GIS for Obstetric Fistula Outreach and Advocacy
•Download as PPTX, PDF•
0 likes•391 views
Obstetric fistula is a condition for which there is a significant gap in information on prevalence, incidence, outcomes, and service provision. These gaps impair identification, treatment, and care by limiting understanding on the part of donor agencies, advocates, NGOs, and health providers. While overall data on fistula needs to be gathered, it is important to connect this information to geography (home location, service location, etc.) to allow for better program planning, resource allocation, and advocacy. In this presentation Direct Relief (DR) will describe two projects conducted using location information, one global and one regional, to aid in these areas. 1) Direct Relief (DR), The Fistula Foundation (FF), and UNFPA formed a partnership to visualize facilities at which fistula services are provided. While not providing prevalence estimates, it is possible to collect information on the provision of services. The Global Fistula Map displays locations of facilities with the number of surgeries conducted, capacity information, and other program details. The map is an evolving project updated through surveys and 'informed crowdsourcing' that can provide advocates and policymakers with data regarding services as well as a visual tool to help tell the breadth of the obstetric fistula story. 2) Together with Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, Kenya, DR is working on a long term project looking at profiles of fistula patients receiving care. The project uses ArcGIS to map patient's home locations, district hospitals, and sub-district hospitals. This analysis allows JOOTRH to understand where their fistula patient population comes from. This has enabled JOOTRH to conduct targeted outreach campaigns in areas of patient clusters lacking in EmOC services and/or in areas of suspected prevalence, but where a lack of patients came from. This information can also be used by officials in infrastructure and personnel planning.
Recommended
Recommended
More Related Content
Similar to GIS for Obstetric Fistula Outreach and Advocacy
Similar to GIS for Obstetric Fistula Outreach and Advocacy (20)
Recently uploaded
Recently uploaded (20)
GIS for Obstetric Fistula Outreach and Advocacy
- 1. Location, Location, Location HOW GIS CAN CONTRIBUTE TO OUTREACH AND ADVOCACY FOR OBSTETRIC FISTULA American Public Health Association Annual Conference, Nov. 2015
- 2. Presenter Disclosers Jen Lemberger No relationships to disclose.
- 4. Direct Relief and JOOTRH PATIENT LEVEL DATA TO INFORM OUTREACH AND HEALTH POLICY CHANGE
- 5. -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 Home Locations of JOOTRH Obstetric Fistula Patients, July 2010 – June 2013 Goals of the JOOTRH and Direct Relief Collaboration
- 6. Patient Incidence to Inform Outreach
- 7. Patient Incidence to Inform Outreach July 2010 – June 2011
- 8. Patient Incidence to Inform Outreach July 2010 – June 2011 July 2011 – June 2012
- 9. Patient Incidence to Inform Outreach July 2010 – June 2011 July 2011 – June 2012 July 2012 – June 2013
- 10. Mapping Access: BEOC + CEOC
- 11. 30km Mapping Access: BEOC + CEOC
- 12. 30km Mapping Access: BEOC + CEOC
- 13. The Global Fistula Map PARTNERSHIPS TO IDENTIFY POINTS OF ACCESS AND BUILD A HUMANITARIAN KNOWLEDGE PLATFORM
- 16. Cross-Cutting Partnerships - Contact building - Funding www.globalfistulamap.org
- 17. Cross-Cutting Partnerships - Contact building - Funding - Facility leverage www.globalfistulamap.org
- 18. Cross-Cutting Partnerships - Contact building - Funding - Facility leverage - Knowledge consolidation www.globalfistulamap.org
- 19. Building a Humanitarian Knowledge Platform - EXPLORABLE - EXPORTABLE - CONTEXTUAL
- 20. Building a Humanitarian Knowledge Platform - EXPLORABLE: what is important to the user www.globalfistulamap.org
- 21. Building a Humanitarian Knowledge Platform - EXPORTABLE: open data, this isn't just ours www.globalfistulamap.org
- 22. Building a Humanitarian Knowledge Platform - EXPORTABLE: open data, this isn't just ours www.globalfistulamap.org
- 23. Building a Humanitarian Knowledge Platform - CONTEXTUAL: related variables to give the data even greater meaning www.globalfistulamap.org
- 24. Building a Humanitarian Knowledge Platform - CONTEXTUAL: related variables to give the data even greater meaning www.globalfistulamap.org
- 25. Mobilizing the Community and Resources - Instant user feedback : • additional facilities • facility data • verification of info - Allows for data flow into same space, thus enabling all to see same picture - Evolving platform for treatment data, research, and advocacy - Exemplifies role knowledge plays in solving problems
- 26. Thank You Jen Lemberger, MPH jmxlemberger@outlook.com, @lemintheworld Andrew Schroeder – aschroeder@directrelief.org
Editor's Notes
- Since 1948, Direct Relief has supported local healthcare on a global scale. Direct Relief’s medical assistance programs equip health professionals working in resource-poor communities to better meet the challenges of diagnosing, treating, and caring for individuals and communities. People who can rely on a strong healthcare system have a better chance to survive, become healthy, and realize their inherent human potential. It is with these in mind that we began a partnership with JOORTH, formerly Nyanza Provincial General Hospital…
- …in Kisumu, Kenya. JOORTH is a key research and training facility in Western Kenya and is an institute for clinical training for other hospitals. Over 13,000 women receive antenatal services and ~5,000 deliveries recorded per year 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.
- What was formerly Nyanza Province is the Western corner of Kenya that surrounds Lake Victoria, there are now 6 counties that make up the area. Obstetric fistula patient catchment area, 369 women from July 2010 through June 2013, some during focused camps. Individual women seen at JOORTH 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. Of the 369 women, 360 women’s home locations were geocoded using the given information on home province, district, division and location. 269 women were geolocated to a precision expected to be within 10 km of their precise home location. When unable to geocode to the home location level the individual was located to the center of the lowest geographic area able to be verified. Most from within the former Nyanza Province, but surrounding area and Uganda also represented.
- Red = Less than 1 per 100,000 Less than 2 Less than 3 3+ per 100,000 2010-2011 = 127 women, 26% - Homa, 33, 23% - Kisumu, 29, 19% - Siaya, 24 2011-2012 = 100 women, 20% - Homa, 20, 35% - Kisumu, 35, 23% - Siaya, 23 2012-2013 = 92 women, 33% - Homa 30, 17% - Kisumu, 16, 30% - Siaya, 28 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. Continuation of collection of comprehensive patient information to help better understand home location versus possible temporary location reporting. Chose to use only 15 of the districts from which women came as the others the number of women was too low (less than 8 patients) to draw supportable conclusions from. This is where only the 269 (74.72% of total) women whose home locations identified to a precision within 10km were used for analysis.
- Red = Less than 1 per 100,000 Less than 2 Less than 3 3+ per 100,000 2010-2011 = 127 women, 26% - Homa, 33, 23% - Kisumu, 29, 19% - Siaya, 24 2011-2012 = 100 women, 20% - Homa, 20, 35% - Kisumu, 35, 23% - Siaya, 23 2012-2013 = 92 women, 33% - Homa 30, 17% - Kisumu, 16, 30% - Siaya, 28 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. Continuation of collection of comprehensive patient information to help better understand home location versus possible temporary location reporting. Chose to use only 15 of the districts from which women came as the others the number of women was too low (less than 8 patients) to draw supportable conclusions from. This is where only the 269 (74.72% of total) women whose home locations identified to a precision within 10km were used for analysis.
- Red = Less than 1 per 100,000 Less than 2 Less than 3 3+ per 100,000 2010-2011 = 127 women, 26% - Homa, 33, 23% - Kisumu, 29, 19% - Siaya, 24 2011-2012 = 100 women, 20% - Homa, 20, 35% - Kisumu, 35, 23% - Siaya, 23 2012-2013 = 92 women, 33% - Homa 30, 17% - Kisumu, 16, 30% - Siaya, 28 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. Continuation of collection of comprehensive patient information to help better understand home location versus possible temporary location reporting. Chose to use only 15 of the districts from which women came as the others the number of women was too low (less than 8 patients) to draw supportable conclusions from. This is where only the 269 (74.72% of total) women whose home locations identified to a precision within 10km were used for analysis.
- Red = Less than 1 per 100,000 Less than 2 Less than 3 3+ per 100,000 2010-2011 = 127 women, 26% - Homa, 33, 23% - Kisumu, 29, 19% - Siaya, 24 2011-2012 = 100 women, 20% - Homa, 20, 35% - Kisumu, 35, 23% - Siaya, 23 2012-2013 = 92 women, 33% - Homa 30, 17% - Kisumu, 16, 30% - Siaya, 28 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. Continuation of collection of comprehensive patient information to help better understand home location versus possible temporary location reporting. Chose to use only 15 of the districts from which women came as the others the number of women was too low (less than 8 patients) to draw supportable conclusions from. This is where only the 269 (74.72% of total) women whose home locations identified to a precision within 10km were used for analysis.
- Using ehealth.or.ke and opendata.go.ke mapped District and Sub-District hospitals as these are the places that patients served by NPGH for obstetric fistula would be able to access and afford. In total there are 31 district hospitals and 60 subdistrict or mission hospitals within the catchment area. So using the patient attributes collected in the survey along with location of health access points we were able to take a better look at patterns amongst this particular patient population and contributing spatial factors. The 3 classic delays in getting the appropriate Emergency Obstetric Care are 1 – delay in deciding to seek medical attention, 2 – delay in reaching a health care facility, and 3 – delay in receiving EmOC at the facility. With these three stages in mind we looked at JOORTHs OF patient population and their home locations in relation to these delays. Nearest location is likely to have BEOC, which involves antibiotics, oxytoxics and anticonvulsants, as well as simpler physical procedures, but no surgery. 19 of the 23 district hospitals and 22 of the 33 subdistrict/mission hospitals reported having BEOC services (73% of facilities). As the majority of maternal deaths occur at home investing in BEOC access in the community is a large step in getting mothers and infants the care and necessary referrals needed. Percentage of women from within a district that have measured distances 10km+ from BEOC or CEOC <25%, 25-49, 50-74, 75+ , but often times, by the time care is sought these facilities do not have the resources or skills to deal with the situation Additional layer is if further complications (like OF) develop and a higher level service, and another referral are needed… CEOC, Comprehensive emergency obstetric care covers BEOC plus surgical procedures such as caesarian section and obstetric fistula repair and the ability to provide blood transfusions and other higher need emergency services. When a woman finally makes it to a facility where she can be properly cared for delays at this level are much less, but they occur due to lack of personnel available, theater space for surgery, and other procedures that take precedence in emergency surgery. 10 of the 23 district hospitals and 0 of the 33 subdistrict/mission hospitals reported having CEOC services (18% of facilities). Area of policy advocacy. 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. 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.
- Using ehealth.or.ke and opendata.go.ke mapped District and Sub-District hospitals as these are the places that patients served by NPGH for obstetric fistula would be able to access and afford. In total there are 31 district hospitals and 60 subdistrict or mission hospitals within the catchment area. So using the patient attributes collected in the survey along with location of health access points we were able to take a better look at patterns amongst this particular patient population and contributing spatial factors. The 3 classic delays in getting the appropriate Emergency Obstetric Care are 1 – delay in deciding to seek medical attention, 2 – delay in reaching a health care facility, and 3 – delay in receiving EmOC at the facility. With these three stages in mind we looked at JOORTHs OF patient population and their home locations in relation to these delays. Nearest location is likely to have BEOC, which involves antibiotics, oxytoxics and anticonvulsants, as well as simpler physical procedures, but no surgery. 19 of the 23 district hospitals and 22 of the 33 subdistrict/mission hospitals reported having BEOC services (73% of facilities). As the majority of maternal deaths occur at home investing in BEOC access in the community is a large step in getting mothers and infants the care and necessary referrals needed. Percentage of women from within a district that have measured distances 10km+ from BEOC or CEOC <25%, 25-49, 50-74, 75+ , but often times, by the time care is sought these facilities do not have the resources or skills to deal with the situation Additional layer is if further complications (like OF) develop and a higher level service, and another referral are needed… CEOC, Comprehensive emergency obstetric care covers BEOC plus surgical procedures such as caesarian section and obstetric fistula repair and the ability to provide blood transfusions and other higher need emergency services. When a woman finally makes it to a facility where she can be properly cared for delays at this level are much less, but they occur due to lack of personnel available, theater space for surgery, and other procedures that take precedence in emergency surgery. 10 of the 23 district hospitals and 0 of the 33 subdistrict/mission hospitals reported having CEOC services (18% of facilities). Area of policy advocacy. 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. 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.
- Using ehealth.or.ke and opendata.go.ke mapped District and Sub-District hospitals as these are the places that patients served by NPGH for obstetric fistula would be able to access and afford. In total there are 31 district hospitals and 60 subdistrict or mission hospitals within the catchment area. So using the patient attributes collected in the survey along with location of health access points we were able to take a better look at patterns amongst this particular patient population and contributing spatial factors. The 3 classic delays in getting the appropriate Emergency Obstetric Care are 1 – delay in deciding to seek medical attention, 2 – delay in reaching a health care facility, and 3 – delay in receiving EmOC at the facility. With these three stages in mind we looked at JOORTHs OF patient population and their home locations in relation to these delays. Nearest location is likely to have BEOC, which involves antibiotics, oxytoxics and anticonvulsants, as well as simpler physical procedures, but no surgery. 19 of the 23 district hospitals and 22 of the 33 subdistrict/mission hospitals reported having BEOC services (73% of facilities). As the majority of maternal deaths occur at home investing in BEOC access in the community is a large step in getting mothers and infants the care and necessary referrals needed. Percentage of women from within a district that have measured distances 10km+ from BEOC or CEOC <25%, 25-49, 50-74, 75+ , but often times, by the time care is sought these facilities do not have the resources or skills to deal with the situation Additional layer is if further complications (like OF) develop and a higher level service, and another referral are needed… CEOC, Comprehensive emergency obstetric care covers BEOC plus surgical procedures such as caesarian section and obstetric fistula repair and the ability to provide blood transfusions and other higher need emergency services. When a woman finally makes it to a facility where she can be properly cared for delays at this level are much less, but they occur due to lack of personnel available, theater space for surgery, and other procedures that take precedence in emergency surgery. 10 of the 23 district hospitals and 0 of the 33 subdistrict/mission hospitals reported having CEOC services (18% of facilities). Area of policy advocacy. 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. 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.