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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

See all articles by Marta Caviglia

Marta Caviglia

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM)

Giovanni Putoto

Doctors with Africa CUAMM

Andrea Conti

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM)

Francesca Tognon

Doctors with Africa CUAMM

Amara Jambai

Government of Sierra Leone - Ministry of Health and Sanitation

Matthew Jusu Vandy

Government of Sierra Leone - Ministry of Health and Sanitation

Riccardo Buson

Doctors with Africa CUAMM

Sara Pini

Doctors with Africa CUAMM

Paolo Rosi

Regione Veneto - SUEM 118 - Servizio Urgenza Emergenza Medica

Ives Hubloue

Vrije Universiteit Brussel (VUB) - Research Group on Emergency and Disaster Medicine

Francesco Della Corte

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM)

Luca Ragazzoni

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM)

Francesco Barone-Adesi

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM)

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

Caviglia, Marta and Putoto, Giovanni and Conti, Andrea and Tognon, Francesca and Jambai, Amara and Vandy, Matthew Jusu and Buson, Riccardo and Pini, Sara and Rosi, Paolo and Hubloue, Ives and Della Corte, Francesco and Ragazzoni, Luca and Barone-Adesi, Francesco, Association Between Ambulance Prehospital Time and Maternal and Perinatal Outcomes in Sierra Leone: A Countrywide Study. Available at SSRN: https://ssrn.com/abstract=3906593 or http://dx.doi.org/10.2139/ssrn.3906593

Marta Caviglia (Contact Author)

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM) ( email )

Novara
Italy

Giovanni Putoto

Doctors with Africa CUAMM ( email )

Padua
Italy

Andrea Conti

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM) ( email )

Novara
Italy

Francesca Tognon

Doctors with Africa CUAMM ( email )

Padua
Italy

Amara Jambai

Government of Sierra Leone - Ministry of Health and Sanitation ( email )

Freetown
Sierra Leone

Matthew Jusu Vandy

Government of Sierra Leone - Ministry of Health and Sanitation ( email )

Freetown
Sierra Leone

Riccardo Buson

Doctors with Africa CUAMM ( email )

Padua
Italy

Sara Pini

Doctors with Africa CUAMM ( email )

Padua
Italy

Paolo Rosi

Regione Veneto - SUEM 118 - Servizio Urgenza Emergenza Medica ( email )

Italy

Ives Hubloue

Vrije Universiteit Brussel (VUB) - Research Group on Emergency and Disaster Medicine ( email )

Brussels
Belgium

Francesco Della Corte

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM) ( email )

Novara
Italy

Luca Ragazzoni

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM) ( email )

Novara
Italy

Francesco Barone-Adesi

University of Eastern Piedmont - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM) ( email )

Novara
Italy

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