Abstract
BackgroundTo maximise the potential benefits of maternity care services, pregnant women need to be able to physically get to health facilities in a timely manner. In most of sub–Saharan Africa, transport represents a major practical barrier. Here we evaluate the extent to which an innovative national ambulance service in Ethiopia, together with mobile phones, may have been successful in averting pregnancy–related deaths.MethodsAn operational assessment of pregnancy–related deaths in relation to utilisation of the new national ambulance service was undertaken in six randomly selected Districts in northern Ethiopia. All 183 286 households in the six randomly selected Districts were visited to identify live–births and deaths among women of reproductive age that occurred over a one–year period. The uptake of the new ambulance transport service for women’s deliveries in the same six randomly selected Districts over the same period was determined retrospectively from ambulance log books. Pregnancy–related deaths as determined by the World Health Organization (WHO 2012) verbal autopsy tool [13] and the InterVA–4 model [14] were analysed against ambulance utilisation by District, month, local area, distance from health facility and mobile network coverage.FindingsA total of 51 pregnancy–related deaths and 19 179 live–births were documented. Pregnancy–related mortality for Districts with above average ambulance utilisation was 149 per 100 000 live–births (95% confidence interval CI 77–260), compared with 350 per 100 000 (95% CI 249–479) for below average utilisation (P = 0.01). Distance to a health facility, mobile network availability and ambulance utilisation were all significantly associated with pregnancy–related mortality on a bivariable basis. On a multivariable basis, ambulance non–utilisation uniquely persisted as a significant determinant of mortality (mortality rate ratio 1.97, 95% CI 1.05–3.69; P = 0.03).ConclusionsThe uptake of freely available transport in connection with women’s obstetric needs correlated with substantially reduced pregnancy–related mortality in this operational assessment, though the design did not allow cause and effect to be attributed. However, the halving of pregnancy–related mortality associated with ambulance uptake in the sampled Districts suggests that the provision of transport to delivery facilities in Africa may be a key innovation for delivering maternal health care, which requires wider consideration.
Highlights
The halving of pregnancy–related mortality associated with ambulance uptake in the sampled Districts suggests that the provision of transport to delivery facilities in Africa may be a key innovation for delivering maternal health care, which requires wider consideration
Despite major international concerns around maternal health and institutional delivery rates [1], little innovative thought has been given to the logistic issues of getting African women in to appropriate institutions in a timely fashion
Though that innovation was widely considered unscalable and unsustainable, millions of pregnant African women have died in the intervening decades, partly from not being able to reach maternity services [3,4]
Summary
All 183 286 households in the six randomly selected Districts were visited to identify live–births and deaths among women of reproductive age that occurred over a one–year period. A two–stage retrospective household mortality survey was carried out in mid–2013 by community health staff in the selected Districts, following up deaths among women of reproductive age (15–49 years) over a one–year period (from the ninth month of Ethiopian year 2004 to the eighth month of Ethiopian year 2005, corresponding to 9 May 2012 to 8 May 2013 in the international calendar) using the WHO 2012 verbal autopsy tool [13], and deriving cause of death using the corresponding InterVA–4 model [14]. Maternal mortality ratio (MMR) is defined here as pregnancy–related deaths per 100 000 live–births, as adopted by the Demographic and Health Survey programme [9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
