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Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study

INTRODUCTION: 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 countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the ac...

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Autores principales: Caviglia, Marta, Putoto, Giovanni, Conti, Andrea, Tognon, Francesca, Jambai, Amara, Vandy, Matthew Jusu, Youkee, Daniel, Buson, Riccardo, Pini, Sara, Rosi, Paolo, Hubloue, Ives, Della Corte, Francesco, Ragazzoni, Luca, Barone-Adesi, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634006/
https://www.ncbi.nlm.nih.gov/pubmed/34844999
http://dx.doi.org/10.1136/bmjgh-2021-007315
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author Caviglia, Marta
Putoto, Giovanni
Conti, Andrea
Tognon, Francesca
Jambai, Amara
Vandy, Matthew Jusu
Youkee, Daniel
Buson, Riccardo
Pini, Sara
Rosi, Paolo
Hubloue, Ives
Della Corte, Francesco
Ragazzoni, Luca
Barone-Adesi, Francesco
author_facet Caviglia, Marta
Putoto, Giovanni
Conti, Andrea
Tognon, Francesca
Jambai, Amara
Vandy, Matthew Jusu
Youkee, Daniel
Buson, Riccardo
Pini, Sara
Rosi, Paolo
Hubloue, Ives
Della Corte, Francesco
Ragazzoni, Luca
Barone-Adesi, Francesco
author_sort Caviglia, Marta
collection PubMed
description INTRODUCTION: 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 countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality. METHODS: We collected prehospital data of 6387 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 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data. RESULTS: At the national level, the proportion of emergency obstetric referrals with a PT within 2 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 between 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 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%. CONCLUSION: NEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes.
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spelling pubmed-86340062021-12-10 Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study Caviglia, Marta Putoto, Giovanni Conti, Andrea Tognon, Francesca Jambai, Amara Vandy, Matthew Jusu Youkee, Daniel Buson, Riccardo Pini, Sara Rosi, Paolo Hubloue, Ives Della Corte, Francesco Ragazzoni, Luca Barone-Adesi, Francesco BMJ Glob Health Original Research INTRODUCTION: 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 countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality. METHODS: We collected prehospital data of 6387 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 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data. RESULTS: At the national level, the proportion of emergency obstetric referrals with a PT within 2 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 between 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 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%. CONCLUSION: NEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes. BMJ Publishing Group 2021-11-29 /pmc/articles/PMC8634006/ /pubmed/34844999 http://dx.doi.org/10.1136/bmjgh-2021-007315 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Caviglia, Marta
Putoto, Giovanni
Conti, Andrea
Tognon, Francesca
Jambai, Amara
Vandy, Matthew Jusu
Youkee, Daniel
Buson, Riccardo
Pini, Sara
Rosi, Paolo
Hubloue, Ives
Della Corte, Francesco
Ragazzoni, Luca
Barone-Adesi, Francesco
Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
title Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
title_full Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
title_fullStr Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
title_full_unstemmed Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
title_short Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
title_sort association between ambulance prehospital time and maternal and perinatal outcomes in sierra leone: a countrywide study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634006/
https://www.ncbi.nlm.nih.gov/pubmed/34844999
http://dx.doi.org/10.1136/bmjgh-2021-007315
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