Shoklo Malaria Research Unit (SMRU) has had a major focus on reproductive health in border communities on the Thailand–Myanmar border for decades, led for many years by Professor Rose McGready.
One of the rewarding outcomes of the METF mapping work was linking many of the home communities of pregnant women who had been making their way to SMRU migrant antenatal care (ANC) clinics over the years. Prior to METF, this was a bit of a black box — women would arrive, often sharing harrowing stories of how far and how long they had traveled, sometimes entirely on foot.
A student visitor, Eric Steinbrook, worked with ANC handwritten records and local Karen staff to cross-validate and link these records to the METF database. This enabled us to measure the rough distances pregnant women had traveled over time.
Maps indicating catchment areas for the clinics over time. Each of the four clinics is indicated by a different color scheme. The ellipses are standard deviational ellipses (with 2 and 3 standard deviations), with the darker circle representing roughly 98% of people’s home villages for that specific clinic and the lighter circle representing 99.9% of people’s home villages. WPA (green) and MKT (blue) provided both antenatal care and skilled birth attendants, and MRC (yellow) and WAL (orange) provided antenatal care. These ellipses were originally generated using CrimeStat; a similar process can now be done in R using the SDEtool.
Photo: Supplemental material from Steinbrook et al. 2021. See citation below.
- Late ANC initiation: Women presenting for antenatal care in the 3rd trimester traveled 50% farther than those enrolled in the 1st trimester (Distance Ratio, DR = 1.5; 95% CI 1.4–1.5).
- Loss to follow-up (LTFU): Women who dropped out of care traveled 50% farther than those with full-term deliveries (DR = 1.5; 95% CI 1.4–1.5).
- Malaria in pregnancy: Cases of Plasmodium falciparum infection were associated with 60% greater travel distance (DR = 1.6; 95% CI 1.6–1.8).
- Geographic access to ANC remains a significant barrier.
- The true magnitude of the access gap is unknown (we cannot account for those missing entirely from our data).
- Service delivery models need to reach women in their communities, rather than relying on them to undertake difficult journeys.
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Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand–Myanmar border from 2007 to 2015, a pregnancy cohort study.
Steinbrook E, Min MC, Kajeechiwa L, Wiladphaingern J, Kho Paw M, Paw Jay Pimanpanarak M, Parker DM, et al. BMC Pregnancy and Childbirth. 2021;21:802.
https://doi.org/10.1186/s12884-021-04276-5 -
Trends and birth outcomes in adolescent refugees and migrants on the Thailand–Myanmar border, 1986–2016: an observational study.
Parker AL, Parker DM, Zan BN, et al. Wellcome Open Research. 2018;3:62.
https://doi.org/10.12688/wellcomeopenres.14613.1 -
Empirical lessons regarding contraception in a protracted refugee setting: A descriptive study from Maela camp on the Thai–Myanmar border, 1996–2015.
Srikanok S, Parker DM, Parker AL, Lee T, Min AM, Ontuwong P, Tan SO, Sirinonthachai S, McGready R. PLOS ONE. 2017;12(2):e0172007.
https://doi.org/10.1371/journal.pone.0172007
These repositories connect different parts of my spatial epidemiology research:
- spatial-epidemiology-hub — Umbrella repository tying together my career arc.
- earth-observation-hub — How Earth Observation methods became central to my work, with curated papers and case studies.
- activity-spaces — Research on multi-place exposure (farm huts, GPS, mobile phone data) and its health relevance.
- METF-mapping — Mapping malaria post placement & community engagement.
- tMDA-program — Targeted mass drug administration trials & modeling.
- early-dx-tx — Early access to malaria diagnosis & treatment.
- tm-border-mch — Maternal and child health research on the Thailand–Myanmar border.