title: Seasonal variation in geographical access to maternal health services in regions of southern Mozambique.
abstract: Geographic proximity to health facilities is a known determinant of access to maternal care. Methods of quantifying geographical access to care have largely ignored the impact of precipitation and flooding. Further, travel has largely been imagined as unimodal where one transport mode is used for entire journeys to seek care. This study proposes a new approach for modeling potential spatio-temporal access by evaluating the impact of precipitation and floods on access to maternal health services using multiple transport modes, in southern Mozambique.
  
  
  
  A facility assessment was used to classify 56 health centres. GPS coordinates of the health facilities were acquired from the Ministry of Health while roads were digitized and classified from high-resolution satellite images. Data on the geographic distribution of populations of women of reproductive age, pregnancies and births within the preceding 12 months, and transport options available to pregnant women were collected from a household census. Daily precipitation and flood data were used to model the impact of severe weather on access for a 17-month timeline. Travel times to the nearest health facilities were calculated using the closest facility tool in ArcGIS software.
  
  
  
  Forty-six and 87 percent of pregnant women lived within a 1-h of the nearest primary care centre using walking or public transport modes respectively. The populations within these catchments dropped by 9 and 5% respectively at the peak of the wet season. For journeys that would have commenced with walking to primary facilities, 64% of women lived within 2 h of life-saving care, while for those that began journeys with public transport, the same 2-hour catchment would have contained 95% of the women population. The population of women within two hours of life-saving care dropped by 9% for secondary facilities and 18% for tertiary facilities during the wet season.
  
  
  
  Seasonal variation in access to maternal care should not be imagined through a dichotomous and static lens of wet and dry seasons, as access continually fluctuates in both. This new approach for modelling spatio-temporal access allows for the GIS output to be utilized not only for health services planning, but also to aid near real time community-level delivery of maternal health services.
authors.affiliation: Department of Geography, Simon Fraser University, RCB7106 8888 University Drive, Burnaby, BC, V5A1S6, Canada. pmakanga@sfu.ca.|Department of Surveying and Geomatics, Midlands State University, Gweru, Zimbabwe. pmakanga@sfu.ca.
authors.forename: Prestige Tatenda
authors.initials: PT
authors.lastname: Makanga
authors.affiliation: Department of Geography, Simon Fraser University, RCB7106 8888 University Drive, Burnaby, BC, V5A1S6, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.
authors.forename: Charfudin
authors.initials: C
authors.lastname: Sacoor
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.
authors.forename: Helena Edith
authors.initials: HE
authors.lastname: Boene
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.
authors.forename: Faustino
authors.initials: F
authors.lastname: Vilanculo
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Department of Obstetrics and Gynaecology, St George's, University of London, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Magee
authors.affiliation: Department of Obstetrics and Gynaecology, St George's, University of London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
authors.affiliation: Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.
authors.forename: Khátia
authors.initials: K
authors.lastname: Munguambe
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Tabassum
authors.initials: T
authors.lastname: Firoz
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D009073:Mozambique / Q000453:epidemiology; D011247:Pregnancy; D012621:Seasons; D014186:Transportation / Q000379:methods; D016138:Walking; D014887:Weather
keywords: Geographical access to care; Geographical information systems; Global health; Health geography; Maternal health services