Original Research Spatial analysis of perinatal mortality rates with geographic information systems in Kocaeli, Turkey O. Arslan a, *, M.S. C ¸ epni a , N. Etiler b a Department of Geomatics, Engineering Faculty, Kocaeli University, Kocaeli, Turkey b Public Health Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey article info Article history: Received 9 February 2012 Received in revised form 27 August 2012 Accepted 13 December 2012 Available online 7 March 2013 Keywords: Perinatal mortality Geographic information systems Health Spatial data Spatial autocorrelation summary Objectives: To determine the spatial patterns of perinatal mortality in Kocaeli, Turkey using geographic information systems (GIS); to examine whether regional differences exist for the period selected; and whether these differences are linked to regional risk factors. Study design: Ecological research. Methods: Data were obtained from the linked birthedeath records data registry maintained by Kocaeli Provincial Health Directorate. Mortality data are added to the geodatabase on a monthly basis. Spatial patterns of mortality rates were determined with GIS by mapping the case differences in the districts, and spatial autocorrelation was used to examine the spatial pattern of mortality rates in the region. Results: Various risk factors contributing to spatial variation of perinatal mortality were revealed in the region. Districts with high mortality rates were shown to be sensitive to these risk factors. The results of this study confirm the direct link between perinatal mortality and poor environmental conditions in the study region. The analyses applied in the study showed that some complex demographic and socio-economic factors should be associated with perinatal mortality rates to identify the geographic patterns of mortality. Conclusions: Implementation of spatial tools within GIS for mortality data showed the efficiency of GIS in perinatal mortality surveillance. This study also demonstrated the capability and utility of GIS to clarify the geographical distribution of perinatal mortality rates in the study area. ª 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. Introduction Perinatal mortality is an important indicator of health and the quality of healthcare. It is a crucial indicator of maternal care, and maternal health and nutrition, and also reflects the quality of obstetric and paediatric care available. Awareness of mortality rates has increased among countries and regions, due to the provision of information needed to improve the health status and antenatal care of pregnant women. That information allows decision makers to identify problems, track temporal and geographical trends and disparities, and assess changes in public health policy and practice. Although * Corresponding author. Department of Geomatics, Engineering Faculty, Kocaeli University, Umuttepe Yerleskesi, 41380 Kocaeli, Turkey. Tel.: þ90 262 3033244. E-mail address: ozan601@yahoo.com (O. Arslan). Available online at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe public health 127 (2013) 369 e379 0033-3506/$ e see front matter ª 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.puhe.2012.12.009