Geographical access, transport and referral systems.

Munjanja, Stephen; Magure, Tsitsi; Kandawasvika, Gwendoline; Hussein, Julia; McCaw-Binns, Affette; Webber, Robert J.

doi:10.1079/9781845937454.0139

Cited by 10 publications

(7 citation statements)

References 72 publications

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“…The most prominent type of article included was cohort study, with 19 studies having critical appraisal scores ranging from 55% to 100%. 15,[41][42][43]45,47,[54][55][56][57][58][59][60][61][62][63][64][65][66] For this study type, the greatest concerns were whether confounding factors were identified and dealt with appropriately, as well as whether they used the…”

Section: Methodological Qualitymentioning

confidence: 99%

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review

Dol

Hughes

Bonet

et al. 2022

JBI Evidence Synthesis

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Objective: The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). Introduction: Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period. Inclusion criteria: This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to the available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants. Methods: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by 2 reviewers using a study-specific data extraction form. All conflicts were resolved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively. Results: A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,760,731 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week had the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8 and 28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2 and 7 (48.1%), and diarrhea between days 8 and 28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%). Conclusion: Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring r...

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Section: Methodological Qualitymentioning

confidence: 99%

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review

Dol

Hughes

Bonet

et al. 2022

JBI Evidence Synthesis

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“…Maternal deaths mostly occur around time of birth from obstetric complications [8]. These complications are often unpredictable and estimated to affect 15% of pregnant women [8,9,10]. Management of obstetric complications requires specialized care of Emergency Obstetric and Newborn Care (EmONC) [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…These complications are often unpredictable and estimated to affect 15% of pregnant women [8,9,10]. Management of obstetric complications requires specialized care of Emergency Obstetric and Newborn Care (EmONC) [9,10]. The EmONC is a strategy for reducing maternal and neonatal mortality by focusing on identification, referral and treatment of women with obstetric complications [2].…”

Section: Introductionmentioning

confidence: 99%

“…These delays were delay in decision making to seek care, delay in reaching the health facility and delay in provision of prompt care at the health facility [11]. The second delay, which is due to poor referral transportation to an EmONC facility is most neglected in LDC [12] and known to be responsible for a significant proportion of maternal and newborn deaths in these countries [9]. In Ghana, one in every five births occur at home with no access to skilled attendant especially in rural areas due mainly to poor access to referral transportation [7].…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness Analysis of a Community Emergency Transport System for Maternal Care in Northern Ghana

Ofosu

2023

TIJAR

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Maternal mortality is a function of economic underdevelopment. Obstetric complications are the major cause of maternal mortality. Early detection, rapid transportation and prompt care utilizing Emergency Obstetric and Newborn Care (EmONC) can help end preventable maternal mortality. However, poor referral transportation limits utilization of lifesaving EmONC in least developed countries. Korea International Cooperation Agency supported Ghana to implement a 5-year Primary Health Care project in Upper East region in 2016. This project had a Community Emergency Transport System (CETS) component. CETS was implemented using customized ‘motorking’ tricycle ambulances to strengthen maternal referral transportation. We conducted cost-effectiveness analysis to determine CETS’ value-for-money (VfM). The incremental cost-effectiveness ratio (ICER) and incremental net-benefit (INB) were estimated. The study perspective was societal. The comparator was traditional transportation system (TTS). The cost-effectiveness threshold was Ghana’s GDP for 2020 (USD2,254.15/GH₵11,045.34). The study respondents were women with pregnancy experience in 2020 within the project area who utilize a referral transport. Respondents were randomly selected from CETS and TTS areas. Primary and secondary data were collected at households and health facilities respectively. Data was analyzed with STATA 15.0. The ICER computed was GH₵559.69 (USD114.22). CETS was deemed cost-effective because ICER was below the cost-effectiveness threshold. The net-benefit was GH₵31,456.96 (USD6,419.79). The INB was less than zero (-2002.61) implying CETS was not cost-effective. There was a conflict between ICER and INB on VfM of CETS. Affordability should be considered in Policy adoption. Keywords: Community emergency transport system, Cost-effectiveness, Ending preventable maternal mortality, Northern Ghana, Traditional transport system.

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“…In this study, our operational definition of access to care, is travel times to care facilities during pre-and/or postnatal care through the referral system triggered through the CLIP trials, from an origin point; a definition which conforms more to addressing the second delay in access to care. References [6,7] articulates the three delays as: delays at home prior to deciding to seek care (the first delay); delays in finding and managing transport to a facility (the second delay); and delays in receiving appropriate treatment once at the facility (the third delay).…”

Section: Introductionmentioning

confidence: 99%

Is the closest health facility the one used in pregnancy care-seeking? A cross-sectional comparative analysis of self-reported and modelled geographical access to maternal care in Mozambique, India and Pakistan

et al. 2020

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Background: Travel time to care is known to influence uptake of health services. Generally, pregnant women who take longer to transit to health facilities are the least likely to deliver in facilities. It is not clear if modelled access predicts fairly the vulnerability in women seeking maternal care across different spatial settings. Objectives: This cross-sectional analysis aimed to (i) compare travel times to care as modelled in a GIS environment with self-reported travel times by women seeking maternal care in Community Level Interventions for Pre-eclampsia: Mozambique, India and Pakistan; and (ii) investigate the assumption that women would seek care at the closest health facility. Methods: Women were interviewed to obtain estimated travel times to health facilities (R). Travel time to the closest facility was also modelled (P) (closest facility tool (ArcGIS)) and time to facility where care was sought estimated (A) (route network layer finder (ArcGIS)). Bland-Altman analysis compared spatial variation in differences between modelled and self-reported travel times. Variations between travel times to the nearest facility (P) with modelled travel times to the actual facilities accessed (A) were analysed. Log-transformed data comparison graphs for medians, with box plots superimposed distributions were used. Results: Modelled geographical access (P) is generally lower than self-reported access (R), but there is a geography to this relationship. In India and Pakistan, potential access (P) compared fairly with self-reported travel times (R) [P (H 0 : Mean difference = 0)] < .001, limits of agreement: [− 273.81; 56.40] and [− 264.10; 94.25] respectively. In Mozambique, mean differences between the two measures of access were significantly different from 0 [P (H 0 : Mean difference = 0) = 0.31, limits of agreement: [− 187.26; 199.96]]. Conclusion: Modelling access successfully predict potential vulnerability in populations. Differences between modelled (P) and self-reported travel times (R) are partially a result of women not seeking care at their closest facilities.

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Geographical access, transport and referral systems.

Cited by 10 publications

References 72 publications

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review

Cost-Effectiveness Analysis of a Community Emergency Transport System for Maternal Care in Northern Ghana

Is the closest health facility the one used in pregnancy care-seeking? A cross-sectional comparative analysis of self-reported and modelled geographical access to maternal care in Mozambique, India and Pakistan

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