title: Local use of geographic information systems to improve data utilisation and health services: mapping caesarean section coverage in rural Rwanda.
abstract: OBJECTIVE
  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.
authors.affiliation: Women and Infants Hospital, Providence, RI, USA. LSudhof@wihri.org
authors.forename: Leanna
authors.initials: L
authors.lastname: Sudhof
authors.forename: Cheryl
authors.initials: C
authors.lastname: Amoroso
authors.forename: Peter
authors.initials: P
authors.lastname: Barebwanuwe
authors.forename: Fabien
authors.initials: F
authors.lastname: Munyaneza
authors.forename: Adolphe
authors.initials: A
authors.lastname: Karamaga
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zambotti
authors.forename: Peter
authors.initials: P
authors.lastname: Drobac
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D046689:Fetal Mortality; D040362:Geographic Information Systems / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research / Q000379:methods*; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012107:Research Design; D040841:Resource Allocation; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology; D014597:Uterine Rupture / Q000453:epidemiology