{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:57:33Z","timestamp":1790866653671,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005075","name":"Universitair Medisch Centrum Groningen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005075","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The disparity in maternal mortality and severe morbidity between high\u2010 and low\u2010income countries is well established. Previously, we highlighted within\u2010country disparities in Ethiopia using demographic and health survey data. This study used enhanced obstetric surveillance data to detect subnational hotspot areas and factors associated with disparities in severe maternal morbidity in eastern Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used data from the Ethiopian Obstetric Surveillance System (EthOSS) study, which collected data for all women who experienced severe maternal morbidity in 13 hospitals in eastern Ethiopia between April 2021 and March 2022. Women whose geographical location was not recorded were excluded. We used optimized hotspot analysis to identify areas with higher rates of severe maternal morbidity while controlling for population density and conducted linear and geographically weighted regression analyses to assess factors associated with the distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of all 2043 women with severe maternal outcomes, 1775 (87%) women with severe maternal morbidity with complete geographical information were included for analysis. Less than half (47%) lived within the recommended 2\u2010h travel time to the nearest emergency obstetric and newborn care (EmONC) facility, with significant geographic variation. Hotspot analysis identified clusters of high rates near urban centers such as Dire Dawa and Harari even after controlling for the population density, while lower rates were found in eastern Oromia. Geographically weighted regression analysis showed that proximity to health facilities, especially to a basic or comprehensive EmONC facility, was associated with higher maternal complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights the value of leveraging geocoded surveillance data to conduct geospatial analyses to uncover spatial patterns. We found a higher rate of severe maternal morbidity in the larger cities, indicating that the urban population had better access to care during obstetric complications, while rural and remote areas with limited access might fail to come to hospitals when complications arise or die at home or lower\u2010level facilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70973","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T12:44:27Z","timestamp":1775565867000},"page":"127-137","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Application of geospatial analysis for mapping the distribution of severe maternal morbidities in eastern Ethiopia: The case of the Ethiopian obstetric surveillance system"],"prefix":"10.1002","volume":"175","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9270-9281","authenticated-orcid":false,"given":"Sisay Mulugeta","family":"Alemu","sequence":"first","affiliation":[{"name":"Global Health Unit, Department of Health Sciences University Medical Center Groningen  Groningen the Netherlands"},{"name":"Policy &amp; Implementation Research for Cancer Prevention DKFZ Hector Cancer Institute at the University Medicine Mannheim  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7367-8467","authenticated-orcid":false,"given":"Gerd","family":"Weitkamp","sequence":"additional","affiliation":[{"name":"Department of Cultural Geography, Faculty of Spatial Sciences University of Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1984-4575","authenticated-orcid":false,"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit University of Oxford  Oxford 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Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-6620","authenticated-orcid":false,"given":"Jelle","family":"Stekelenburg","sequence":"additional","affiliation":[{"name":"Global Health Unit, Department of Health Sciences University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department Obstetrics &amp; Gynaecology Leeuwarden Medical Centre  Leeuwarden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-9145","authenticated-orcid":false,"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center  Leiden the Netherlands"},{"name":"Athena Institute Vrije Universiteit Amesterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5532-0242","authenticated-orcid":false,"given":"Regien","family":"Biesma","sequence":"additional","affiliation":[{"name":"Global Health Unit, Department of Health Sciences University Medical Center Groningen  Groningen the Netherlands"},{"name":"Julius Center Global Health University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abera Kenay","family":"Tura","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery College of Health and Medical Sciences, Haramaya University  Haramaya Ethiopia"},{"name":"Department of Obstetrics and Gynaecology University Medical Centre Groningen, University of Groningen  Groningen the Netherlands"},{"name":"Department of International Public Health Liverpool School of Tropical Medicine  Liverpool 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