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Association Between Ambulance Prehospital Time and Maternal and Perinatal Outcomes in Sierra Leone: A Countrywide Study
25 Pages Posted: 17 Aug 2021
More...Abstract
Background: Sierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a country-wide assessment to analyze NEMS operational times for obstetric emergencies in respect to one of the goals proposed by the Lancet Commission on Global Surgery (LCoGS), namely the access to timely essential surgery within two hours for at least 80% of the population. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality.
Methods: We collected prehospital data of 6,387 obstetric emergencies referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within two hours. The association between PT and mortality was investigated using Poisson regression models for binary data.
Findings: At the national level, the proportion of emergency obstetric referral with a PT within two hours was 58.5% (95% CI 56.9 to 60.1) during the rainy season and 61.4% (95% CI 59.5 to 63.2) during the dry season. Results were substantially different among districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120 and 180 minutes of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for newborn were 16%, 18% and 25%.
Interpretation: Despite the implementation of NEMS, operational times for obstetric emergencies in Sierra Leone still does not meet the LCoGS target for access to timely essential surgery. Maternal and perinatal risk of death increased concurrently with operational times and any reduction of the time to reach the hospital, even if still exceeding the two-hour benchmark, might translate into better patients’ outcomes.
Funding: None to declare.
Declaration of Interest: None to declare.
Ethical Approval: Sierra Leone’s Ethics and Scientific Committee; Ethics Committee of the
Maggiore Hospital, Novara, Italy.
Suggested Citation: Suggested Citation