Effects of Improved Access to Transportation on Emergency obstetric Care Outcomes in Uganda

Stephen Mucunguzi, Henry Wamani, Peter Lochoro, Thorkild Tylleskar

Abstract

Reduction in maternal mortality has not been appreciable in most low-income countries. Improved access to transport for mothers is one way to improve maternal health. This study evaluated a free-of-charge 24-hour ambulance and communication services intervention in Oyam district using ‘Caesarean section rate’ (CSR) and compared with the neighbouring non-intervention district. Ecological data were collected retrospectively from maternity/theatre registers in October 2010 for 3 years pre and 3 years intervention period. The average CSR in the intervention district increased from 0.57% before the intervention to 1.21% (p=0.022) during the intervention, while there was no change in the neighbouring district (0.51% to 0.58%, p=0.512). Hospital deliveries increased by over 50% per year with a slight reduction in the average hospital stillbirths per 1000 hospital births in the intervention district (46.6 to 37.5, p=0.253). Reliable communication and transport services increased access to and utilization of maternal health services, particularly caesarean delivery services. (Afr J Reprod Health 2014; 18[3]: 87-94)

 

Keywords: caesarean section, emergency obstetric care, ambulance services, accessibility, referral and communication system 

 

Résumé 

La réduction de la mortalité maternelle n'a pas été appréciable dans la plupart des pays à faible revenu. L’amélioration de l'accès aux transports pour les mères est une façon d'améliorer la santé maternelle. Cette étude a évalué l’intervention des services gratuits d’ambulance et des communications assurés pour 24 heures dans le district d'Oyam à l’aide de « taux d’opération césarienne» (TOC) et nous l’avons comparé avec le quartier voisin de non-intervention. Les données écologiques ont été recueillies rétrospectivement à partir des dossiers de maternité / théâtre en octobre 2010 au cours de trois ans avant et pendant la période d'intervention de 3 ans. Le TOC moyen dans le district d'intervention a augmenté de 0,57% avant l'intervention à 1,21% (p = 0,022) au cours de l'intervention, alors qu'il n'y avait pas de changement dans le district voisin (0,51% à 0,58%, p = 0,512). L’accouchement à l'hôpital a augmenté de plus de 50% par an, avec une légère diminution dans les mortinaissances en milieu hospitalier   pour 1000 naissances dans le district d'intervention (de 46,6 à 37,5, p = 0,253). Les services de communication et de transport fiables ont augmenté l'accès aux, et à l'utilisation des services de santé maternelle, notamment les services d’accouchement par voie césarienne. (Afr J Reprod Health 2014; 18[3]: 87-94)

 

Mots-clés: césarienne, soins obstétricaux d'urgence, services ambulanciers, accessibilité, orientation et le système de

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