“In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria
Background Travel time to comprehensive emergency obstetric care (CEmOC) facilities in low-resource settings is commonly estimated using modelling approaches. Our objective was to derive and compare estimates of travel time to reach CEmOC in an African megacity using models and web-based platforms a...
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BMJ Publishing Group
2021-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/1/e004318.full |
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| author | Lenka Benova Aduragbemi Banke-Thomas Francis Ifeanyi Ayomoh Kerry L M Wong Rokibat Olabisi Giwa-Ayedun |
| author_facet | Lenka Benova Aduragbemi Banke-Thomas Francis Ifeanyi Ayomoh Kerry L M Wong Rokibat Olabisi Giwa-Ayedun |
| author_sort | Lenka Benova |
| collection | DOAJ |
| description | Background Travel time to comprehensive emergency obstetric care (CEmOC) facilities in low-resource settings is commonly estimated using modelling approaches. Our objective was to derive and compare estimates of travel time to reach CEmOC in an African megacity using models and web-based platforms against actual replication of travel.Methods We extracted data from patient files of all 732 pregnant women who presented in emergency in the four publicly owned tertiary CEmOC facilities in Lagos, Nigeria, between August 2018 and August 2019. For a systematically selected subsample of 385, we estimated travel time from their homes to the facility using the cost-friction surface approach, Open Source Routing Machine (OSRM) and Google Maps, and compared them to travel time by two independent drivers replicating women’s journeys. We estimated the percentage of women who reached the facilities within 60 and 120 min.Results The median travel time for 385 women from the cost-friction surface approach, OSRM and Google Maps was 5, 11 and 40 min, respectively. The median actual drive time was 50–52 min. The mean errors were >45 min for the cost-friction surface approach and OSRM, and 14 min for Google Maps. The smallest differences between replicated and estimated travel times were seen for night-time journeys at weekends; largest errors were found for night-time journeys at weekdays and journeys above 120 min. Modelled estimates indicated that all participants were within 60 min of the destination CEmOC facility, yet journey replication showed that only 57% were, and 92% were within 120 min.Conclusions Existing modelling methods underestimate actual travel time in low-resource megacities. Significant gaps in geographical access to life-saving health services like CEmOC must be urgently addressed, including in urban areas. Leveraging tools that generate ‘closer-to-reality’ estimates will be vital for service planning if universal health coverage targets are to be realised by 2030. |
| format | Article |
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| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-8a0a3f50b3af4c57addcd6ee1eb5b6122025-08-20T02:09:51ZengBMJ Publishing GroupBMJ Global Health2059-79082021-01-016110.1136/bmjgh-2020-004318“In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, NigeriaLenka Benova0Aduragbemi Banke-Thomas1Francis Ifeanyi Ayomoh2Kerry L M Wong3Rokibat Olabisi Giwa-Ayedun4Department of Public Health, Institute of Tropical Medicine, Antwerpen, BelgiumLSE Health, London School of Economics and Political Science, London, UKHealth Policy, Federal Ministry of Health, Abuja, Federal Capital Territory, NigeriaInfectious Disease and Epidemiology, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UKMaternal and Child Centre, Ifako Ijaiye General Hospital, Lagos, NigeriaBackground Travel time to comprehensive emergency obstetric care (CEmOC) facilities in low-resource settings is commonly estimated using modelling approaches. Our objective was to derive and compare estimates of travel time to reach CEmOC in an African megacity using models and web-based platforms against actual replication of travel.Methods We extracted data from patient files of all 732 pregnant women who presented in emergency in the four publicly owned tertiary CEmOC facilities in Lagos, Nigeria, between August 2018 and August 2019. For a systematically selected subsample of 385, we estimated travel time from their homes to the facility using the cost-friction surface approach, Open Source Routing Machine (OSRM) and Google Maps, and compared them to travel time by two independent drivers replicating women’s journeys. We estimated the percentage of women who reached the facilities within 60 and 120 min.Results The median travel time for 385 women from the cost-friction surface approach, OSRM and Google Maps was 5, 11 and 40 min, respectively. The median actual drive time was 50–52 min. The mean errors were >45 min for the cost-friction surface approach and OSRM, and 14 min for Google Maps. The smallest differences between replicated and estimated travel times were seen for night-time journeys at weekends; largest errors were found for night-time journeys at weekdays and journeys above 120 min. Modelled estimates indicated that all participants were within 60 min of the destination CEmOC facility, yet journey replication showed that only 57% were, and 92% were within 120 min.Conclusions Existing modelling methods underestimate actual travel time in low-resource megacities. Significant gaps in geographical access to life-saving health services like CEmOC must be urgently addressed, including in urban areas. Leveraging tools that generate ‘closer-to-reality’ estimates will be vital for service planning if universal health coverage targets are to be realised by 2030.https://gh.bmj.com/content/6/1/e004318.full |
| spellingShingle | Lenka Benova Aduragbemi Banke-Thomas Francis Ifeanyi Ayomoh Kerry L M Wong Rokibat Olabisi Giwa-Ayedun “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria BMJ Global Health |
| title | “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria |
| title_full | “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria |
| title_fullStr | “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria |
| title_full_unstemmed | “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria |
| title_short | “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria |
| title_sort | in cities it s not far but it takes long comparing estimated and replicated travel times to reach life saving obstetric care in lagos nigeria |
| url | https://gh.bmj.com/content/6/1/e004318.full |
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