Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh
Posted on 2019-07-16 - 05:00
Abstract Background A spatial and temporal study of the distribution of facility-based deliveries can identify areas of low and high facility usage and help devise more targeted interventions to improve delivery outcomes. Developing countries like Bangladesh face considerable challenges in reducing the maternal mortality ratio to the targets set by the Sustainable Development Goals. Recent studies have already identified that the progress of reducing maternal mortality has stalled. Giving birth in a health facility is one way to reduce maternal mortality. Methods Facility delivery data from a demographic surveillance site was analyzed at both village and Bari (comprising several households with same paternal origins) level to understand spatial and temporal heterogeneity. Global spatial autocorrelation was detected using Moranâs I index while local spatial clusters were detected using the local Getis Gi* statistics. In addition, space-time scanning using a discrete Poisson approach facilitated the identification of space-time clusters. The likelihood of delivering at a facility when located inside a cluster was calculated using log-likelihood ratios. Results The three cluster detection approaches detected significant spatial and temporal heterogeneity in the distribution of facility deliveries in the study area. The hot and cold spots indicated contiguous and relocation type diffusion and increased in number over the years. Space-time scanning revealed that when a parturient woman is located in a Bari inside the cluster, the likelihood of delivering at a health facility increases by twenty-seven times. Conclusions Spatiotemporal studies to understand delivery patterns are quite rare. However, in resource constraint countries like Bangladesh, detecting hot and cold spot areas can aid in the detection of diffusion centers, which can be targeted to expand regions with high facility deliveries. Places and periods with reduced health facility usages can be identified using various cluster detection techniques, to assess the barriers and facilitators in promoting health facility deliveries.
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Chowdhury, Atique; Abdullah, Abu; Haider, Rafiqul; Alam, Asraful; Billah, Sk; Bari, Sanwarul; et al. (2019). Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4579205.v1
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AUTHORS (10)
AC
Atique Chowdhury
AA
Abu Abdullah
RH
Rafiqul Haider
AA
Asraful Alam
SB
Sk Billah
SB
Sanwarul Bari
QR
Qazi Rahman
WJ
Warren Jochem
AD
Ashraf Dewan
SA
Shams Arifeen