Proximity and Prenatal Care: Geographic Accessibility to Healthcare Facilities in N’Djamena, Chad

Abstract

Access to prenatal care is critical for reducing maternal and neonatal mortality rates. Yet, accessibility to healthcare facilities remains an understudied challenge in many sub-Saharan African countries. This study examines the spatial accessibility to healthcare facilities in N’Djamena, Chad, across various transportation modes, as well as the relationship between travel time and adherence to WHO-recommended prenatal care visits. This analysis utilized a mixed-methods approach. A geospatial analysis was conducted to estimate travel times and distances to the nearest healthcare facility across the city of N’Djamena using various transportation modes to uncover areas of low accessibility. This analysis was supplemented with survey data collected from interviews with 67 pregnant women across three different hospitals. Findings show that 72% of the surveyed population use motorcycles or cars and benefit from high accessibility. 95% of these patients have travel times under 26 and 30 minutes, respectively. In contrast, pedestrians have poor accessibility, especially when patients only attend district or national hospitals. This behavior is very likely – 81% of the surveyed population reported bypassing closer facilities, advancing familiarity and quality of care as the main reasons. In this instance, 20% of the population have travel times greater than one hour on foot. While adherence to WHO guidelines was high in early pregnancy (below 20 weeks), it declined in later stages. The study found no statistically significant correlation between travel time and adherence. Improving accessibility for pedestrians will require a combination of health system improvements, better facility distribution, and transport subsidies. The Ministry of Public Health and urban planners can employ similar data-driven approaches to plan the placement of new healthcare facilities and develop outreach strategies to ensure equitable access in a growing urban context.