The place of geographic information and analysis in global health: A case of maternal health in regions of southern Mozambique

Maternal ill-health is a major global health burden, responsible for approximately 350000 deaths every year. While this is a very high figure considering that most maternal deaths are avoidable, it represents close to a 45% reduction in maternal death rates from 1990, and is a largely the result of successful clinical strategies that were pioneered through the Millennium Development Goals. However, emerging strategies in global maternal health now acknowledge the broad nature of the socio-cultural and environmental determinants associated with maternal health, and call for multi-sectoral approaches to complement the dominant clinical perspectives. While there is mounting evidence on the importance of the social determinants of health, there are multiple challenges associated with identifying, measuring and taking action on the context specific determinants of health.This dissertation posits that some of the techniques that have been developed in the discipline of health geography offer potential to address these challenges. The objectives of this dissertation were to implement geographic methods for identifying and measuring the context relevant determinants of maternal ill-health, and to elucidate the place specific characteristics of associations between these social determinants and maternal health outcomes. The thematic premise of this dissertation was partly determined through extensive exploration of literature on what is known concerning the use of geographical information systems in maternal health. The core empirical work supporting this dissertation was completed in the southern region of Mozambique and addressed the objectives through both qualitative and quantitative exploration, identifying community perceptions of these determinants and validating them using geostatistical methods. Key data challenges concerning the use of geographical analysis are also addressed. Chiefly, this dissertation contributes a suite of methods that demonstrate how to measure the social determinants of maternal health. While this research was conducted in Mozambique and addresses maternal health, the geographic approach highlighted in this work could be used to understand other health concerns and in different places.