Analysis of emergency obstetric care availability and obstetric fistula patients using GIS

Background: Direct Relief and Nyanza Provincial General Hospital (NPGH) in Kisumu, Kenya, are working on a long term project looking at obstetric fistula (OF) patients receiving care. Obstetric fistula is associated with prolonged labor, in turn prolonged labor is associated with lack of access to emergency obstetric care (EmOC). To explore this relationship Geographic Information System (GIS) was used to examine home locations of individuals receiving obstetric fistula repair at NPGH and their distance to health facilities. Purpose: Place is an integral component of accessing and receiving care. This project is an example of using GIS to investigate access to care and possible birth outcomes. Methodology: Information on home location for women seeking obstetric fistula repair at NPGH was used to map the patient population to the sub-district level using GIS. These locations were plotted against known district and sub-district hospitals that reported providing basic and comprehensive EmOC. Buffers of 10km around the hospitals were used to identify clusters of obstetric fistula patients in areas without access to EmOC. Results: Access to EmOC was different across districts and clusters of patients without access to appropriate care were identified. Though hospitals may exist in proximity to populations the availability of EmOC is not uniform across facilities and thus leaves populations of women without access to needed care. Conclusion: EmOC services amongst hospitals in Nyanza Province are not distributed uniformly and thus leave pockets of women without needed care during delivery. This contributes to a disproportionate burden in areas of the province. GIS can aid in identifying geographic areas that lack access to particular services. This analysis allows NPGH to understand where their obstetric fistula patient population comes from. In the absence of expanded services NPGH can conduct targeted outreach campaigns in areas of patient clusters lacking in EmOC services.