Geographical accessibility to emergency obstetric care in urban Nigeria using closer-to-reality travel time estimates
Abstract
Background
Better accessibility of emergency obstetric care (CEmOC) facilities can significantly reduce maternal and perinatal deaths. However, pregnant women living in urban settings face additional complex challenges travelling to facilities. We estimated geographical accessibility and coverage to the nearest, second nearest, and third nearest public and private CEmOC facilities in the 15 largest Nigerian cities.
Methods
We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assembled population distribution for women of childbearing age (WoCBA). We used Google Maps Platform’s internal Directions Application Programming Interface (API) to derive driving times to public, private, or either facility-type. Median travel time (MTT) and percentage of WoCBA able to reach care were summarised for eight traffic scenarios (peak and non-peak hours on weekdays and weekends) by city and within-city (wards) under different travel time thresholds (<15, <30, <60 min).
Findings
City-level MTT to the nearest CEmOC facility ranged from 18min (Maiduguri) to 46min (Kaduna). Within cities, MTT varied by location, with informal settlements and peripheral areas being the worst off. The percentages of WoCBA within 60min to their nearest public CEmOC were nearly universal; whilst the percentages of WoCBA within 30min reach to their nearest public CEmOC were between 33% in Aba to over 95% in Ilorin and Maiduguri. During peak traffic times, the median number of public CEmOC facilities reachable by WoCBA under 30min was zero in eight of 15 cities.
Interpretation
This approach provides more context-specific, finer, and policy-relevant evidence to support improving CEmOC service accessibility in urban Africa.
Better accessibility of emergency obstetric care (CEmOC) facilities can significantly reduce maternal and perinatal deaths. However, pregnant women living in urban settings face additional complex challenges travelling to facilities. We estimated geographical accessibility and coverage to the nearest, second nearest, and third nearest public and private CEmOC facilities in the 15 largest Nigerian cities.
Methods
We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assembled population distribution for women of childbearing age (WoCBA). We used Google Maps Platform’s internal Directions Application Programming Interface (API) to derive driving times to public, private, or either facility-type. Median travel time (MTT) and percentage of WoCBA able to reach care were summarised for eight traffic scenarios (peak and non-peak hours on weekdays and weekends) by city and within-city (wards) under different travel time thresholds (<15, <30, <60 min).
Findings
City-level MTT to the nearest CEmOC facility ranged from 18min (Maiduguri) to 46min (Kaduna). Within cities, MTT varied by location, with informal settlements and peripheral areas being the worst off. The percentages of WoCBA within 60min to their nearest public CEmOC were nearly universal; whilst the percentages of WoCBA within 30min reach to their nearest public CEmOC were between 33% in Aba to over 95% in Ilorin and Maiduguri. During peak traffic times, the median number of public CEmOC facilities reachable by WoCBA under 30min was zero in eight of 15 cities.
Interpretation
This approach provides more context-specific, finer, and policy-relevant evidence to support improving CEmOC service accessibility in urban Africa.
Research Areas
