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Banke-Thomas A, Wong KLM, Olubodun T, Macharia PM, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Ogunyemi O, Gwacham-Anisiobi U, Wang J, Abejirinde IOO, Makanga PT, Azodoh N, Nzelu C, Afolabi BB, Stanton C, Beňová L. Geographical accessibility to functional emergency obstetric care facilities in urban Nigeria using closer-to-reality travel time estimates: a population-based spatial analysis. Lancet Glob Health 2024; 12:e848-e858. [PMID: 38614632 DOI: 10.1016/s2214-109x(24)00045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/17/2023] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Better accessibility for emergency obstetric care facilities can substantially reduce maternal and perinatal deaths. However, pregnant women and girls living in urban settings face additional complex challenges travelling to facilities. We aimed to assess the geographical accessibility of the three nearest functional public and private comprehensive emergency obstetric care facilities in the 15 largest Nigerian cities via a novel approach that uses closer-to-reality travel time estimates than traditional model-based approaches. METHODS In this population-based spatial analysis, we mapped city boundaries, verified and geocoded functional comprehensive emergency obstetric care facilities, and mapped the population distribution for girls and women aged 15-49 years (ie, of childbearing age). We used the Google Maps Platform's internal Directions Application Programming Interface to derive driving times to public and private facilities. Median travel time and the percentage of women aged 15-49 years able to reach care were summarised for eight traffic scenarios (peak and non-peak hours on weekdays and weekends) by city and within city under different travel time thresholds (≤15 min, ≤30 min, ≤60 min). FINDINGS As of 2022, there were 11·5 million girls and women aged 15-49 years living in the 15 studied cities, and we identified the location and functionality of 2020 comprehensive emergency obstetric care facilities. City-level median travel time to the nearest comprehensive emergency obstetric care facility ranged from 18 min in Maiduguri to 46 min in Kaduna. Median travel time varied by location within a city. The between-ward IQR of median travel time to the nearest public comprehensive emergency obstetric care varied from the narrowest in Maiduguri (10 min) to the widest in Benin City (41 min). Informal settlements and peripheral areas tended to be worse off compared to the inner city. The percentages of girls and women aged 15-49 years within 60 min of their nearest public comprehensive emergency obstetric care ranged from 83% in Aba to 100% in Maiduguri, while the percentage within 30 min ranged from 33% in Aba to over 95% in Ilorin and Maiduguri. During peak traffic times, the median number of public comprehensive emergency obstetric care facilities reachable by women aged 15-49 years under 30 min was zero in eight (53%) of 15 cities. INTERPRETATION Better access to comprehensive emergency obstetric care is needed in Nigerian cities and solutions need to be tailored to context. The innovative approach used in this study provides more context-specific, finer, and policy-relevant evidence to support targeted efforts aimed at improving comprehensive emergency obstetric care geographical accessibility in urban Africa. FUNDING Google.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; School of Human Sciences, University of Greenwich, London, UK; Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Zimbabwe; Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Zimbabwe
| | - Ngozi Azodoh
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Charles Nzelu
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria; Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Kolawole OM, Tomori O, Agbonlahor D, Ekanem E, Bakare R, Abdulsalam N, Okojie O, Braide E, Uzochukwu B, Rafindadi A, Bello S, Shehu S, Gureje O, Lecky M, Onwujekwe O, Onyedum C, Ezike A, Bukbuk D, Ashir G, Anyaehie B, Amazigo U, Habib A, Ufere J, Azodoh N. SARS CoV-2 Seroprevalence in Selected States of High and Low Disease Burden in Nigeria. JAMA Netw Open 2022; 5:e2236053. [PMID: 36219441 PMCID: PMC9554701 DOI: 10.1001/jamanetworkopen.2022.36053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The global impact of COVID-19 has led to an increased need to continuously assess disease surveillance tools. The utility of SARS-CoV-2 serologic tools in determining immunity levels across different age groups and locations in helping to quickly assess the burden of COVID-19 with significant health policy implications is unknown. OBJECTIVE To determine the prevalence of SARS-CoV-2 antibodies with respect to the age group and sex of participants. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey of 4904 individuals across 12 states with high and low COVID-19 disease burden in Nigeria was carried out between June 29 and August 21, 2021. MAIN OUTCOMES AND MEASURES Enzyme-linked immunosorbent assay was used for the detection of specific SARS-CoV-2 immunoglobulin G and immunoglobulin M antibodies, such as the nucleocapsid protein-NCP and spike protein S1. Interviewer-administered questionnaires provided information on participants' history of disease and associated risk factors. RESULTS A total of 4904 individuals participated in the study (3033 were female [61.8%]; mean [SD] age, 26.7 [6.51] years). A high seroprevalence of SARS-CoV-2 (78.9%) was obtained. Seropositivity was consistent across the states surveyed, ranging from 69.8% in Lagos to 87.7% in Borno. There was no association between sex and seropositivity (female, 2414 [79.6%]; male, 1456 [77.8%]; P = .61); however, an association was noted between age and seropositivity, with the peak prevalence observed in participants aged 15 to 19 years (616 [83.6%]; P = .001). Similarly, loss of appetite (751 [82.3%]; P = .04) and smell (309 [84.4%]; P = .01) were associated with seropositivity. CONCLUSIONS AND RELEVANCE In this cross-sectional study, a high SARS-CoV-2 seroprevalence was obtained among the study population during the low level of vaccination at the time of the survey. Thus, there is a need for both an efficacy and antibody neutralization test study to ascertain the efficacy of the antibody detected and the potential for herd immunity in Nigeria.
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Affiliation(s)
- Olatunji Matthew Kolawole
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Oyewale Tomori
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Dennis Agbonlahor
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Ekanem Ekanem
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Rasheed Bakare
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Nasidi Abdulsalam
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Obehi Okojie
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Eka Braide
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Benjamin Uzochukwu
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Abdulmumini Rafindadi
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Shaibu Bello
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Sule Shehu
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Oye Gureje
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Muhammed Lecky
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Obinna Onwujekwe
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Cajetan Onyedum
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Adaobi Ezike
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - David Bukbuk
- Department of Microbiology, Faculty of Science, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Garba Ashir
- Department of Microbiology, Faculty of Science, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Bond Anyaehie
- Department of Physiology, College of Medicine, University of Nigeria, Enugu
| | - Uche Amazigo
- Pan-African Community Initiative on Education and Health, Enugu, Enugu State, Nigeria
| | - Abdulrajak Habib
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Joy Ufere
- World Health Organization Country Office, Federal Capital Territory, Abuja, Nigeria
| | - Ngozi Azodoh
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
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