Longer travel time to district hospital worsens neonatal outcomes: a retrospective cross-sectional study of the effect of delays in receiving emergency cesarean section in Rwanda

BMC Pregnancy and Childbirth

Research Article

Joseph Niyitegeka¹  Paulin Banguti¹  Georges Nshimirimana²  Regis Habimana²  Theoneste Nkurunziza³  Martin Macharia³  Bethany Hedt-Gauthier⁴  Hema Magge⁵  Jackline Odhiambo⁶  Robert Riviello⁷  Yihan Lin⁸  Allison Silverstein⁹  Stephen Rulisa^1,10 

[1] Department of Anesthesia, Critical Care and Emergency Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda;Ministry of Health, Kigali, Rwanda;Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda;Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda;Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA;Partners In Health / Inshuti Mu Buzima, Kigali, Rwanda;Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA;Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA;Partners In Health, Boston, MA, USA;Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA;Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA;Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA;Department of Surgery, University of Colorado Hospital, Aurora, CO, USA;Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA;Miller School of Medicine, University of Miami, Miami, FL, USA;School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda;

关键词: Emergency obstetric care;    Rural health delivery;    Maternal and newborn health;    Neonatal mortality;    Quality improvement;    Sub-Saharan Africa;   

DOI  :  10.1186/s12884-017-1426-1

 received in 2017-01-14, accepted in 2017-07-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn low-resource settings, access to emergency cesarean section is associated with various delays leading to poor neonatal outcomes. In this study, we described the delays a mother faces when needing emergency cesarean delivery and assessed the effect of these delays on neonatal outcomes in Rwanda.MethodsThis retrospective study included 441 neonates and their mothers who underwent emergency cesarean section in 2015 at three district hospitals in Rwanda. Four delays were measured: duration of labor prior to hospital admission, travel time from health center to district hospital, time from admission to surgical incision, and time from decision for emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR <7 at 5 min or death) and favorable (alive and APGAR ≥7 at 5 min). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression.ResultsIn our study, 9.1% (40 out of 401) of neonates had an unfavorable outcome, 38.7% (108 out of 279) of neonates’ mothers labored for 12–24 h before hospital admission, and 44.7% (159 of 356) of mothers were transferred from health centers that required 30–60 min of travel time to reach the district hospital. Furthermore, 48.1% (178 of 370) of cesarean sections started within 5 h after hospital admission and 85.2% (288 of 338) started more than 30 min after the decision for cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 min of travel time from the health center to the district hospital compared to mothers referred from health centers located on the same compound as the hospital (aOR = 5.12, p = 0.02). Neonates with cesarean deliveries starting more than 30 min after decision for cesarean section had better outcomes than those starting immediately (aOR = 0.32, p = 0.04).ConclusionsLonger travel time between health center and district hospital was associated with poor neonatal outcomes, highlighting a need to decrease barriers to accessing emergency maternal services. However, longer decision to incision interval posed less risk for adverse neonatal outcome. While this could indicate thorough pre-operative interventions including triage and resuscitation, this relationship should be studied prospectively in the future.

【 授权许可】

CC BY   
© The Author(s). 2017