Seasonal variation access to maternal health services at primary health care facilities (PHCs) in the CLIP study area in Mozambique. 49% of reproductive age women live within 1 hr walking time to PHCs in the dry season and this drops to 31% in the wet season, due to disruption of traffic infrastructure by rainfall and flooding
The Mapping Outcomes for Mothers (MOM) project utilises geographic methods to describe the contextual factors that elevate risk for adverse maternal outcomes. Underpinned by the social determinants of health framework, maternal risk is evaluated in four dimensions: maternal characteristics, health systems and services factors, socio-economic and environmental determinants.
The goal of MOM is to elucidate the geographical influences that are related to adverse maternal outcomes. The project creates an integrated picture of local maternal health risk, using Geographical Information Systems (GIS) a uniquely integrative mix of hardware, software and analyses that enable spatial epidemiology, or the geo-visualization of the distribution and determinants of health phenomena. We envision that our work contributes towards achieving a more precise public health approach and will allow policy makers to take targeted and individualised action at the community level to improve maternal health.
Much of the recent progress is reflected in the publications that have been produced to date. The project, in collaboration with the Mozambique National Mapping Agency, has developed a set of guidelines that address some of the challenges around accessing good quality framework for Geographical Information Systems (GIS) data. This work highlights the importance of manual digitalisation in generating meaningful spatial analyses in a typical data poor setting.
Using these data, we developed a novel method for modeling geographical access to maternal health services. Access to care is a known determinant for adverse maternal outcomes and in our study region of southern Mozambique, perennial floods are known to isolate communities from health facilities. The same data were used to identify the place specific factors associated with adverse maternal outcomes in Mozambique.
As part of our broader policy outreach goal, the core lessons learned from MOM were also shared with the First Nations Health Authority in British Columbia, Canada. This engagement is part of initiating a conversation on ‘reverse innovation’ - how experiences from resource-poor settings can be translated to solve problems in high resource settings. Our work has informed discussion on addressing poor access to maternal health services and high rates of maternal mortality in isolated First Nations communities in northern British Columbia. MOM is also contributing to global maternal health policy through its representative who is a steering committee member of USAID’s technical committee on mapping and reporting maternal deaths.
We are currently using data from the CLIP trials to describe the spatial epidemiology of adverse maternal outcomes in the CLIP study areas. GIS is also being used to chart progress and impact of the trials across the axes of time and space in the same areas. MOM is also using the trial data to explore if women who had similar POM characteristics went on to experience different outcomes, and the extent to which geography could explain these differences. This is a first step towards integrating geography with the other mobile tools used in CLIP.
Firoz, T., Makanga, P. T., Nathan, H. L., Payne, B., & Magee, L. A. (2017). Reverse innovation in maternal health. Obstetric Medicine, 1753495X17700515.
Makanga, P. T., Schuurman, N., Sacoor, C., Boene, H. E., Vilanculo, F., Vidler, M., … Firoz, T. (2017). Seasonal variation in geographical access to maternal health services in regions of southern Mozambique. International Journal of Health Geographics, 16(1), 1.
Molla, Y. B., Rawlins, B., Makanga, P. T., Cunningham, M., Ávila, J. E. H., Ruktanonchai, C. W., … Matthews, Z. (2017). Geographic information system for improving maternal and newborn health: recommendations for policy and programs. BMC Pregnancy and Childbirth, 17(1), 26.
Firoz, T., Vidler, M., Makanga, P. T., Boene, H., Chiaú, R., Sevene, E., … Munguambe, K. (2016). Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study. Reproductive Health, 13(2), 123–131.Makanga PT, Schuurman N, Sacoor C, Boene H, von Dadelszen P, Firoz T. Guidelines for creating framework data for GIS analysis in low‐and middle‐income countries. The Canadian Geographer/Le Géographe Canadien. 2016 Sep 1;60(3):320-32.
- Makanga PT, Schuurman N, von Dadelszen P, Firoz T. A scoping review of geographic information systems in maternal health. International Journal of Gynecology & Obstetrics. 2016 Apr 1.