Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda.
Glob Health Sci Pract. 2019 Mar 13;7(Suppl 1):S151-S167. doi: 10.9745/GHSP-D-18-00366. Print 2019 Mar 11.
Interventions for the Saving Mothers, Giving Life (SMGL) initiative aimed to ensure all pregnant women in SMGL-supported districts have timely access to emergency obstetric and newborn care (EmONC). Spatial travel-time analyses provide a visualization of changes in timely access.
We compared travel-time estimates to EmONC health facilities in SMGL-supported districts in western Uganda in 2012, 2013, and 2016. To examine EmONC access, we analyzed a categorical variable of travel-time duration in 30-minute increments. Data sources included health facility assessments, geographic coordinates of EmONC facilities, geolocated population estimates of women of reproductive age (WRA), and other road network and geographic sources.
The number of EmONC facilities almost tripled between 2012 and 2016, increasing geographic access to EmONC. Estimated travel time to EmONC facilities declined significantly during the 5-year period. The proportion of WRA able to access any EmONC and comprehensive EmONC (CEmONC) facility within 2 hours by motorcycle increased by 18% (from 61.3% to 72.1%, < .01) and 37% (from 51.1% to 69.8%, < .01), respectively from baseline to 2016. Similar increases occurred among WRA accessing EmONC and CEmONC respectively if 4-wheeled vehicles (14% and 31% increase, < .01) could be used. Increases in timely access were also substantial for nonmotorized transportation such as walking and/or bicycling.
Largely due to the SMGL-supported expansion of EmONC capability, timely access to EmONC significantly improved. Our analysis developed a geographic outline of facility accessibility using multiple types of transportation. Spatial travel-time analyses, along with other EmONC indicators, can be used by planners and policy makers to estimate need and target underserved populations to achieve further gains in EmONC accessibility. In addition to increasing the number and geographic distribution of EmONC facilities, complementary efforts to make motorized transportation available are necessary to achieve meaningful increases in EmONC access.
“拯救母亲，赋予生命”（SMGL）倡议的干预措施旨在确保 SMGL 支持地区的所有孕妇都能及时获得紧急产科和新生儿护理（EmONC）。空间旅行时间分析提供了及时获得情况变化的可视化效果。
我们比较了乌干达西部 SMGL 支持地区的 2012 年、2013 年和 2016 年的紧急产科保健设施的旅行时间估计值。为了检查 EmONC 的可及性，我们分析了以 30 分钟为增量的旅行时间持续时间的分类变量。数据来源包括卫生设施评估、EmONC 设施的地理坐标、育龄妇女（WRA）的地理位置估计数以及其他道路网络和地理来源。
2012 年至 2016 年间，EmONC 设施的数量几乎增加了两倍，增加了获得 EmONC 的地理机会。在 5 年期间，估计前往 EmONC 设施的旅行时间显著下降。在摩托车 2 小时内能够获得任何 EmONC 和综合 EmONC（CEmONC）设施的 WRA 比例增加了 18%（从 61.3%增加到 72.1%，<.01）和 37%（从 51.1%增加到 69.8%，<.01），分别从基线到 2016 年。如果可以使用四轮车（分别增加 14%和 31%，<.01），WRA 对 EmONC 和 CEmONC 的访问也会出现类似的增加。对于步行和/或骑自行车等非机动交通方式，及时获得 EmONC 的情况也有了很大的改善。
主要由于 SMGL 支持的 EmONC 能力扩大，及时获得 EmONC 的情况有了显著改善。我们的分析使用多种交通方式开发了设施可及性的地理概况。空间旅行时间分析以及其他 EmONC 指标可被规划者和决策者用于估计需求并确定服务不足的人群，以实现 EmONC 可及性的进一步提高。除了增加 EmONC 设施的数量和地理分布外，还需要努力提供机动化交通，才能使 EmONC 的获得情况有意义地增加。
