Local use of geographic information systems to improve data utilisation and health services: mapping caesarean section coverage in rural Rwanda

Trop Med Int Health. 2013 Jan;18(1):18-26. doi: 10.1111/tmi.12016.


Objectives: 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.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Cesarean Section / statistics & numerical data*
  • Emergency Medical Services / standards*
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Fetal Mortality
  • Geographic Information Systems / statistics & numerical data*
  • Health Services Accessibility*
  • Health Services Needs and Demand
  • Health Services Research / methods*
  • Hospitals
  • Humans
  • Incidence
  • Maternal Health Services / standards*
  • Maternal Health Services / statistics & numerical data
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Quality Improvement
  • Research Design
  • Resource Allocation
  • Rural Health Services / standards
  • Rural Health Services / statistics & numerical data
  • Rural Population
  • Rwanda / epidemiology
  • Uterine Rupture / epidemiology