Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh

• Published in: Tropical Medicine and Health
• Main Authors: Atique Iqbal Chowdhury, Abu Yousuf Md Abdullah, Rafiqul Haider, Asraful Alam, Sk Masum Billah, Sanwarul Bari, Qazi Sadeq-ur Rahman, Warren Christopher Jochem, Ashraf Dewan, Shams El Arifeen
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2019
• Subjects: Space-time scanning; Hot spots; Cold spots; Facility delivery; Heterogeneity; Cluster; Arctic medicine. Tropical medicine; RC955-962; Arctic
• Online Access: https://doi.org/10.1186/s41182-019-0170-9; https://doaj.org/article/65d6eaf0040c47bf8ed51244b231931b

Abstract Background A spatial and temporal study of the distribution of facility-based deliveries can identify areas of low and high facility usage and help devise more targeted interventions to improve delivery outcomes. Developing countries like Bangladesh face considerable challenges in reducing the maternal mortality ratio to the targets set by the Sustainable Development Goals. Recent studies have already identified that the progress of reducing maternal mortality has stalled. Giving birth in a health facility is one way to reduce maternal mortality. Methods Facility delivery data from a demographic surveillance site was analyzed at both village and Bari (comprising several households with same paternal origins) level to understand spatial and temporal heterogeneity. Global spatial autocorrelation was detected using Moran’s I index while local spatial clusters were detected using the local Getis G i * statistics. In addition, space-time scanning using a discrete Poisson approach facilitated the identification of space-time clusters. The likelihood of delivering at a facility when located inside a cluster was calculated using log-likelihood ratios. Results The three cluster detection approaches detected significant spatial and temporal heterogeneity in the distribution of facility deliveries in the study area. The hot and cold spots indicated contiguous and relocation type diffusion and increased in number over the years. Space-time scanning revealed that when a parturient woman is located in a Bari inside the cluster, the likelihood of delivering at a health facility increases by twenty-seven times. Conclusions Spatiotemporal studies to understand delivery patterns are quite rare. However, in resource constraint countries like Bangladesh, detecting hot and cold spot areas can aid in the detection of diffusion centers, which can be targeted to expand regions with high facility deliveries. Places and periods with reduced health facility usages can be identified using various cluster detection techniques, to ...