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