Geographic information system‐based evaluation of spatial accessibility to maternal health facilities in Siaya County,Kenya

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.     

INEQUALITY BEFORE THE BRONZE AGE: THE CASE OF CHALCOLITHIC CYPRUS

The emergence and nature of social inequality has been the topic of a substantial amount of research in recent years, with one group of scholars concluding that social inequality increased significantly with the rise of urbanism on the basis of the application of Gini measures, and another group arguing that social inequalities existed long before urbanism and that not all urban societies were class societies. Here, we present the case of Chalcolithic Cyprus, a decidedly pre-urban period for which we have quantifiable evidence that might indicate social inequality. On the basis of this dataset we will re-evaluate recent postulates on the emergence and nature of social inequality.