Banke-Thomas, Aduragbemi ORCID: 0000-0002-4449-0131, Wong, Kerry, Ayomoh, Francis, Giwa-Ayedun, Rokibat and Benova, Lenka (2021) “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, 6:e004318. ISSN 2059-7908 (Print), 2059-7908 (Online) (doi:https://doi.org/10.1136/bmjgh-2020-004318)

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Abstract

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 costfriction 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 50–52min. The mean errors were >45min
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 nighttime 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.

Item Type:	Article
Uncontrolled Keywords:	travel, access, emergency obstetric care, maternal health, Lagos, Nigeria
Subjects:	H Social Sciences > HE Transportation and Communications R Medicine > RG Gynecology and obstetrics
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM) Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families
Related URLs:	Publisher
Last Modified:	08 Apr 2022 13:38
URI:	http://gala.gre.ac.uk/id/eprint/34160

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