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  • Title: Local use of geographic information systems to improve data utilisation and health services: mapping caesarean section coverage in rural Rwanda.
    Author: Sudhof L, Amoroso C, Barebwanuwe P, Munyaneza F, Karamaga A, Zambotti G, Drobac P, Hirschhorn LR.
    Journal: Trop Med Int Health; 2013 Jan; 18(1):18-26. PubMed ID: 23279379.
    Abstract:
    OBJECTIVES: To show the utility of combining routinely collected data with geographic location using a Geographic Information System (GIS) in order to facilitate a data-driven approach to identifying potential gaps in access to emergency obstetric care within a rural Rwandan health district. METHODS: Total expected births in 2009 at sub-district levels were estimated using community health worker collected population data. Clinical data were extracted from birth registries at eight health centres (HCs) and the district hospital (DH). C-section rates as a proportion of total expected births were mapped by cell. Peri-partum foetal mortality rates per facility-based births, as well as the rate of uterine rupture as an indication for C-section, were compared between areas of low and high C-section rates. RESULTS: The lowest C-section rates were found in the more remote part of the hospital catchment area. The sector with significantly lower C-section rates had significantly higher facility-based peri-partum foetal mortality and incidence of uterine rupture than the sector with the highest C-section rates (P < 0.034). CONCLUSIONS: This simple approach for geographic monitoring and evaluation leveraging existing health service and GIS data facilitated evidence-based decision making and represents a feasible approach to further strengthen local data-driven decisions for resource allocation and quality improvement.
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