abstract: 'Maternal mortality is a major problem in middle-income and low-income

  countries, and the availability and accessibility of healthcare

  facilities offering safe delivery is important in averting maternal

  deaths. Siaya County, in Kenya, has one of the highest maternal

  mortality rates in the country-far more than the national average. This

  study aimed to evaluate geographic access to health facilities offering

  delivery services in Siaya County. A mixed-methods approach

  incorporating geographic information system analysis and individual data

  from semi-structured interviews was used to derive travel time maps to

  facilities using different travel scenarios: AccessMod5 and ArcGIS were

  used for these tasks. The derived maps were then linked to georeferenced

  household survey data in a multilevel logistic regression model in R to

  predict the probability of expectant women delivering in a health

  facility. Based on the derived travel times, 26 per cent (13,140) and 67

  per cent (32,074) of the estimated 46,332 pregnant women could reach any

  facility within one and two hours, respectively, while walking with the

  percentage falling to seven per cent (3,415) and 20 per cent (8,845)

  when considering referral facilities. Motorised transport significantly

  increased coverage. The findings revealed that the predicted probability

  of a pregnant woman delivering in a health facility ranged between 0.14

  and 0.86. Significant differences existed in access levels with

  transportation-based interventions significantly increasing coverage.

  The derived maps can help health policy planners identify underserved

  areas and monitor future reductions in inequalities. This work has

  theoretical implications for conceptualising healthcare accessibility

  besides advancing the literature on mixed methodologies.'
affiliation: 'Ouko, JJO (Corresponding Author), Kenya Govt Med Res Ctr, Wellcome Trust
  Res Programme, Populat Hlth Unit, POB 43640-00100, Nairobi, Kenya.

  Ouko, Jacob Joseph Ochieng; Gachari, Moses Karoki; Sichangi, Arthur Wafula, Kenya
  Govt Med Res Ctr, Wellcome Trust Res Programme, Populat Hlth Unit, POB 43640-00100,
  Nairobi, Kenya.

  Alegana, Victor, Univ Southampton, Geog \& Environm Sci, Highfield Campus, Southampton
  SO17 1BJ, Hants, England.'
author: Ouko, Jacob Joseph Ochieng and Gachari, Moses Karoki and Sichangi, Arthur
  Wafula and Alegana, Victor
author-email: oukojacob1@gmail.com
author_list:
- family: Ouko
  given: Jacob Joseph Ochieng
- family: Gachari
  given: Moses Karoki
- family: Sichangi
  given: Arthur Wafula
- family: Alegana
  given: Victor
da: '2023-09-28'
doi: 10.1111/1745-5871.12339
eissn: 1745-5871
files: []
issn: 1745-5863
journal: GEOGRAPHICAL RESEARCH
keywords: 'maternal health; geographic information systems; travel times;

  healthcare access; multilevel modelling; Kenya'
keywords-plus: SERVICES; ACCESS; CARE
language: English
month: AUG
number: '3'
number-of-cited-references: '30'
orcid-numbers: 'Sichangi, Arthur/0000-0001-6266-8741

  Alegana, Victor/0000-0001-5177-9227'
pages: 286-298
papis_id: 6dbc3dd1662713556297b63d67a8456d
ref: Ouko2019geographicinformatio
researcherid-numbers: 'Sichangi, Arthur/Y-6599-2019

  Alegana, Victor/P-6579-2019'
times-cited: '13'
title: Geographic information system-based evaluation of spatial accessibility to
  maternal health facilities in Siaya County, Kenya
type: article
unique-id: WOS:000482408800007
usage-count-last-180-days: '2'
usage-count-since-2013: '10'
volume: '57'
web-of-science-categories: Geography
year: '2019'