3. Env Eco - Ijeefus - Utilization of Geo

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International Journal of Environment, Ecology,

Family and Urban Studies (IJEEFUS)

ISSN(P): 2250-0065; ISSN(E): 2321-0109

Vol. 5, Issue 2, Apr 2015, 21-30

© TJPRC Pvt. Ltd.

UTILIZATION OF GEO-SPATIAL AS METHOD FOR TRENDS PREGNANCY

COMPLICATION, A CASE STUDY OF RURAL AND URBAN

NUGROHO SUSANTO1, CHATARINA UW2, HARI BASUKI N3, STEFANUS SUPRIYANTO4, KUNTORO5,

LUTFAN LAZUARDI6, WINDHU PURNOMO7, FLORENTINA SUSTINI8

1Department of Epidemiology, Health Science Faculty, Respati University, Yogyakarta, Indonesia

2Department of Epidemiology, Public Health Faculty, Airlangga University, Surabaya, Indonesia

3,5,7Department of Bio statistic, Public Health Faculty, Airlangga University, Surabaya, Indonesia

4Department of Health Administration and Policy, Public Health Faculty of Airlangga University, Surabaya, Indonesia

6Department of Health Informatics, Medicine Faculty, Gadjah Mada University, Yogyakarta, Indonesia

8Department of Epidemiology, Medicine Faculty, Airlangga University, Surabaya, Indonesia

ABSTRACT

Background: Maternal and infant mortality is a problem in many parts of the world. Epidemiological factors play

an important role in the distribution of complications during pregnancy. Location identified as place and socioeconomic

status contributed to health problems in the region. Environmental factors play an important role on issues of maternal and

child health, especially as the slope of the neighborhood. Slope of land is a factor related to the mother's pregnancy health.

Location of pregnant women is a factor associated with health problems during pregnancy such as the difficult to access of

services. Pregnancy had a height location area important role incidence of hemorrhage and eclampsia. Display data bymapping easier to understand and interesting, thus data more accuracy is displayed.

Method: A spatial data mapping with cross sectional study based regions between rural and urban areas. Sample

was required total 612 pregnant with 306 collected urban area and 306 collected rural area. Data were collected by physical

examination, interviews and ordinate point. Data ware analyzed with Epi info Program and health mapper program.

Results: Rural areas are dominated proportion abortion higher twice than urban areas 10.5%, 4.9%. Proportion of

SC greater in rural areas (2.0%) than urban (0.3%). proportion of bleeding greater in rural areas (11.4%) than urban areas

(3.6%), proportion of eclampsia greater in rural areas (6.9%) than urban (3.3%), while the condition of anemia in both

regions showed a similar 87.6%, 87.9%. Location of pregnant bleeding around community health service reached more 3km2 and some pregnant with bleeding conditions are in a location away from the main street of the village.

Conclusion: This study shown that cases of bleeding and eclampsia greater in rural areas, thus rural areas is main

focus of study related pregnant health. Spatial analyzed used to construct the buffer neighborhoods might far outweigh the

value added to the statistical analysis, especially because the census geography neighborhoods showed very similar

statistical effects.

KEYWORDS: Geo-Spatial, Pregnant, Complication

INTRODUCTION

Maternal and infant mortality is a problem in many parts of the world. Attention has been focused on curative


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22 Nugroho Susanto, Chatarina Uw, Hari Basuki N, Stefanus Supriyanto,Kuntoro, Lutfan Lazuardi, Windhu Purnomo, Florentina Sustini

Impact Factor (JCC): 3.0965 Index Copernicus Value (ICV): 3.0

treatment, thus main concern is more devoted to service providers. Other factors related maternal and infant mortality are

not important as epidemiology factors. Geography factors play an important role in the distribution of complication during

pregnancy. Previous studies mention that population lives in rural areas higher risk to death than urban areas OR = 8.38

(95% CI: 3.94-17.83)

1

. Identity of residence and socioeconomic status are importance to predicted health problems in theregion

2. Weather changes could increase incidence of malnutrition, infectious diseases, environmental issues, and direct

exposure on pregnancy outcomes. Climate change a major impact to maternal and neonatal health3.

Environmental factors with slope condition is factor that cause maternal physical activity in their interaction with

the environment3. The slope of the land in the neighborhood of pregnant women is a factor related to the mother's

pregnancy status. The slope of land is factor related health problems during pregnancy such as the difficulty of access to

services, high incidence of hemorrhage, eclampsia and miscarriage. Slope condition increasing incidence of health

problems in isolated areas with high ground5

Access service is an important condition associated with health status in the community

4

.

Child care over adistance of 1.5 hours more at risk of death compared to children whose distance services < 1.5 hours RR = 2.3 [95% CI;

0.95-5.6]12

. Significant range of services related to health status in a region. Pregnant with distance services are far from

health service higher opportunities death OR = 2.06 times compared with a close range to health problems2. Availability of

basic facilities in the local government is key determinant of maternal and child health. Decreased of utilization health

service related geographically conditions increased various diseases in the areas.

Close of health service get easily to facilitate the public in accessing services. Availability of basic facilities in

community health service is the key determinant of maternal and child health 6. Display data by mapping more easily

understood and attractive. Display data in form of mapping can utilize GPS technology (Global Positioning System) so that

more accurate data is displayed.

Using of Geographic Information Systems (GIS) in the health sector is driven by the orientation of efficiency and

effectiveness, especially in process and results achieved. Mapping display data more clearer spatial location information,

each position can be measured with certainty.

The study aimed to determine factors for complications in pregnancy especially environment related as places and people

in Bantul. Identified trends in the incidence of pregnancy complications with the use of spatial-based regional area.

MATERIALS AND METHODS

Study Setting

The study was conducted at the Data primer and Health Demographic Surveillance Site (HDSS) located at district

in Bantul, District south of Indonesia.

Study Design

The study was part of a cross sectional research during pregnancy. The complication (bleeding and eclamsia)

which occurred during the follow-up period from April 2012 to August 2012 were included.

Study Population and Sample Size

All mothers living in the site and reported in first, second and third trimester of pregnancy were invited to join thecross sectional study. Pregnancy was detected through interview by trained data collectors. For identifying the predictors of


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Utilization of Geo-spatial as Method for Trends Pregnancy Complication, a Case Study of Rural and Urban 23


complication pregnant, all complicated during the pregnancy period were compared to those who not complication period.

Sample were collected with stratified random sampling method. Sample size estimate with stratified random sampling

lemeshow (1997):

Note

H = strata = 2 region rural and urban; Nh = Population in strata; Ph = Proportion in strata; Wh = relative weight in

strata; d = precision = 0.01; L = number of strata; 1-α = level of significant = 0.05.

Referent for formula above, estimated sample size 612 pregnancy. 306 were collected from urban area and 306

were collected from rural area.

Data Collection

Data ordinate points were collected using Garmin 3.0 and pregnant complication status was collected with

pregnant physical examination. The data collection was overseen by two field supervisors who had previous experiences in

conducting similar studies in the study area by classified midwifery. For same perception between researcher and collectors

we prior to the actual data collection, a 3 day intensive training, was given to data collectors and field supervisors about

data collection tools and study procedures. The data collectors and field supervisors were assisted in the field by local

informants who were residents of the study villages. The local informants were trained to report the end of pregnancy to

the data collectors as soon as they identify the event irrespective of the pregnancy outcome.

Data Analyzed

Data point ordinate were analyzed with health mapper software and data of subject characteristic were analysis

with Epi Info software.

Ethical Consideration

Ethical approval was obtained from the University of Airlangga ethical review board. A formal letter was written

to the local district administrative and health offices. Informed verbal consent was secured from all mothers or guardians of

the study participants. The right of the respondent to withdraw from the interview or not to participate was informed and

respected. The final results of the research will be communicated to government offices and most importantly to the study

subjects and members of the community through health extension workers.

Results

Table 1: Characteristics of Subjects Based on a History of Pregnancy Shown in the following Table 1

Pregnancy History Rural Urban Total

N % N % N %

History of Abortion YesNo

32274

10.589.5

15291

4.995.1

47565

7.792.3

History of bad labor YesNo

19287

6.293.8

20286

6.593.5

39573

6.493.6


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History of SC Yes

No

6

300

2.0

98.0

1

305

0.3

99.7

7

605

1.1

98.9

History of malaria Yes

No

9

297

2.9

97.1

7

299

2.3

97.7

16

596

2.6

97.4

History of tuberculosis Yes

No

1

305

0.3

99.7

0

306

0.0

100.0

1

611

0.2

99.8

Table 1 Shows that rural districts (Imogiri) conditions dominate abortus twice more than in urban areas (Bantul) is

10.5%; 4.9%. SC previous is dominated by rural communities 2.0%; 0.3%, while the bad labor previous of the disease such

as malaria, tuberculosis between rural and urban areas are not much differences.

Table 2: Characteristics of the Study Subjects Based on the Results

of the Examination of Pregnant Women in Bantul

Pregnancy AssessmentRural

(Imogiri)

Urban

(Bantul)Total

N % N % N %

Pregnant twins YesNo

1305

0.399.7

0306

0.0100.0

1611

0.299.8

Hidramion Yes

No

0

306

0.0

100.0

0

306

0.0

100.0

0

306

0.0

100.0

Stillbirth Yes

No

0

306

0.0

100.0

0

306

0.0

100.0

0

306

0.0

100.0

Hemorrhage Yes

No

35

271

11.4

271

11

295

3.6

96.4

46

566

7.5

92.5

Anemia Yes

No

268

38

87.6

12.4

269

37

87.9

12.1

537

75

87.8

12.3

Eclampsia Yes

No

21

285

6.9

93.1

10

296

3.3

96.7

31

581

5.1

94.9

Table 2 Shown that Pregnancy-related conditions such as maternal bleeding dominated by rural areas (11.4%)

than urban areas (3.6%), eclampsia conditions dominated rural areas (6.9%) than urban (3.3%), while the condition of

anemia in both regions showed that almost same as 87.6%; 87.9%.

Table 3: Description Epidemiological Place and Access to Services in the Area of Study

Characteristic Rural (Imogiri) Urban (Bantul) Total

N % N % N %

Private midwivesNo

Yes

270

36

88.2

11.8

247

59

80.7

19.3

517

95

84.5

15.5

Distance community

health service

≥ 30 minute

< 30 minute

198

108

64.7

35.5

104

202

34.0

66.0

302

310

49.3

50.7

Elevation HighLow

149157

48.751.3

64242

20.979.1

213399

34.86.5.2

Slant > 25%

≤ 25%25947

84.615.4

0306

0.0100.0

259353

42.357.7

Based on Table 3 shows that both areas majority pregnant women were closed midwives private service

(88.2; 80.7). Pregnant women who are live in rural areas (Imogiri) distance to the clinic > 30 minutes 64.7%, whereas in

the area in urban (Bantul) < 30 minute 66.0%. Based on environment elevation around pregnant greater proportion in rural

than urban (70.0%, 30%). The higher proportion of slant environment more 25 % greater proportion in rural area than

urban area.


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Figure 1: Shows that the Location Pregnant Seen around 3 kilo Meter in Center of Community Health Service

Display on mapping data that case of hemorrhage higher at rural area than urban and the location in rural area

around shown more elevated. Hemorrhage and eclampsia cases biggest estimated for rural than urban. Hemorrhage was

distributed around center community health service 3 kilo meter.

Distribution of hemorrhage based health facility between rural and urban areas shown figure bellow:

Figure 2

Distribution of Eclampsia based Health Facility between Rural and Urban Areas shown Figure Bellow


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Figure 3: Differences Distribution of Hemorrhage and Eclampsia between Rural and urban Area

Figure 2 Shows that pregnant who’s have experience bleeding on order first village street for urban and rural.

Some hemorrhage cases location closed with private midwives, estimate around 3 kilo meters. Based on health facility, that

rural area location estimated four private midwives, beside in urban area estimate 21 private midwives. Proportion

eclampsia cases closed with hospital by radius of less than 3 kilo meters. Several cases of hemorrhage were in conditions

close the road. In the urban region there are 2 hospital services, in other hand in rural region nothing.

DISCUSSIONS

Condition of Geographical significant related hemorrhage and eclampsia during pregnancy. Geographical

conditions with sloping plateau cause pregnant women to travel from one place to other requires more physical exertion

than walking on the lowlands. Excessive physical activity during pregnancy especially in the first trimester of pregnancy

can cause uterine contractions that can lead to bleeding during pregnancy. More activity in pregnant women can lead to an

increase in cardiac work that resulted in increased maternal blood pressure during pregnancy. Conditions increased blood

pressure during pregnancy can lead to eclampsia during pregnancy. There are significant differences in bleeding events

between the regions with the status of rural and urban status7. Difficult geographical conditions increased incidence of

hemorrhage and history abortion. The availability of geospatial data can provide audit services in accordance with the

access to services and can provide support to pregnant women in labor planning, placement and developing a human

resources strategy and determination to achieve the target reduction in maternal and infant mortality6. The high rate of

abortion history, hemorrhage, eclampsia incidence may be caused by habits mother running from one house to another

house, besides when viewed from the status of the proportion of mothers who work mothers work as farmers and farm

workers is greater in the working area Imogiri health centers. Conditions excessive physical activity and jobs that require a

lot of physical activity can cause a miscarriage because the fetus in the womb is not sticking too strong. This situation often

occurs in the first trimester of pregnancy so that the mother in early pregnancy required a special focus on pregnancy.

Study show different pregnant blood pressure between rural and urban status. Average blood pressure was higher

in rural areas compared with urban areas7. Geographic factors could account for the differences in coverage midwife

services as they relate to the condition of pregnant women are difficult location and away from the reach of health centers.

Availability of basic facilities in the mother is the key determinant of maternal and child health. Low utilization of health

service related geographical conditions. Geographical condition with slant more 40 percent increased variety of diseases


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and this situation made increasing maternal mortality rate due to the ineffectiveness of maternal and child health programs

that exist8

Based on available clinical services, pregnant around urban area more accessible compared with rural area.

Clinical service was operated in urban area nearly 30%, in other hand rural area 0%. This situation shows that the equity of

access to health services remains uneven, especially in the districts of Bantul.

Strategies equalization efforts to improve the quality of service by identifying factors related to health issues,

especially maternal health. One factor is the dominant antenatal care, lack of quality service in aid delivery, unavailability

regulations governing obstetric procedures so that gravity acts done fast handling9. Efforts to reduce maternal mortality can

be done through a regional-based approach7.

Socio-demographic conditions between rural and urban area are different. The existence of a large area can lead to

a less equal distribution of care facilities available making it difficult for people to access health services. Difficulties in

accessing services can lead to a higher risk of health problems. Previous study shown that population residing in rural areas

are more at risk of death compared with urban areas OR = 8.38 (95% CI: 3.94, 17.83)1. Child care over a distance of 1.5

hours more at risk of death compared to children whose distance services


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midwife referral services such as the level of education, housing, transportation12

. Referral service is particularly important

for emergency conditions. Village midwives need to provide information about the mechanism of referral and referral

hospitals are becoming so did not experience delays in the handling of emergency conditions. Ability hospital referral is

importance role for the village midwife, referral services closeness to health care facilities is essential in handling obstetricemergency action.

CONCLUSIONS

This study shown differences in the proportion of hemorrhage and eclampsia between urban and rural areas, the

proportion of hemorrhage and eclampsia higher in rural areas. Factors slope conditions as dominated caused hemorrhage in

pregnancy-related physical activity during pregnancy.

Spatial analyzed show, that rural areas highest case of hemorrhage and eclampsia than urban. Spatial analyzed

used to construct the buffer neighborhoods might far outweigh the value added to the statistical analysis, especially

because the census geography neighborhoods showed very similar statistical effects. Geo-Spatial analyzed possibly not in

all health studies, but a more precise neighborhood definition could (1) validate previous findings because it reflects the

geographic reality of the population areas or case or (2) be more important in studies of certain health outcomes, such as

disease related environment condition effect.

REFERENCES

1.

Andargie, G., Berhane, Y., 2, Worku, A., 3 and Kebede, Y., (2013) Predictors of perinatal mortality in rural

population of Northwest Ethiopia: a prospective longitudinal study, BMC Public Health 2013, 13:168,

http://www.biomedcentral.com/1471-2458/13/168

2. Root, E. D., (2013) Moving Neighborhoods and Health Research Forward: Using Geographic Methods to

Examine the Role of Spatial Scale in Neighborhood EfFects on Health, Ann Assoc Am Geogr. Author

manuscript; available in PMC 2013 September 01.; 102(5): 986–995. doi:10.1080/00045608.2012.659621.

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Rylander, C., Odland, J. O., and Sandanger, T. M., (2013) Climate change and the potential efFects on maternal

and pregnancy outcomes: an assessment of the most vulnerable _ the mother, Fetus, and newborn child, Citation:

Glob Health Action 2013, 6: 19538, http://dx.doi.org/10.3402/gha.v6i0.19538

4. Kent, S., McClure, L. A., Zaitchik B. F., and Gohlke, J., (2013) Area-level risk faktors for adverse birth outcomes:

trends in urban and rural settings, BMC Pregnancy and Childbirth 2013, 13:129,


5. Tatem, A. J., Adamo, S., Bharti, N., Burgert, C. R., Castro, M., Dorelien, A., Fink, G., Linard, C., John, M.,

Montana, L., Montgomery, M. R., Nelson, A., Noor, A. M., Pindolia, D., Yetman, G., and Balk, D., (2012)

Mapping populations at risk: improving spatial demographic data for inFectious disease modeling and metric

derivation Mapping populations at risk: improving spatial demographic data for inFectious disease modeling and

metric derivation, Population Health Metrics 2012, 10:8, http://www.pophealthmetrics.com/Content/10/1/8

6. Gething, P. W., Johnson, F. A., Ainguah, F. F., Nyarko, P., Baschieri, A., Aboagye, P., Falkingham, J., Matthews,

Z., and Atkinson, P. M., (2012) Geographical access to care at birth in Ghana: a barrier to saFe motherhood, BMC

Public Health 2012, 12:991, http://www.biomedcentral.com/1471-2458/12/991


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7. Liang, J., Dai, L., Zhu, J., Li, X., Zeng, W., Wang, H., Li, Q., Li, M., Zhou, R., and Wang, Y., (2011) Preventable

maternal mortality: Geographic/ruralurban difFerences and associated faktors from the population-based maternal

mortality surveillance system in China, BMC Public Health 2011, 11:243, http://www.biomedcentral.com/1471-

2458/11/243

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Menendez, C., Bardaji, A., Sigauque, B., Romagosa, C., Sanz, S., Serra-Casas, E., Macete, E., Berenguera, A.,

David, C., Dobano, C., Naniche, D., Mayor, A., Ordi, J., Mandomando, I., Aponte, J. J., Mabunda, S. & Alonso,

P. L. (2008) A randomized placebo-controlled trial on intermittent preventive treatment in pregnant women in the

context of insecticide treated nets delivered throught the antenatal clinic. PLoS ONE,3(4):e1934.

9. Manandhar, D. (2004) Perinatal death audit. Kathmandu University Medical Journal 2(8): 375-383.

10.

Okwaraji, Y. B., Cousens, S., Berhane, Y., Mulholland, K., Edmond, K., (2012) EfFect of Geographical Access to

Health Facilities on Child Mortality in Rural Ethiopia: A Community Based Cross Sectional Study,

www.plosone.org 1 March 2012 | Volume 7 | Issue 3 | e33564

11. Mehrabadi, A., Hutcheon, J. A., Lee, L., Liston, R. M., and Joseph, K. S., (2013) Trends in postpartum

hemorrhage from 2000 to 2009: a population-based study, BMC Pregnancy and Childbirth 2012, 12:108,


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Lassi, Z. S., Haider, B. A. & Bhutta, Z. A. (2010) Community-based intervention packages for reducing maternal

and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev,

11CD007754.

APPENDICES

Perbaikan

Urutan isi harus sesuai urutan berikut;

• Judul Halaman dengan rincian Penulis (Termasuk email dan afiliasi)

• Abstrak & Kata Kunci

• Pendahuluan

• Metode, jika ada / salah

• Hasil, jika ada / salah

• Kesimpulan

• Acknowledgements, jika ada / salah

• Referensi

• Lampiran (jika ada / ada)


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3. Env Eco - Ijeefus - Utilization of Geo