RESUMEN
Background: Systematic information on the association between community-level determinants and maternal health outcomes and disparities is needed. We aimed to investigate multi-dimensional place-based contributions to Black-White maternal health disparities in the United States. Methods: We constructed the Maternal Vulnerability Index, a geospatial measure of vulnerability to poor maternal health. The index was linked to 13m live births and maternal deaths to mothers aged 10-44 for 2014-2018 in the United States. We quantified racial disparities in exposure to higher risk environments, and used logistic regression to estimate associations between race, vulnerability, and maternal death (n = 3633), low birthweight (n = 1.1m), and preterm birth (n = 1.3m). Findings: Black mothers lived in disproportionately higher maternal vulnerability counties, when compared to White mothers (median of 55 vs 36/100 points). Giving birth in the highest-quartile MVI counties was associated with an increase in the odds of poor outcomes when compared to the lowest-quartile (aOR 1.43 [95% CI 1.20-1.71] for mortality, 1.39 [1.37-1.41] for low birthweight and 1.41 [1.39-1.43] for preterm birth, adjusted for age, educational attainment level and race/ethnicity). Racial disparities exist in low- and high-vulnerability counties: Black mothers in the least vulnerable counties remain at higher risk of maternal mortality, preterm birth, and low birthweight as White mothers in the most vulnerable. Interpretation: Exposure to community maternal vulnerability is associated with increased odds of adverse outcomes, but the Black-White gap in outcomes remained under all vulnerability levels. Our findings suggest that locally-informed precision health interventions and further research into racism are needed to achieve maternal health equity. Funding: Bill & Melinda Gates Foundation (grant number INV-024583).
RESUMEN
In West Africa, long and complex livestock value chains connect producers mostly in the Sahel with consumption basins in urban areas and the coast. Regional livestock trade is highly informal and, despite recent efforts to understand animal movement patterns in the region, remains largely unrecorded. Using CILSS' database on intraregional livestock trade, we built yearly and overall weighted networks of animal movements between markets. We mapped and characterized the trade networks, identified market communities, key markets and their roles. Additionally, we compared the observed network properties with null-model generated ensembles. Most movements corresponded to cattle, were made by vehicle, and originated in Burkina Faso. We found that live animals in the central and eastern trade basins flow through well-defined, long distance trade corridors where markets tend to trade in a disassortive way with others in their proximity. Modularity-based communities indicated that both national and cross-border trade groups exist. The network's degree and link distributions followed a log-normal or a power-law distribution, and key markets located primarily in urban centers and near borders serve as hubs that give peripheral markets access to the regional network. The null model ensembles could not reproduce the observed higher-level properties, particularly the propinquity and highly negative assortativity, suggesting that other possibly spatial factors shape the structure of regional live animal trade. Our findings support eliminating cross-border impediments and improving the condition of the regional road network, which limit intraregional trade of and contribute to the high prices of food products in West Africa. Although with limitations, our study sheds light on the abstruse structure of regional livestock trade, and the role of trade communities and markets in West Africa.