A new geographic information system (GIS) analysis of Kenya has found “disproportionate” rates of maternal morbidity and mortality due to postpartum haemorrhage (PPH) in areas without interventional radiology (IR) capabilities.
Led by Ryan W England (Princeton Radiology Associates, Princeton, USA) and published in the Journal of Vascular and Interventional Radiology (JVIR), the study employed multilayered GIS mapping to pinpoint healthcare disparities and propose a framework for global IR outreach.
The authors detail that PPH is a leading cause of preventable maternal mortality globally, particularly in low- and middle-income countries. Minimally invasive endovascular procedures such as uterine artery embolization (UAE), performed as standard for interventional radiologists, can be used to treat severe cases of PPH that are unresponsive to first-line treatments.
“UAE has been shown to be safe and effective, with systematic reviews demonstrating a clinical success rate (as defined by controlled bleeding without need for additional procedure or surgery) of 89%,” write England and colleagues, referencing a 2021 paper by Matthew Brown et al. Although the treatment has been shown to control PPH while preserving the uterus, access to UAE in Kenya is currently limited to just six hospitals—all located in the capital city of Nairobi.
In their analysis, the authors reviewed publicly available Kenyan health and demographic data from 2014–2018. Using county-level statistics, they constructed three key indices: a PPH Risk Index (PRI), a Health Severity Index (HSI) and a Combined Risk Index (CRI). These indices were derived from variables such as adolescent pregnancy rates, maternal mortality ratios (MMRs), access to antenatal care, insurance coverage and physician density.
A total of f 14,718,288 female Kenyans of childbearing age were included in the geospatial analysis. Between 2014 and 2018, the number of maternal haemorrhages across the country was found to increase from 15,457 to 21,332, rising by 38% over the five-year period.
Notably, the highest MMRs were observed in the southeastern and northwestern counties, with standard deviations 1.5–2.3 above the national mean. This finding correlated with lower densities of healthcare facilities, longer travel times to a healthcare facility, and lack of IR services. In contrast, Nairobi’s MMR fell within the national average, despite housing the country’s only IR-equipped hospitals.
“Geospatial analysis has been successfully used for public health mapping and radiology outreach in the past,” write England and colleagues. “Prior research using GIS has shown that distance to quality healthcare facilities is a substantial factor in the utilisation of clinical services.”
Translating their findings into actionable measures, the authors examined the density of the study target population within a one-hour drive of each hospital overlaid onto the CRI for each county. By doing so, the authors were able to identify the hospital in which development of IR services may have the greatest impact on decreasing PPH morbidity and mortality. Among them, Homa Bay County Teaching and Referral Hospital in southwestern Kenya was highlighted as a high-priority site for IR development, due to its high CRI score and catchment population of women of childbearing age.
Despite Nairobi being relatively better equipped, England and colleagues emphasise that a broader nationwide expansion of IR services is critical. As of 2024, only around 10 practicing interventional radiologists serve the entire country, with all initially trained abroad. “This information only highlights the dramatic need in such a populated city for IR services to grow and expand,” the authors write.
Efforts are underway to bolster local capacity, including a dedicated IR fellowship programme at the University of Nairobi that began producing graduates in 2020.
“Moving forward, further investigation of targeted individual healthcare facilities in Kenya needs to be assessed to better understand the unique needs of each hospital and region. One approach includes performing an ‘IR Readiness Assessment’ to successfully create meaningful and sustainable solutions to each individual hospital’s radiology needs,” England et al state.
“Using a framework such as this may allow for a comprehensive examination of current and future barriers involved in implementing IR outreach and resource allocation in the regions identified through this analysis,” the authors write. They note that further research will aim to correlate GIS-driven service expansion with real-world maternal health outcomes as IR capacity in Kenya grows.
