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Abstract
Visualising maternal and newborn health (MNH) outcomes at fine spatial resolutions is crucial to ensuring the most vulnerable women and children are not left behind in improving health. Disaggregated data on life-saving MNH interventions remain difficult to obtain, however, necessitating the use of Bayesian geostatistical models to map outcomes at small geographical areas. While these methods have improved model parameter estimates and precision among spatially correlated health outcomes and allowed for the quantification of uncertainty, few studies have examined the trade-off between higher spatial resolution modelling and how associated uncertainty propagates. Here, we explored the trade-off between model outcomes and associated uncertainty at increasing spatial resolutions by quantifying the posterior distribution of delivery via caesarean section (c-section) in Tanzania. Overall, in modelling delivery via c-section at multiple spatial resolutions, we demonstrated poverty to be negatively correlated across spatial resolutions, suggesting important disparities in obtaining life-saving obstetric surgery persist across sociodemographic factors. Lastly, we found that while uncertainty increased with higher spatial resolution input, model precision was best approximated at the highest spatial resolution, suggesting an important policy trade-off between identifying concealed spatial heterogeneities in health indicators.
- maternal health
- geographic information systems
- epidemiology
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Footnotes
Handling editor Seye Abimbola
Contributors CWR conceived of the study framework and methods for this study, performed all data management and analysis, generated all study visualisations and results interpretations, and wrote and prepared the manuscript for journal submission. JJN and NR contributed insight and feedback on the conceptual study design, as well as statistical feedback on analysis and model results. KN and JES provided input on how the study results fit into the broader fields of maternal health and geography, respectively. Lastly, ZM and AJT supervised CWR during production of this manuscript and oversaw that methods and analysis were executed within a sound and scientifically rigorous framework. All authors reviewed the manuscript and provided feedback before final submission to the journal.
Funding The authors would like to acknowledge the support provided by the Economic and Social Research Council’s Doctoral Training Programme, which funds CWR.
Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. All data used in these analyses were freely obtained from the DHS program (dhsprogram.com). The results of these analyses will be freely available via worldpop.org.