Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone
Introduction Longer travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reporte...
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/12/e003943.full |
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| author | Håkon A Bolkan Lars Hagander Hampus Holmer Michael M Koroma Alex J van Duinen Håvard A Adde Ola Fredin Andrew JM Leather Arne Wibe |
| author_facet | Håkon A Bolkan Lars Hagander Hampus Holmer Michael M Koroma Alex J van Duinen Håvard A Adde Ola Fredin Andrew JM Leather Arne Wibe |
| author_sort | Håkon A Bolkan |
| collection | DOAJ |
| description | Introduction Longer travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance.Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma et al; model II Munoz et al). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed.Results The median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001).Conclusion The standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off. |
| format | Article |
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| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-0ffdecebda0e42a0904af9f0005e4be22025-08-20T02:31:10ZengBMJ Publishing GroupBMJ Global Health2059-79082020-12-0151210.1136/bmjgh-2020-003943Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra LeoneHåkon A Bolkan0Lars Hagander1Hampus Holmer2Michael M Koroma3Alex J van Duinen4Håvard A Adde5Ola Fredin6Andrew JM Leather7Arne Wibe8CapaCare, Trondheim, Norway, & Tappita, Liberia3 Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, SwedenKarolinska University Hospital, Solna, SwedenMinistry of Health and Sanitation, Freetown, Sierra LeoneInstitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, NorwayDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, NorwayGeological Survey of Norway, Trondheim, NorwayKing`s Centre for Global Health & Health Partnerships, King`s College London, London, UKInstitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, NorwayIntroduction Longer travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance.Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma et al; model II Munoz et al). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed.Results The median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001).Conclusion The standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.https://gh.bmj.com/content/5/12/e003943.full |
| spellingShingle | Håkon A Bolkan Lars Hagander Hampus Holmer Michael M Koroma Alex J van Duinen Håvard A Adde Ola Fredin Andrew JM Leather Arne Wibe Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone BMJ Global Health |
| title | Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone |
| title_full | Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone |
| title_fullStr | Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone |
| title_full_unstemmed | Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone |
| title_short | Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone |
| title_sort | travel time and perinatal mortality after emergency caesarean sections an evaluation of the 2 hour proximity indicator in sierra leone |
| url | https://gh.bmj.com/content/5/12/e003943.full |
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