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ORIGINAL ARTICLE
Open Access

Did Saving Mothers, Giving Life Expand Timely Access to Lifesaving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care

Michelle M. Schmitz, Florina Serbanescu, Vincent Kamara, Joan Marie Kraft, Marc Cunningham, Gregory Opio, Patrick Komakech, Claudia Morrissey Conlon and Mary M. Goodwin on behalf of the Saving Mothers, Giving Life Working Group
Global Health: Science and Practice March 2019, 7(Supplement 1):S151-S167; https://doi.org/10.9745/GHSP-D-18-00366
Michelle M. Schmitz
aDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Florina Serbanescu
aDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • For correspondence: fxs7@cdc.gov
Vincent Kamara
bBaylor College of Medicine Children's Foundation–Uganda, Kampala, Uganda.
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Joan Marie Kraft
aDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Marc Cunningham
cBureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
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Gregory Opio
dInfectious Diseases Institute, Makerere University, Kibaale, Uganda.
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Patrick Komakech
eDivision of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Kampala, Uganda.
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Claudia Morrissey Conlon
cBureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
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Mary M. Goodwin
aDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Figures & Tables

Figures

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  • FIGURE 1
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    FIGURE 1

    Visual Representation of Data Sources Used in Health Care Accessibility Modeling Analysis

    Abbreviation: WRA, women of reproductive age.

  • FIGURE 2
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    FIGURE 2

    Percentage of Women of Reproductive Age Living Within 2 Hours of CEmONC Facilities by Motorized Transportation and SMGL District

    Abbreviations: CEmONC, comprehensive emergency obstetric and newborn care; SMGL, Saving Mothers, Giving Life.

  • FIGURE 3
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    FIGURE 3

    Distribution of Estimated Travel Time to EmONC Facilities, Walking or Bicycling and Walking

    Abbreviation: EmONC, emergency obstetric and newborn care.

  • FIGURE 4
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    FIGURE 4

    Distribution of Estimated Travel Time to CEmONC Facilities, Walking or Bicycling and Walking

    Abbreviation: CEmONC, comprehensive emergency obstetric and newborn care.

  • FIGURE 5
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    FIGURE 5

    Distribution of Estimated Travel Time to EmONC Facilities Using Motorized Transportationa

    a Transportation defined as motorcycles or 4-wheeled vehicles.

    Abbreviation: EmONC, emergency obstetric and newborn care.

  • FIGURE 6
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    FIGURE 6

    Distribution of Estimated Travel Time to CEmONC Facilities Using Motorized Transportationa

    a Transportation defined as motorcycles or 4-wheeled vehicles.

    Abbreviation: CEmONC, comprehensive emergency obstetric and newborn care.

Tables

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    TABLE 1.

    Demographic Factors, SMGL-Supported Districts in Uganda, 2016

    DistrictTotal Population, 2016aNumber of WRA, 2016aPopulation Density (People/km2)bUrbanization Level (% Urban)b
    Kabarole456,052121,79425926.0
    Kamwenge392,501101,6501775.5
    Kibaale818,176206,5961857.9
    Kyenjojo428,451108,66617915.4
    Total2,095,180538,70617321.3
    • Abbreviations: km2, kilometers squared; SMGL, Saving Mothers, Giving Life; WRA, women of reproductive age.

    • ↵a Estimated from SMGL Reproductive Age Mortality Study, 2017.19

    • ↵b 2014 National Census Main Report, Uganda Bureau of Statistics.33

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    TABLE 2.

    Recommended and Observed Number of EmONCa and CEmONC Facilities per Capita in SMGL-Supported Districts at Baseline (2012), Phase 1 (2013), and Endline (2016)

    BaselinePhase 1Endline
    PopulationaRecommended EmONCb,cObserved EmONCc,dObserved CEmONCc,ePopulationaRecommended EmONCb,cObserved EmONCc,dObserved CEmONCc,ePopulationfRecommended EmONCb,cObserved EmONCdObserved CEmONCc,e
    Kabarole415,600533421,700586456,052586
    Kibaale681,300733717,500855818,176975
    Kamwenge332,000430339,500452392,501433
    Kyenjojo383,600411397,700473428,451583
    Total1,812,500201071,876,4002125162,095,180232617
    • Abbreviations: CEmONC, comprehensive emergency obstetric and neonatal care; EmONC, emergency obstetric and neonatal care; RAMOS, Reproductive Age Mortality Study; SMGL, Saving Mothers, Giving Life; WHO, World Health Organization.

    • ↵a Estimated from SMGL RAMOS 2013.19

    • ↵b EmONC encompasses facilities performing at least 7 lifesaving interventions within the past 3 months. CEmONC indicates those facilities providing 9 lifesaving interventions in the past 3 months.

    • ↵c Uses the WHO minimum-recommended number of EmONC and CEmONC per 500,000 population (5 EmONC, including at least 1 CEmONC, per 500,000).

    • ↵d Observed EmONC includes facilities that may not have provided assisted vaginal delivery in the past 3 months.

    • ↵e Observed CEmONC includes facilities that may not have provided assisted vaginal delivery in the past 3 months; a few facilities reported shortage of blood in Phase 1 in the previous 3 months but were still classified as CEmONC facilities.

    • ↵f Estimated from SMGL RAMOS 2017.19

    • Source: SMGL Uganda Health Facility Assessments, 2012, 2013, and 2016.

    • View popup
    TABLE 3.

    Estimated Proportion of WRA Within Each Travel-Time Zone in SMGL-Supported Districts in Uganda (2012–2016), by Transportation Mode

    Transportation ModeaEmONC FacilitiesCEmONC Facilities
    Baseline, 2012 (%)Phase 1,2013 (%)Endline, 2016 (%)% ChangebSig.LevelcBaseline, 2012 (%)Phase 1, 2013 (%)Endline, 2016 (%)% ChangebSig.Levelc
    Walking, minutes
    0–301.42.42.6+88***1.21.91.9+55***
    31–601.53.53.5+131***1.42.42.7+96***
    61–902.04.04.4+124***1.73.03.1+89***
    91–1201.84.34.5+152***1.53.23.3+118***
    ≤1206.714.215.0+125***5.810.511.1+91***
    >12093.385.885.0−9***94.289.588.9−6***
    Bicycle, minutes
    0–303.76.36.5+77***3.44.85.0+45***
    31–604.08.68.5+113***3.56.66.8+96***
    61–904.810.411.0+129***3.67.77.9+118***
    91–1205.410.811.6+115***3.89.29.4+150***
    ≤12017.936.037.6+110***14.328.229.1+103***
    >12082.164.062.4−24***85.771.870.9−17***
    Motorcycle, minutes
    0–3011.621.321.9+89***10.616.917.2+62***
    31–6015.722.322.5+44***12.222.323.2+91***
    61–9019.716.816.8−15***15.717.617.7+13***
    91–12014.310.710.9−24***12.712.011.7−7***
    ≤12061.371.272.1+18***51.168.769.8+37***
    >12038.728.827.9−28***48.931.330.2−38***
    4-wheeled vehicles, minutes
    0–3013.724.725.4+85***12.320.220.6+68***
    31–6019.423.523.2+20***15.824.125.2+60***
    61–9020.115.115.4−23***15.816.315.9+1NS
    91–12011.910.210.2−15***11.410.710.6−7***
    ≤12065.173.474.1+14***55.271.372.3+31***
    >12034.926.625.9−26***44.828.727.7−38***
    • Abbreviations: CEmONC, comprehensive emergency obstetric and newborn care; EmONC, emergency obstetric and newborn care; SMGL, Saving Mothers, Giving Life; Sig. level, Significance level; WRA, women of reproductive age.

    • ↵a Walking mode includes walking alone. Bicycle mode includes walking to a road and use of a bicycle. Motorized transportation modes (motorcycle, 4-wheeled vehicles) include walking to the road and use of a motorized transportation thereafter.

    • ↵b Relative % change (% change) is calculated by the formula, ((p2-p1)/p1)*100.

    • ↵c Asterisks indicate significance level of the % change between baseline and endline, calculated using z scores: *** P<.01, ** P<.05, NS = not significant.

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Global Health: Science and Practice: 7 (Supplement 1)
Global Health: Science and Practice
Vol. 7, No. Supplement 1
March 11, 2019
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Did Saving Mothers, Giving Life Expand Timely Access to Lifesaving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care
Michelle M. Schmitz, Florina Serbanescu, Vincent Kamara, Joan Marie Kraft, Marc Cunningham, Gregory Opio, Patrick Komakech, Claudia Morrissey Conlon, Mary M. Goodwin
Global Health: Science and Practice Mar 2019, 7 (Supplement 1) S151-S167; DOI: 10.9745/GHSP-D-18-00366

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Did Saving Mothers, Giving Life Expand Timely Access to Lifesaving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care
Michelle M. Schmitz, Florina Serbanescu, Vincent Kamara, Joan Marie Kraft, Marc Cunningham, Gregory Opio, Patrick Komakech, Claudia Morrissey Conlon, Mary M. Goodwin
Global Health: Science and Practice Mar 2019, 7 (Supplement 1) S151-S167; DOI: 10.9745/GHSP-D-18-00366
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