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. 2024 Feb 28;4(1):34.
doi: 10.1038/s43856-024-00458-2.

Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria

Kerry L M Wong #  1 , Aduragbemi Banke-Thomas #  2   3   4 , Tope Olubodun  5 , Peter M Macharia  6   7   8 , Charlotte Stanton  9 , Narayanan Sundararajan  10 , Yash Shah  10 , Gautam Prasad  10 , Mansi Kansal  10 , Swapnil Vispute  10 , Tomer Shekel  10 , Olakunmi Ogunyemi  11 , Uchenna Gwacham-Anisiobi  12 , Jia Wang  13 , Ibukun-Oluwa Omolade Abejirinde  14   15 , Prestige Tatenda Makanga  16   17 , Bosede B Afolabi  18   19 , Lenka Beňová  6
Affiliations

Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria

Kerry L M Wong et al. Commun Med (Lond). .

Erratum in

Abstract

Background: Better geographical accessibility to comprehensive emergency obstetric care (CEmOC) facilities can significantly improve pregnancy outcomes. However, with other factors, such as affordability critical for care access, it is important to explore accessibility across groups. We assessed CEmOC geographical accessibility by wealth status in the 15 most-populated Nigerian cities.

Methods: We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assembled population distribution for women of childbearing age and Meta's Relative Wealth Index (RWI). We used the Google Maps Platform's internal Directions Application Programming Interface to obtain driving times to public and private facilities. City-level median travel time (MTT) and number of CEmOC facilities reachable within 60 min were summarised for peak and non-peak hours per wealth quintile. The correlation between RWI and MTT to the nearest public CEmOC was calculated.

Results: We show that MTT to the nearest public CEmOC facility is lowest in the wealthiest 20% in all cities, with the largest difference in MTT between the wealthiest 20% and least wealthy 20% seen in Onitsha (26 vs 81 min) and the smallest in Warri (20 vs 30 min). Similarly, the average number of public CEmOC facilities reachable within 60 min varies (11 among the wealthiest 20% and six among the least wealthy in Kano). In five cities, zero facilities are reachable under 60 min for the least wealthy 20%. Those who live in the suburbs particularly have poor accessibility to CEmOC facilities.

Conclusions: Our findings show that the least wealthy mostly have poor accessibility to care. Interventions addressing CEmOC geographical accessibility targeting poor people are needed to address inequities in urban settings.

Plain language summary

Access to critical obstetric care can be lifesaving for pregnant women and their offspring. However, socioeconomic factors are known to affect accessibility to health services across different groups. Here, we assessed peak and off-peak travel times to functional health facilities for women from 15 Nigerian cities, using travel time estimates produced by Google Maps and stratified by wealth status. Travel time to the nearest hospital and the number of hospitals reachable within 60 min varied across cities. The wealthiest 20% across all cities had the shortest travel time and vice versa for the least wealthy 20%. Women who live in the suburbs particularly have poor accessibility. Tailored action is needed to improve access for vulnerable populations living in urban settings.

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Conflict of interest statement

CS, NS, YS, GP, MK, SV, and TS are employees of Google LLC, which makes the Google Maps Platform. AB-T received grant funding from Google to support this work. PMM is an Editorial Board Member for Communications Medicine and Guest Editor for the Geospatial Analysis for Improved Understanding of Health Inequalities Collection but was not involved in the editorial review or peer review, nor in the decision to publish this article. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Equiplot of geographic accessibility by relative wealth in 15 cities in Nigeria.
a Median Travel Time (MTT) to the nearest public comprehensive emergency obstetric care (CEmOC) facility in minutes in 15 cities in Nigeria by quintile of relative wealth. b MTT to the nearest public or private CEmOC facility in minutes. c Average number of public CEmOC facilities reachable within 60 min. d Average number of public or private CEmOC facilities reachable within 60 min. In all panels, red circles correspond to the least wealth 20% of S2 cells in that city (Q1), orange (Q2), yellow (Q3), green (Q4), and blue circles correspond to the wealthiest 20% of S2 cells.
Fig. 2
Fig. 2. Geographic accessibility to the nearest public CEmOC facility in 15 cities in Nigeria by wealth quintile of S2 cells—peak vs. off-peak.
a Median travel time (MTT) to the nearest public comprehensive emergency obstetric care (CEmOC) facility during peak hours (weekday 18–20 h) and off-peak hours (weekend 01-03 h) shown as a scatter plot, with each circle corresponding to a wealth quintile in one of 15 cities in Nigeria. b Number of public CEmOC facilities reachable within 60 min during peak hours (weekday 18–20 h) and off-peak hours (weekend 01-03 h) shown as a scatter plot, with each circle corresponding to a wealth quintile in one of 15 cities in Nigeria. In both panels, red circles correspond to the least wealth 20% of S2 cells in that city (Q1), orange (Q2), yellow (Q3), green (Q4), and blue circles correspond to the wealthiest 20% of S2 cells.
Fig. 3
Fig. 3. Relative wealth index and travel time of individual S2 cells in 15 cities in Nigeria (weekday 18–20 h).
The relative wealth index (RWI) and travel time to the nearest CEmOC facility of individual S2 cells in 15 cities in Nigeria are shown as a scatter plot. Each S2 cell is represented by a circle, with the colour of the circle indicating 1. its relative wealth compared against other cells in the same city, and 2. travel time from the cell to the nearest public CEmOC facility. Purple for MTT ≤ 60 min; orange for MTT > 60 min.
Fig. 4
Fig. 4. Spatial distribution of public CEmOC and spatial distribution of relative wealth index at S2 cell level in Benin City, Kaduna, Onitsha, and Port Harcourt.
The locations of public CEmOC facilities and relative wealth index of individual S2 cells in four selected Nigerian cities (a Benin City, b Kaduna, c Port Harcourt, and d Onitsha). The locations of cells by relative wealth and median travel time (MTT ≤ 60 min or not) are also presented. Purple for MTT ≤ 60 min; orange for MTT > 60 min.
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References

    1. UNICEF, WHO, World Bank & UNPD. A neglected tragedy: the global burden of stillbirths. (United Nations Children’s Fund, New York, 2020).
    1. Paxton A, Maine D, Freedman L. The evidence for emergency obstetric care. Int. J. Gynaecol. Obstetrics. 2005;88:181–193. doi: 10.1016/j.ijgo.2004.11.026. - DOI - PubMed
    1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc. Sci. Med. 1994;38:1091–1110. doi: 10.1016/0277-9536(94)90226-7. - DOI - PubMed
    1. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med. Care. 1981;19:127–140. doi: 10.1097/00005650-198102000-00001. - DOI - PubMed
    1. Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division.(World Health Organization: Geneva, Switzerland, 2023.