Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Login to get access

Abstract

Background

Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh.

Methods

A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors.

Results

Increasing travel time to the nearest EmOC facility is found to act as a strong deterrent to seeking care for the urban poor in Sylhet. Logistic regression results indicate that a 5-min increase in travel time to the nearest EmOC facility is associated with a 30 % decrease (0.655 odds ratio, 95 % CI: 0.529–0.811) in the likelihood of delivery at an EmOC facility rather than at home. Moreover, the impact of travel time varies substantially between public, NGO and private facilities. A 5-min increase in travel time from a private EmOC facility is associated with a 32.9 % decrease in the likelihood of delivering at a private facility, while for public and Non-Government Organizations (NGO) EmOC facilities, the impact is lower (28.2 and 28.6 % decrease respectively). Other strong determinants of delivery at an EmOC facility are the use of antenatal care and mother’s formal education, while Muslim mothers are found to be more likely to deliver at home.

Conclusions

Geospatial evidence points to the need to strengthen referral and emergency transport systems in order to reduce urban travel time, and establish or relocate EmOC facilities closer to where the poor reside. However, female education and antenatal care coverage remain the most important determinants of facility delivery.
Footnotes
1
Variable ‘mother’s age’ is not included as covariate of the binomial logistic regression (Table 2) on grounds of posing a collinearity problem (based on collinearity diagnostics). However, this poses no loss of information since the parameter was found insignificant in the statistical analysis.
 
2
Due to collinearity problem affecting model convergence, variable ‘antenatal care usage’ could not be included in multinomial regression model (Table 4). All other covariates, however, were included.
 
Literature
1.
2.
National Institute of Population Research and Training (NIPORT) ME, icddr,b. Bangladesh maternal mortality and health care survey 2010. Dhaka: National Institute of Population Research and Training (NIPORT) ME, icddr,b; 2012.
3.
4.
5.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF International. Bangladesh demographic and health survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA: NIPORT, Mitra and Associates, and ICF International; 2013.
6.
Government of Bangladesh, Implementation Monitoring and Evaluation Division, Ministry of Planning. End-line Evaluation of Health, Nutrition and Population Sector Programme (HNPSP). Bangladesh: Government of Bangladesh, Implementation Monitoring and Evaluation Division, Ministry of Planning; 2011.
7.
8.
Rahman SA, Parkhurst J, Normand C. Maternal health review. Dhaka: Policy Research Unit, Ministry of Health and Family Welfare; 2003.
9.
Banu M, Akter M, Begum K, Choudhury R, Nasreen H. ‘The clock keeps ticking’ – the role of a community-based intervention in reducing delays in seeking emergency obstetric care in rural Bangladesh: a quasi-experimental study. Public Health. 2014;128(4):332–40.CrossRefPubMed
10.
Barnes-Josiah D, Myntti C, Augustin A. The “three delays” as a framework for examining maternal mortality in Haiti. Soc Sci Med. 1998;46(8):981–93.CrossRefPubMed
11.
12.
Islam M, Hossain M, Islam M, Haque Y. Improvement of coverage and utilization of EmOC services in southwestern Bangladesh. Int J Gynecol Obstet. 2005;91(3):298–305.CrossRef
13.
14.
Parkhurst J, Rahman S. Non-professional health practitioners and referrals to facilities: lessons from maternal care in Bangladesh. Health Policy Plan. 2007;22(3):149–55.CrossRefPubMed
15.
Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007;85(10):812–9.CrossRefPubMedPubMedCentral
16.
National Institute of Population Research and Training (NIPORT) MEASURE Evaluation, UNC-Chapel Hill, USA and icddr, b. Bangladesh Urban Health Survey 2013: Preliminary Resulys. Bangladesh: Dhaka; 2014.
17.
Banu M, Nahar S, Nasreen H. Assessing the MANOSHI referral system - addressing delays in seeking emergency obstetric care in Dhaka’s slums. In: ICDDR B, BRAC, editor. Manoshi-WP102010. 2010. p. 1–36.
18.
19.
20.
Gabrysch S. The influences of distance on health facility delivery in rural Zambia. PhD thesis, London School of Hygiene & Tropical Medicine. 2010. DOI:10.​17037/​PUBS.​00768499.
21.
Nahar S, Banu M, Nasreen HE. Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study. BMC Pregnancy Childbirth. 2011. doi:10.​1186/​1471-2393-11-11.
22.
Amooti-Kaguna B, Nuwaha F. Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med. 2000;50(2):203–13.CrossRefPubMed
23.
24.
25.
Mwaliko E, Downing R, O’Meara W, Chelagat D, Obala A, Downing T, et al. “Not too far to walk”: the influence of distance on place of delivery in a western Kenya health demographic surveillance system. BMC Health Serv Res. 2014. doi:10.​1186/​1472-6963-14-212.PubMedPubMedCentral
26.
Scott S, Chowdhury M, Pambudi ES, Qomariyah S, Ronsmans C. Maternal mortality, birth with a health professional and distance to obstetric care in Indonesia and Bangladesh. Trop Med Int Health. 2013;18(10):1193–201.CrossRefPubMed
27.
Yanagisawa S, Oum S, Wakai S. Determinants of skilled birth attendance in rural Cambodia. Trop Med Int Health. 2006;11(2):238–51.CrossRefPubMed
28.
29.
Duong D, Binns C, Lee A. Utilization of delivery services at the primary health care level in rural Vietnam. Soc Sci Med. 2004;59(12):2585–95.CrossRefPubMed
30.
Paul B, Rumsey D. Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study. Soc Sci Med. 2002;54(12):1755–65.CrossRefPubMed
31.
Griffiths P, Stephenson R. Understanding users’ perspectives of barriers to maternal health care use in Maharashtra, India. J Biosoc Sci. 2001;33(3):339–59.CrossRefPubMed
32.
Pebley A, Goldman N, Rodriguez G. Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter? Demography. 1996;33(2):231–47.CrossRefPubMed
33.
Potter J. Utilizacion de los servicios de salud materna en el Mexico rural [Use of maternal health services in rural Mexico]. Salud Publica Mex. 1988;30(3):387–402.PubMed
34.
Karkee R, Binns C, Lee A. Determinants of facility delivery after implementation of safer mother programme in Nepal: a prospective cohort study. BMC Pregnancy Childbirth. 2013;13(193). doi:10.​1186/​1471-2393-13-193.
35.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRefPubMed
36.
Anson O. Utilization of maternal care in rural HeBei Province, the People’s Republic of China: individual and structural characteristics. Health Policy. 2004;70(2):197–206.CrossRefPubMed
37.
Hounton S, Chapman G, Menten J, De Brouwere V, Ensor T, Sombié I, Meda N, Ronsmans C. Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso. Trop Med Int Health. 2008;13 Suppl 1:44–52.CrossRefPubMed
38.
Okwaraji Y, Edmond K. Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2015. doi:10.​1136/​bmjopen-2012-001196.
39.
40.
Simões P, Moritz R, Almeida V. Maternal mortality and accessibility to health services by means of transit-network estimated traveled distances. Matern Child Health J. 2014;18(6):1506–11.CrossRefPubMed
41.
42.
Rushton G. Public health, GIS, and spatial analytic tools. Annu Rev Public Health. 2003;24:43–56.CrossRefPubMed
43.
World Health Organization, UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care: A Handbook. Geneva: World Health Organization, UNFPA, UNICEF, AMDD; 2009.
44.
Chowdhury M, Roy L, Biswas T, Rahman M, Akther S, Al-Sabir A. needs assessment study for emergency obstetric and newborn care (EmONC) services in 24 districts of Bangladesh. Dhaka: International Centre for Diarrhoeal Disease Research, Bangladesh; 2014.
45.
Higgs G. A literature review of the use of GIS-based measures of access to health care services. Health Serv Outcomes Res Methodol. 2004;5:119–39.CrossRef
46.
47.
48.
Banik B, Chowdhury M, Sarkar M. Study of the Traffic congestion in Sylhet City. J Ind Roads Congress. 2009;70(1):75–86.
49.
Rogers WH. Regression standard errors in clustered samples. Stata Technical Bulletin 13:19–23. Reprinted Stata Tech Bull Reprints. 1993;3:88–94.
50.
Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics. 2000;56(2):645–6.CrossRefPubMed
51.
Huber PJ. The behavior of maximum likelihood estimates under nonstandard conditions. In: Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, vol. 1. Berkeley: University of California Press; 1967. p. 221–33.
52.
Addai I. Determinants of use of maternal-child health servicesin rural Ghana. J Biosoc Sci. 2000;32(1):1–15.PubMed
53.
Gyimah S, Takyi B, Addai I. Challenges to the reproductive health needs of African women: on religion and maternal health utilization in Ghana. Soc Sci Med. 2006;62(12):2930–44.CrossRefPubMed
54.
Burgard S. Race and pregnancy-related care in Brazil and South Africa. Soc Sci Med. 2004;59(6):1127–46.CrossRefPubMed
55.
Magadi M, Diamond I, Rodrigues R. The determinants of delivery care in Kenya. Soc Biol. 2000;47(3–4):164–88.PubMed
56.
Raghupathy S. Education and the use of maternal health care in Thailand. Soc Sci Med. 1996;43(4):459–71.CrossRefPubMed
57.
Hossain J, Ross S. The effect of addressing demand for as well as supply of emergency obstetric care in Dinajpur, Bangladesh. Int J Gynecol Obstet. 2006;92(3):320–8.CrossRef
Metadata
Title
The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study
Publication date
01-12-2016
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1032-7

Other articles of this Issue 1/2016

BMC Pregnancy and Childbirth 1/2016 Go to the issue

Research article

Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis

Research article

Nutrient intakes and nutritional biomarkers in pregnant adolescents: a systematic review of studies in developed countries

Research article

An interview study of pregnant women who were provided with indoor air quality measurements of second hand smoke to help them quit smoking

Research article

Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study

Study protocol

AURORA: bariatric surgery registration in women of reproductive age - a multicenter prospective cohort study

Research article

Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies