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

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In Kisumu, Kenya. JOORTH is a key research and training facility in Western Kenya and is an institute for clinical training for other hospitals. Through the partnership between JOORTH and Direct Relief’s support of the referral hospital and training center in what is formerly Nyanza Province, it was realized that JOORTH was well positioned to take a lead in expanding availability of a particular obstetric treatment, that of fistula repair services, while at the same time improving quality of fistula treatment management among health providers.

The former Nyanza Province is the Western corner of Kenya that surrounds Lake Victoria, 12 districts were within the province. This was the obstetric fistula patient catchment area men from July 2010 thru June 2013. Individual women seen at JOOTRH were asked a variety questions ranging from current age, height and weight to age at menarche, distance from home location to nearest maternal facility and type of birth attendant, if any, present at the labor at which obstetric fistula developed. Medical information such as type of OF, RVF typing and route of repair is also collected. In total 40 variables are collected. As well, outcome of the surgery at 2 weeks, 1 month, 6 months, and one year are projected to be collected. All women’s home locations were geocoded using the given information on home province, district, division and location. When unable to geocode to the home location level the individual was located to the center of their home division.

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

  1. 1. Analysis of emergency obstetric care availability and obstetric fistula patients using GIS Jen Lemberger, MPH Research + Analytics Associate American Public Health Association Annual Conference, Nov. 2013
  2. 2. Direct Relief’s Partnership with JOOTRH Kisumu, Kenya - 467 bed facility - Only public facility in Western Kenya w/an ICU - Offers specialized services such as Surgery, Ophthalmology, Radiology, Oncology, etc. - Over 13,000 women receive antenatal services and ~5,000 deliveries recorded per year
  3. 3. Overarching Goals of the Collaboration -Increase number of fistula repair procedures conducted - Improving outreach and mobilization to identify women that need repair but are not coming for treatment - Collection of data related to fistula development in Nyanza Province to inform outreach and resource allocation
  4. 4. Home Locations of JOOTRH Obstetric Fistula Patients, July 2010 – June 2013
  5. 5. July 2010 – June 2011 Patient Incidence in Population Percentage of Patient Load
  6. 6. July 2011 – June 2012 Patient Incidence in Population Percentage of Patient Load
  7. 7. July 2012 – June 2013 Patient Incidence in Population Percentage of Patient Load
  8. 8. Yearly Patient Population Load as Compared to Actual Population
  9. 9. Measurement of Factors Influencing Obstetric Fistula Occurence Duration of Labor and Distance to Health Facility
  10. 10. 30km July 2010 – June 2013 Average Duration of Labor Average Distance to Health Facility
  11. 11. 30km All District + Sub-District Hospitals Average Duration of Labor Average Distance to Health Facility
  12. 12. 30km District + Sub-District Hospitals w BEOC Average Duration of Labor Average Distance to Health Facility
  13. 13. 30km District + Sub-District Hospitals w CEOC Average Duration of Labor Average Distance to Health Facility
  14. 14. 30km Percentage of Patients w/o BEOC Access Percentage of Patients w/o CEOC Access Access to BEOC and CEOC Services
  15. 15. 30km Percentage of Patients w/o BEOC Access Percentage of Patients Reporting Health Facility at Least 10km Distance Health Facility Access, Measured vs Reported
  16. 16. Population Density and Locations of Hospitals with Basic Emergency Obstetric Care (BEOC) 30km
  17. 17. WHAT DO WE KNOW? -There are geographic differences in the distribution of women seeking care at JOOTRH for obstetric fistula that are not entirely related to population density. Outreach campaigns seem to show success in affecting this distribution. -There is spatial clustering of obstetric fistula patients that reside outside a reasonable distance from facilities with BEOC and particularly CEOC. - Facilities with BEOC and CEOC are not evenly distributed in the districts in relation to JOOTRH obstetric fistula patients’ home locations. WHERE DO WE GO? -Continuation of collection of comprehensive patient information to help better understand home location versus possible temporary location reporting. - The biggest delay to care is still at the community level based on beliefs and compounded by issues of transport, JOOTRH should continue to conduct further outreach, mobilization and training in identified areas of low access to emergency obstetric care.
  18. 18. Thank you Jen Lemberger, MPH jlemberger@directrelief.org www.directrelief.org

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