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An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality | Journal Article / Research | MSF Science Portal
Journal Article
|Research

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

Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Nyandwi G, Reid AJ, de Plecker E, Lambert V, Nicolai M, Goetghebuer S, Christaens B, Ndelema B, Kabangu A, Manirampa J, Harries AD
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Abstract
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.

Countries

Burundi

Subject Area

women's health

Languages

English
DOI
10.1111/tmi.12121
Published Date
18 May 2013
PubMed ID
23682859
Journal
Tropical Medicine and International Health
Volume | Issue | Pages
Volume 18, Issue 8, Pages 993-1001
Issue Date
2013-05-18
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