An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality

Objectives In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This stud...

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Bibliographic Details
Published in:Tropical medicine & international health 2013-08, Vol.18 (8), p.993-1001
Main Authors: Tayler‐Smith, K., Zachariah, R., Manzi, M., Boogaard, W., Nyandwi, G., Reid, T., Plecker, E., Lambert, V., Nicolai, M., Goetghebuer, S., Christiaens, B., Ndelema, B., Kabangu, A., Manirampa, J., Harries, A. D.
Format: Article
Language:English
Subjects:
Adult
ambulance
Ambulance services
Ambulances - economics
Ambulances - organization & administration
Biological and medical sciences
Burundi
Burundi - epidemiology
Cesarean section
Cross-Sectional Studies
Emergency Medical Service Communication Systems - economics
Emergency Medical Services - methods
Emergency Medical Services - statistics & numerical data
emergency obstetric care
Female
General aspects
Health Care Costs
Health Services Accessibility
Humans
Infant, Newborn
International Agencies
Maternal & child health
Maternal Death - prevention & control
Maternal Health Services - methods
Maternal Health Services - statistics & numerical data
Maternal Mortality
Medical sciences
Mortality
Obstetric Labor Complications - epidemiology
Obstetric Labor Complications - therapy
Obstetric Surgical Procedures - statistics & numerical data
Obstetrics
Patient Transfer - economics
Patient Transfer - methods
Patient Transfer - statistics & numerical data
Perinatal Mortality
Pregnancy
Program Evaluation
referral
Referral and Consultation - statistics & numerical data
Referrals
Retrospective Studies
Rural Population - statistics & numerical data
Time Factors
Young Adult
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Summary:Objectives In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections. Methods Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records. Results In 2011, there were 1478 ambulance call‐outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52–130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1–3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively. Conclusion This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays. ObjectifsEn 2006, Médecins Sans Frontières (MSF) a mis en place un service d'orientation pour des soins obstétricaux et néonataux d'urgence (SONU) lié à un système de transfert par l'ambulance pour référer les femmes avec des complications obstétricales dans les maternités périphériques dans le district de Kabezi, en milieu rural au Burundi. Cette étude visait à (a) décrire le service de communication et d'ambulance ainsi que le coût, (b) d'examiner l'association entre les temps de transfert et les décès néonataux précoces et maternels et (c) d'évaluer l'impact du service de transfert sur la couverture des cas d'obstétriques compliqués et des césariennes.MéthodesLes données ont été recueillies pour la période de janvier à décembre 2011 à l'aide des carnets de bord des ambulances, des registres des patients et des données de l
ISSN:1360-2276
1365-3156
DOI:10.1111/tmi.12121