scholarly journals Referral transit time between sending and first-line receiving health facilities: a geographical analysis in Tanzania

2019 ◽  
Vol 4 (Suppl 5) ◽  
pp. e001568
Author(s):  
Michelle M Schmitz ◽  
Florina Serbanescu ◽  
George E Arnott ◽  
Michelle Dynes ◽  
Paul Chaote ◽  
...  
Keyword(s):  
Travel Time ◽  
Time Delays ◽  
Friction Surface ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Facilities ◽  
Referral System ◽  
Surface Model ◽  
Levels Of Care ◽  
Total Travel Time

BackgroundTimely, high-quality obstetric services are vital to reduce maternal and perinatal mortality. We spatially modelled referral pathways between sending and receiving health facilities in Kigoma Region, Tanzania, identifying communication and transportation delays to timely care and inefficient links within the referral system.MethodsWe linked sending and receiving facilities to form facility pairs, based on information from a 2016 Health Facility Assessment. We used an AccessMod cost-friction surface model, incorporating road classifications and speed limits, to estimate direct travel time between facilities in each pair. We adjusted for transportation and communications delays to create a total travel time, simulating the effects of documented barriers in this referral system.ResultsMore than half of the facility pairs (57.8%) did not refer patients to facilities with higher levels of emergency obstetric care. The median direct travel time was 25.9 min (range: 4.4–356.6), while the median total time was 106.7 min (22.9–371.6) at the moderate adjustment level. Total travel times for 30.7% of facility pairs exceeded 2 hours. All facility pairs required some adjustments for transportation and communication delays, with 94.0% of facility pairs’ total times increasing.ConclusionHalf of all referral pairs in Kigoma Region have travel time delays nearly exceeding 1 hour, and facility pairs referring to facilities providing higher levels of care also have large travel time delays. Combining cost-friction surface modelling estimates with documented transportation and communications barriers provides a more realistic assessment of the effects of inter-facility delays on referral networks, and can inform decision-making and potential solutions in referral systems within resource-constrained settings.

scholarly journals “In cities, it’s not far, but it takes long”: comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria

2021 ◽  
Vol 6 (1) ◽  
pp. e004318
Author(s):  
Aduragbemi Banke-Thomas ◽  
Kerry L M Wong ◽  
Francis Ifeanyi Ayomoh ◽  
Rokibat Olabisi Giwa-Ayedun ◽  
Lenka Benova
Keyword(s):  
Travel Time ◽  
Friction Surface ◽  
Obstetric Care ◽  
Travel Times ◽  
Night Time ◽  
Google Maps ◽  
Surface Approach ◽  
Low Resource ◽  
Life Saving ◽  
The Cost

BackgroundTravel time to comprehensive emergency obstetric care (CEmOC) facilities in low-resource settings is commonly estimated using modelling approaches. Our objective was to derive and compare estimates of travel time to reach CEmOC in an African megacity using models and web-based platforms against actual replication of travel.MethodsWe extracted data from patient files of all 732 pregnant women who presented in emergency in the four publicly owned tertiary CEmOC facilities in Lagos, Nigeria, between August 2018 and August 2019. For a systematically selected subsample of 385, we estimated travel time from their homes to the facility using the cost-friction surface approach, Open Source Routing Machine (OSRM) and Google Maps, and compared them to travel time by two independent drivers replicating women’s journeys. We estimated the percentage of women who reached the facilities within 60 and 120 min.ResultsThe median travel time for 385 women from the cost-friction surface approach, OSRM and Google Maps was 5, 11 and 40 min, respectively. The median actual drive time was 50–52 min. The mean errors were >45 min for the cost-friction surface approach and OSRM, and 14 min for Google Maps. The smallest differences between replicated and estimated travel times were seen for night-time journeys at weekends; largest errors were found for night-time journeys at weekdays and journeys above 120 min. Modelled estimates indicated that all participants were within 60 min of the destination CEmOC facility, yet journey replication showed that only 57% were, and 92% were within 120 min.ConclusionsExisting modelling methods underestimate actual travel time in low-resource megacities. Significant gaps in geographical access to life-saving health services like CEmOC must be urgently addressed, including in urban areas. Leveraging tools that generate ‘closer-to-reality’ estimates will be vital for service planning if universal health coverage targets are to be realised by 2030.

scholarly journals Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district

PLoS ONE ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. e0194576 ◽  
Author(s):  
Siphiwe Bridget Pearl Thwala ◽  
Duane Blaauw ◽  
Freddie Ssengooba
Keyword(s):  
South African ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Facilities

scholarly journals Public provision of emergency obstetric care: a case study in two districts of Pakistan

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027187
Author(s):  
Peter Brückmann ◽  
Ashfa Hashmi ◽  
Marina Kuch ◽  
Jana Kuhnt ◽  
Ida Monfared ◽  
...  
Keyword(s):  
Public Health ◽  
Health Sector ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Facilities ◽  
Public Provision ◽  
Signal Functions ◽  
The Public ◽  
Public Health Sector ◽  
Service Provisions

ObjectivesPakistan is one out of five countries where together half of the global neonatal deaths occur. As the provision of services and facilities is one of the key elements vital to reducing this rate as well as the maternal mortality rate, this study investigates the status of the delivery of essential obstetric care provided by the public health sector in two districts in Khyber Pakhtunkhwa in 2015 aiming to highlight areas where critical improvements are needed.SettingWe analysed data from a survey of 22 primary and secondary healthcare facilities as well as 85 community midwives (CMWs) in Haripur and Nowshera districts.ParticipantsUsing a structured questionnaire we evaluated the performance of emergency obstetric care (EmOC) signal functions and patient statistics in public health facilities. Also, 102 CMWs were interviewed about working hours, basic and specialised delivery service provision, referral system and patient statistics.Primary outcome measuresWe investigate the public provision of emergency obstetric care using seven key medical services identified by the United Nations (UN).ResultsDeliveries by public health cadres account for about 30% of the total number of births in these districts. According to the UN benchmark, only a small fraction of basic EmOC (2/18) and half of the comprehensive EmOC (2/4) facilities of the recommended minimum number were available to the population in both districts. Only a minority of health facilities and CMWs carry out several signal functions. Only 8% of the total births in one of the study districts are performed in public EmOC health facilities.ConclusionsBoth districts show a significant shortage of available public EmOC service provisions. Development priorities need to be realigned to improve the availability, accessibility and quality of EmOC service provisions by the public health sector alongside with existing activities to increase institutional births.

scholarly journals Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Shegufta S Sikder ◽  
Alain B Labrique ◽  
Hasmot Ali ◽  
Abu AM Hanif ◽  
Rolf DW Klemm ◽  
...  
Keyword(s):  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Facilities ◽  
Public And Private

scholarly journals National and subnational estimates of coverage and travel time to emergency obstetric care in Afghanistan: Modeling of spatial accessibility

2020 ◽  
Vol 66 ◽  
pp. 102452 ◽  
Author(s):  
Christine Kim ◽  
Hannah Tappis ◽  
Philip McDaniel ◽  
Mohammad Samim Soroush ◽  
Bruce Fried ◽  
...  
Keyword(s):  
Travel Time ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Spatial Accessibility

scholarly journals Review of obstetric fistulas in a rural hospital in South-South Nigeria

2011 ◽  
Vol 25 (1) ◽  
pp. 7
Author(s):  
Aniefiok J. Umoiyoho ◽  
Aniekan M. Abasiattai ◽  
Okon E. Akaiso
Keyword(s):  
Antenatal Care ◽  
Rural Areas ◽  
Formal Education ◽  
Health Workers ◽  
Medical Condition ◽  
Obstetric Fistula ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Medical Personnel ◽  
Health Facilities

<em>Background</em>. Obstetric fistula is a devastating medical condition associated with adverse social, psychological and reproductive health consequences. This study was carried out to review the pattern of presentation and outcome of patients with obstetric fistulas in a rural health facility in South-South Nigeria. <em>Design and Method</em>. A retrospective review of case notes of 51 patients with obstetric fistula that were managed at the Family Life Center, Mbribit Itam, in Itu, Local Government Area of Akwa Ibom State. <em>Results</em>. During the study period, 51 obstetric fistulas were repaired in the hospital. The ages of the patients ranged from 15 to 50 years with median age of 25.8 years and modal age group of 21-30 years (45.1%). The majority of the patients were of low parity (72.5%), 56.9% had no formal education and 27.5% were traders. Thirty four patients (66.7%) had their fistulas for between 1 and 6 years, 19.6% of the patients had juxta-cervical fistulas, while eight (15.7%) had circumferential loss of the urethra. Thirty-seven (72.5%) of them where unbooked and thus had no antenatal care, while 4 (7.8%) booked and had antenatal care in conventional health facilities. Thirty-four patients (66.7%) remained dry twenty-one days after surgery, thirteen (23.5%) were still wet, while 4 patients (7.8%) had stress incontinence despite repair. <em>Conclusion</em>. Obstetric fistulas are found most commonly among young, poorly educated women of low parity who do not avail themselves of orthodox ANC in our environment. Government, community and religious leaders must make concerted efforts to ensure women obtain formal education and when pregnant, have access to emergency obstetric care even if resident in the rural areas. Government, relevant non-Governmental organisations, community leaders and health workers should through relevant health messages enlighten women in the community about obstetric fistulas and the dangers of delivering in unorthodox health facilities. More medical personnel should be trained as the first attempt at repair is the one that is most likely to succeed.

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