Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach

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Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach

JournalpLOS One
Publication date – Jul – 2020
Authors – Núbia Cristina da Silva, Thiago Augusto Hernandes Rocha , Pedro Vasconcelos Amaral, Cyrus Elahi, Elaine Thumé, Erika Bárbara Abreu Fonseca Thomaz, Rejane Christine de Sousa Queiroz, João Ricardo Nickenig Vissoci, Catherine Staton, Luiz Augusto Facchini
KeywordsAccess, maternal care, neonatal emergency care
Open access – Yes
SpecialityEmergency surgery, Obstetrics and Gynaecology
World region South America
Country: Brazil
Language – English
Submitted to the One Surgery Index on August 2, 2020 at 11:32 pm
Abstract:

Objective
The objective of this study was to better understand how the lack of emergency child and obstetric care can be related to maternal and neonatal mortality levels.

Methods
We performed spatiotemporal geospatial analyses using data from Brazilian municipalities. An emergency service accessibility index was derived using the two-step floating catchment area (2SFCA) for 951 hospitals. Mortality data from 2000 to 2015 was used to characterize space-time trends. The data was overlapped using a spatial clusters analysis to identify regions with lack of emergency access and high mortality trends.

Results
From 2000 to 2015 Brazil the overall neonatal mortality rate varied from 11,42 to 11,71 by 1000 live births. The maternal mortality presented a slightly decrease from 2,98 to 2,88 by 100 thousand inhabitants. For neonatal mortality the Northeast and North regions presented the highest percentage of up trending. For maternal mortality the North region exhibited the higher volume of up trending. The accessibility index obtained highlighted large portions of the rural areas of the country without any coverage of obstetric or neonatal beds.

Conclusions
The analyses highlighted regions with problems of mortality and access to maternal and newborn emergency services. This sequence of steps can be applied to other low and medium income countries as health situation analysis tool.

Significance statement
Low and middle income countries have greater disparities in access to emergency child and obstetric care. There is a lack of approaches capable to support analysis considering a spatiotemporal perspective for emergency care. Studies using Geographic Information System analysis for maternal and child care, are increasing in frequency. This approach can identify emergency child and obstetric care saturated or deprived regions. The sequence of steps designed here can help researchers, and policy makers to better design strategies aiming to improve emergency child and obstetric care.

OSI Number – 20611
PMID – 32702067

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