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Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique

INTRODUCTION: Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program t...

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Autores principales: Amosse, Felizarda, Boene, Helena, Kinshella, Mai-Lei Woo, Drebit, Sharla, Sharma, Sumedha, Makanga, Prestige Tatenda, Valá, Anifa, Magee, Laura A., von Dadelszen, Peter, Vidler, Marianne, Sevene, Esperança, Munguambe, Khátia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Global Health: Science and Practice 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971369/
https://www.ncbi.nlm.nih.gov/pubmed/33727325
http://dx.doi.org/10.9745/GHSP-D-20-00511
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author Amosse, Felizarda
Boene, Helena
Kinshella, Mai-Lei Woo
Drebit, Sharla
Sharma, Sumedha
Makanga, Prestige Tatenda
Valá, Anifa
Magee, Laura A.
von Dadelszen, Peter
Vidler, Marianne
Sevene, Esperança
Munguambe, Khátia
author_facet Amosse, Felizarda
Boene, Helena
Kinshella, Mai-Lei Woo
Drebit, Sharla
Sharma, Sumedha
Makanga, Prestige Tatenda
Valá, Anifa
Magee, Laura A.
von Dadelszen, Peter
Vidler, Marianne
Sevene, Esperança
Munguambe, Khátia
author_sort Amosse, Felizarda
collection PubMed
description INTRODUCTION: Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program to improve access to emergency obstetric care in southern Mozambique. METHODS: From April 2016 to February 2017, a community transport strategy was implemented as part of the Community Level Interventions for Pre-eclampsia Trial. The study aimed to reduce maternal and perinatal mortality and morbidity by 20% in intervention clusters in Maputo and Gaza Provinces, Mozambique, by involving community health workers in the identification and referral of pregnant and puerperal women at risk. Based on a community-based participatory needs assessment, the transport program was implemented with the trial. Demographics, conditions requiring transportation, means of transport used, route, and outcomes were collected during implementation. Data were entered into a REDCap database. RESULTS: Fifty-seven neighborhoods contributed to the needs assessment; of those, 13 (23%) implemented the transport program. Neighborhoods were selected based on their expression of interest and ability to contribute financially to the program (US$0.33 per family per month). In each selected neighborhood, a community management committee was created, training in small-scale financial management was conducted, and monitoring tools were provided. Twenty people from 9 neighborhoods benefited from the transport program, 70% were pregnant and postpartum women. CONCLUSION: These results demonstrate that it was feasible to implement a community-based transport program with no external input of vehicles, fuel, personnel, and maintenance. However, high cost and a lack of acceptable transport options in some communities continue to impede access to obstetric health care services and the ability for timely follow-up. When strengthening capacities of community health workers to promptly assist and refer emergency cases, it is crucial to encourage local transport programs and transportation infrastructure among minimally resourced communities to support access and engagement with health systems.
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spelling pubmed-79713692021-03-19 Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique Amosse, Felizarda Boene, Helena Kinshella, Mai-Lei Woo Drebit, Sharla Sharma, Sumedha Makanga, Prestige Tatenda Valá, Anifa Magee, Laura A. von Dadelszen, Peter Vidler, Marianne Sevene, Esperança Munguambe, Khátia Glob Health Sci Pract Original Article INTRODUCTION: Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program to improve access to emergency obstetric care in southern Mozambique. METHODS: From April 2016 to February 2017, a community transport strategy was implemented as part of the Community Level Interventions for Pre-eclampsia Trial. The study aimed to reduce maternal and perinatal mortality and morbidity by 20% in intervention clusters in Maputo and Gaza Provinces, Mozambique, by involving community health workers in the identification and referral of pregnant and puerperal women at risk. Based on a community-based participatory needs assessment, the transport program was implemented with the trial. Demographics, conditions requiring transportation, means of transport used, route, and outcomes were collected during implementation. Data were entered into a REDCap database. RESULTS: Fifty-seven neighborhoods contributed to the needs assessment; of those, 13 (23%) implemented the transport program. Neighborhoods were selected based on their expression of interest and ability to contribute financially to the program (US$0.33 per family per month). In each selected neighborhood, a community management committee was created, training in small-scale financial management was conducted, and monitoring tools were provided. Twenty people from 9 neighborhoods benefited from the transport program, 70% were pregnant and postpartum women. CONCLUSION: These results demonstrate that it was feasible to implement a community-based transport program with no external input of vehicles, fuel, personnel, and maintenance. However, high cost and a lack of acceptable transport options in some communities continue to impede access to obstetric health care services and the ability for timely follow-up. When strengthening capacities of community health workers to promptly assist and refer emergency cases, it is crucial to encourage local transport programs and transportation infrastructure among minimally resourced communities to support access and engagement with health systems. Global Health: Science and Practice 2021-03-15 /pmc/articles/PMC7971369/ /pubmed/33727325 http://dx.doi.org/10.9745/GHSP-D-20-00511 Text en © Amosse et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00511
spellingShingle Original Article
Amosse, Felizarda
Boene, Helena
Kinshella, Mai-Lei Woo
Drebit, Sharla
Sharma, Sumedha
Makanga, Prestige Tatenda
Valá, Anifa
Magee, Laura A.
von Dadelszen, Peter
Vidler, Marianne
Sevene, Esperança
Munguambe, Khátia
Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
title Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
title_full Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
title_fullStr Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
title_full_unstemmed Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
title_short Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique
title_sort implementation of a community transport strategy to reduce delays in seeking obstetric care in rural mozambique
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971369/
https://www.ncbi.nlm.nih.gov/pubmed/33727325
http://dx.doi.org/10.9745/GHSP-D-20-00511
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