An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria

Banke-Thomas, Aduragbemi ORCID: 0000-0002-4449-0131, Wong, Kerry LM, Collins, Lindsey, Olaniran, Abimbola, Balogun, Mobolanle, Wright, Ololade, Babajide, Opeyemi, Ajayi, Babatunde, Ajayi, Babatunde, Abayomi, Akin and Benova, Lenka (2021) An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria. Health Policy and Planning, 36 (9). 1384 - 1396. ISSN 0268-1080

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Abstract

Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify ‘hotspots’ of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2–240 minutes (without referral) and 7–320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.

Item Type:	Article
Official URL:	https://academic.oup.com/heapol
Additional Information:	© 2021 The Authors
Divisions:	LSE Health
Subjects:	H Social Sciences > HQ The family. Marriage. Woman R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RG Gynecology and obstetrics
Date Deposited:	06 Aug 2021 13:33
Last Modified:	30 Nov 2024 05:15
URI:	http://eprints.lse.ac.uk/id/eprint/111563

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