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 3. GISTECHNIQUES INMATERNALHEALTH Geographic Information Systems (GIS) offer several techniques for maternal health studies. These include: Spatial Analysis Spatial analysis techniques such as network analysis, buffer analysis, and hot spot analysis enable the examination of spatial relationships and patterns related to maternal health services and outcomes. These methods are instrumental in identifying areas with high and low morbidity and mortality rates, as well as understanding the underlying reasons for these differences 12(Banda et al., 2016). Spatial Mapping Visualization through spatial mapping aids in identifying geographical disparities and areas of need. By visually representing the distribution of maternal health variables, stakeholders can gain insights into spatial patterns and prioritize areas for intervention 13. Spatial Modelling GIS enables the analysis and prediction of access to emergency obstetric care and various forms of maternal health services through simulation and scenario prediction. This helps in understanding the potential impact of interventions and resource allocation strategies. 14 4. GEOSPATIAL ANALYSIS FOR IMPROVED HEALTH SYSTEMPERFORMANCE Geographic Disparities inMaternal and Neonatal Morbidity/ Mortality Geospatial analysis has been pivotal in unveiling significant geographic inequalities in maternal and neonatal morbidity and mortality across Sub-Saharan Africa. Studies in Zambia, Tanzania, and South Africa have pinpointed clusters of both lower and higher lifetime risks of pregnancy-related deaths. For instance, a national study in Zambia found lower lifetime risk of pregnancy-related deaths in clusters including Lusaka, Muchinga, Copperbelt, Northwestern, and Southern provinces, while higher risk clusters were observed in Western and Luapula provinces. 15,16 Similarly, investigations across several Sub-Saharan African countries have highlighted disparities in stillbirth, perinatal, and neonatal mortality rates. A large study covering all 49 SSA countries 16 indicated no spatial clustering of neonatal mortality between countries. However, higher neonatal mortality rates were found in Ethiopia, Kenya, and Tanzania compared to other countries. In Ethiopia, lower perinatal deaths were observed in Addis Ababa, parts of Tigray, Gambella, Benishangul-Gumuz, and Southern Nations Nationalities and Peoples Region, while higher perinatal deaths were recorded in the Somali region, South Amhara, North Oromia, and Southern Afar. These findings underscore the critical need for targeted interventions to address these geographical disparities and improve maternal and newborn health outcomes. Regional Variations in Maternal Health Care Utilization The utilization of maternal health care services displays pronounced regional variations, as evidenced by numerous studies spanning Ethiopia, Nigeria, Ghana, and other countries. For example, in Ethiopia, relatively higher utilization rates were found in Addis Ababa, Dire Dawa, and Tigray, while lower utilization rates were observed in regions such as Somali, Afar, Oromia, Amhara, Gambela, and Benishangul Gumuz. 17,18 A significant north-south divide in the likelihood of maternal health care utilization was reported in Nigeria 19,20, with most Northern states showing lower utilization compared to southern states. Similarly, studies in Ghana 21,22 revealed a similar pattern, with women from the north being more likely to utilize maternal health care services. These disparities extend beyond national borders, as seen in West African countries like Nigeria and Benin. 16 Understanding these regional differences is essential for tailoring interventions that effectively enhance maternal health care access and utilization. Availability and Accessibility Challenges Geospatial analyses have shed light on substantial gaps in the availability and geographic accessibility of maternal health facilities. A regional study reported that all countries in Sub- Saharan Africa 23 meet the WHO's accessibility target of 80% of women located within 2 hours of the nearest comprehensive emergency obstetric and newborn care (C-EmONC) at the national level, except Eritrea (71%). However, disparities exist at subnational levels, with significant variability observed. In Ghana, for example, only 55% of women reach their nearest C-EmONC facility within two hours, and substantial variations were observed regarding geographic accessibility at the subnational level. 24 Similar disparities were observed in Ethiopia, where the national average distance to EmONC facilities was 12.8 km, but it varied from 27.1 km in the Somali region to a kilometer in bigger cities like Addis Ababa and Dire Dawa. 25 Figure 1 : showing travel time to nearest hospital in sub SaharanAfrica (23) Fig. 1 Map a showing travel-time to the nearest hospital and map b showing the estimated number of pregnancies in 2015 per km 2 African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 1 | 2024 | 07