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Applying the Global Positioning System and Google Earth to Evaluate the Accessibility of Birth Services for Pregnant Women in Northern Malawi


  • Solomon Chih-Cheng Chen MD, PhD,

  • Jung-Der Wang MD, ScD,

  • Joseph Kwong-Leung Yu MD, PhD,

  • Tzu-Yi Chiang RN MSc,

  • Chang-Chuan Chan ScD,

  • Hsiu-Hung Wang RN MSc, PhD,

  • Yohane M. Z. Nyasulu PhD,

  • Rose Kolola-Dzimadzi SRN, SRM, MSc

Address correspondence to Jung-der Wang, MD, ScD, Department of Public Health, College of Medicine, National Cheng Kung University No. 1, University Rd., Tainan, Taiwan. E-mail:


Introduction: The objective of this study was to validate the combined use of the Global Positioning System (GPS) and Google Earth for measuring the accessibility of health care facilities for pregnant women in northern Malawi.

Methods: We used GPS and Google Earth to identify 5 major health care facilities in Mzuzu (Malawi) and the homes of 79 traditional birth attendants (TBAs). The distance and time required for each TBA to reach the nearest health care facility were measured by both GPS and by self-report of the TBAs. A convenience sample of 1138 pregnant women was interviewed about their choices of birth sites for current and previous pregnancies and the time and cost required to access health care facilities.

Results: The correlation coefficient between the objective measurements by GPS and subjective reports by TBAs for time required from their homes to health care facilities was 0.654 (P < .001). Among pregnant women, 45.6% reported that they could reach a health care facility within 2 hours; 23.8% reported paying more than $1 for transportation to health care facilities. For the current study, 82.6% of women intended to give birth at a health care facility. However, only 48.7% of women actually gave birth in a health care facility in a previous pregnancy, and 32.6% were assisted by TBAs.

Discussion: Combined GPS and Google Earth can be useful in the evaluation of accessibility of health care facilities, especially for emergency obstetric care.