AFJOG

REVIEW African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 1 | 2024 | Geospatial Analysis in Maternal Health: A Comprehensive Review of Applications and Limitations for Improved Outcomes 1. INTRODUCTION Maternal mortality remains a significant global challenge, especially prevalent in low and middle-income countries, which account for 94% of maternal deaths worldwide. 1,2 The United Nations Millennium Development Goals and subsequent Sustainable Development Goals have highlighted the critical need to reduce maternal deaths and achieve Universal Health Coverage (UHC) by 2030 3 (United Nations, 2015). In this context, defining the location of health services in relation to the communities they are intended to serve has become paramount. This ensures that the right services are accessible to the population, addressing the geographic disparities that hinder maternal health outcomes. Across sub-Saharan Africa (SSA), where a large proportion of maternal deaths occur, health services are provided with varying levels of medical sophistication. From community providers delivering basic care to hospitals offering critical emergency interventions, the spectrumof care iswide. However, accessibility to these services is not equitable, leading to significant challenges in addressing maternal mortality. The inability to reach quality- assured health services that can provide life-saving interventions contributes to the sustained high burden of communicable and non-communicable disease morbidity and mortality in SSA compared to other regions of the world. The global health agenda, with its focus on Universal Health Coverage (UHC), seeks to ensure that all individuals can access the health services they need. 3 This agenda is intertwined with the health-related Sustainable Development Goals, emphasizing the importance of equitable access to healthcare. In 2015, the World Health Assembly made a significant shift in strategy, transitioning from the goal of 'ending preventable maternal mortality (EPMM)' to a more focused aim of 'reducing the global Maternal Mortality Ratio (MMR) to less than 70 per 100,000 live births by 2030.' This shift signalled a major transformation in national maternal and child health efforts 1 However, despite these ambitious goals, there remains a noticeable gap in the implementation, integration, and scale- up of maternal health services, posing a significant threat to the success of these programs 4,5 To effectively reduce maternal mortality rates and bridge these implementation gaps, it is imperative to strengthen and scale up maternal health services. Ensuring that all women have access to respectful and high- quality maternity care is a crucial step in achieving these goals, as it not only improves health outcomes but also upholds women's rights. 2,6 Evidence indicates that precise mapping and modelling of maternal-health-related services 7,8, including maternal care utilization during pregnancy and childbirth, can provide invaluable insights for preventing maternal deaths. For instance, previous studies in Ethiopia have highlighted significant geographical disparities in pregnant women's utilization of Antenatal Care (ANC) services (particularly in terms of attending ANC services four or more times ), as well as giving birth in a health facility. 9 Achieving universal equity in access to health services requires better data on the locations of both services and the populations they are intended to serve. It is within this context that geospatial analysis, facilitated by Geographic Information Systems (GIS), has emerged as a valuable tool in maternal health research. This review aims to comprehensively explore the applications and limitations of geospatial analysis in maternal health. By examining how GIS can improve the understanding of geographic disparities in access to maternal health services, identify areas in need of targeted interventions, and contribute to achieving UHC goals, we delve into the potential of GIS to enhance maternal health outcomes globally. 2. CURRENTLANDSCAPEOFMATERNALHEALTH In2020, anestimated287,000maternal deathsoccurredglobally, with Sub-Saharan Africa (SSA) bearing a disproportionate burden of 70% 1(World Health Organization, 2023). Despite efforts, SSA continues to show slow progress in reducing maternal and neonatal morbidity and mortality. Achieving SDGs and UHC targets necessitates a comprehensive approach, including monitoring the availability of Emergency Obstetric and Neonatal care Services (EmONC). 3 However, geographical accessibility poses a significant challenge, impacting maternal outcomes due to delays in reaching facilities. 10 The Lancet Commission on Global Surgery highlights the importance of geographical access to essential services, setting a target of 80% coverage by 2030. 11 K Jere, 1 J Kluge 2 1 Department of Obstetrics and Gynaecology, Urogynaecology unit, Stellenbosch University Tygerberg Hospital, Cape Town, South Africa 2 Department of Obstetrics and Gynaecology, Fellow in Urogynaecology, Stellenbosch University, Cape Town, South Africa CORRESPONDENCE: Dr K Jere| Email: kjere@sun.ac.za Geospatial Analysis in Maternal Health: A Comprehensive Review of Applications and Limitations for Improved Outcomes ABSTRACT Maternal health remains a critical global challenge, particularly in low and middle-income countries where most maternal deaths occur. This comprehensive review explores the applications and limitations of geospatial analysis in maternal health, focusing on its potential to improve outcomes. Emphasizing the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC), geospatial analysis offers insights into geographical inequalities, spatial patterns of health characteristics, and targeted intervention strategies. Various Geographic Information Systems (GIS) techniques and components are discussed, highlighting their role in spatial analysis, mapping, modelling, and decision support. While geospatial analysis shows promise in improving health system performance and reducing maternal health disparities, challenges such as data quality, infrastructure, and ethical considerations must be addressed for its optimal utilization. Keywords: Geospatial analysis, Maternal health, GIS techniques, Spatial analysis, Decision support, Universal Health Coverage African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 1 | 2024 | 06