Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia

Sultan, Menbeu; Abebe, Yonas; Tsadik, Assefu Welde; Jennings, Catherine; Mould‐Millman, Nee‐Kofi

doi:10.1186/s12913-018-3820-4

Cited by 19 publications

(26 citation statements)

References 23 publications

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“…Main indications for ambulance transfer were prolonged labor and hypertensive disorders, comparable to other studies from LICs [24,28]. This may be explained by poor quality of ANC leading to suboptimal knowledge of obstetric danger signs and low levels of birth preparedness and complication readiness (BP/CR) [29,30].…”

Section: Discussionsupporting

confidence: 67%

“…In our setting, ambulances were mainly used to transfer pregnant women from low to higher level health facilities [21][22][23][24]. Our ambulance obstetric transfer rate of 3.7% was lower than those in other African studies that reported rates between 5% and 66% [21,24,25]. This could be explained by accompanying paramedics on ambulances providing support and triage of patients at the referring health facilities, preventing unnecessary referrals.…”

Section: Discussionmentioning

confidence: 64%

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Cost-Effectiveness of Emergency Obstetric Care in rural Kenya: Comparing Ambulance transfer and Self-referral

Kalisa¹,

Muriithi²,

Bijlmakers³

et al. 2020

Preprint

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Background Obstetric complications are difficult to predict and may require referral, expedited by ambulance use. We conducted a cost-effectiveness analysis comparing ambulance transfers and self-referrals in obstetric emergencies in a predominantly rural setting in Kenya. Methods A retrospective cross-sectional cost-effectiveness analysis using a healthcare system perspective was conducted of parturient women transferred by ambulance to a higher level hospital compared with self-referrals between January to June 2019. Direct costs needed for ambulance, self-referral and clinical care were calculated. Every woman admitted with a pregnancy-related complication was assessed using the adapted sub-Saharan African Maternal Near Miss (MNM) criteria. Each referred woman was categorized as: ‘necessary referral’ meaning that they were managed for either MNM or potentially life-threatening complications (PLTC) and ‘unnecessary referral’ meaning those with no obstetric complications. Incremental cost effectiveness ratio (ICER) for referral was considered attractive or very attractive interventions when costs per life years gained (LYG) were below $150 and $30, respectively. Results Overall, 2804 women (96.3%) were self-referrals, while 108 ambulance transfers occurred (3.7%). Main indications for ambulance transfer were prolonged labor (n = 21; 19.4%), pre-eclampsia/eclampsia (n = 19; 17.6%) and sepsis/peritonitis following cesarean section (n = 15; 13.9%). Necessary referrals were considered to have occurred in 81/108 (75%) for ambulance transfers versus 239/2804 (9.3%) self-referrals. If all necessary referral cases had exclusively used ambulance services (ambulance + self-referrals), then the total intervention costs would be $90,112 and LYG 6095, equivalent to ICER of $14.8 per LYG. Women with unnecessary referrals by ambulance were 27/108 (25%) versus self-referrals in 2565/2804 (91.5%) indicating that these women could have been managed in sub-county hospitals or health centers. Conclusions Cost-effectiveness of reasonably well-targeted ambulance services on women with MNM or PLTC in our setting was very attractive.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 64%

Cost-Effectiveness of Emergency Obstetric Care in rural Kenya: Comparing Ambulance transfer and Self-referral

Kalisa¹,

Muriithi²,

Bijlmakers³

et al. 2020

Preprint

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“…Similarly, studies conducted in Addis Ababa, Ethiopia, and Uganda found that ambulance services were used mostly for obstetric (labor) cases. 23,24 In response to the hypothetical scenarios (pedestrian hit by a car and a person with fall-down accident being hurt badly in a house) majority (46.2%) prefer ambulance as their preferred transport option in both scenarios, followed by 16% of Bajaj's. This finding is higher compared to a study conducted in Ghana where the majority of the respondents reported they would prefer a taxi.…”

Section: Discussionmentioning

confidence: 99%

Utilization, Barriers and Determinants of Emergency Medical Services in Mekelle City, Tigray, Ethiopia: A Community-Based Cross-Sectional Study

Takele

Ballo

Gebrekidan

et al. 2021

OAEM

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Background Emergency medical services (EMS) are services that provide out-of-hospital emergency medical care to injured or ill peoples, and transporting to definitive care. EMS is an integral part of the emergency medical system and has been associated with decreased morbidity and mortality related to emergency cases. The aim of this study was to assess the utilization, barriers, and determinants of EMS in Mekelle, Ethiopia. Methods A community-based cross-sectional study was conducted in selected sub-cities of Mekelle. A multistage sampling method was employed to recruit study participants, and data were collected by trained data collectors using an interviewer-administered questionnaire. Multivariate logistic regression analysis was used to examine the statistical association of the determinants of EMS utilization. Results Half (50.5%) of the respondents had experienced or witnessed an emergency incident in the past year. The common means of transportations used were Bajaj’s (39.2%) and ambulances (22.7%). Majority (88.1%) of the respondents did not knew the EMS access phone number of an ambulance. As their preferred mode of transportation in case of emergency conditions, 42.2% of the participants reported an ambulance, followed by Bajaj 33.7%. Where participants who had gynecologic emergencies were 9.4 times (AOR=9.4, 95% CI: 1.04, 85, p=0.046), and those who knew any ambulance numbers were 3.6 times (AOR=3.6, 95% CI: 1.22, 10.8, p=0.02) more likely to use ambulance services in case of emergencies. Conclusion The ambulance utilization level in Mekelle city was low and victims of emergency conditions were being transported mainly using public transports such as Bajaj’s and taxis. Even though the perception of the public towards EMS services is favorable, lack of awareness of EMS access, and lack of integrated EMS system in the city are the barriers that may have contributed to the low utilization. Actions to improve EMS access and integrating the system are warranted to promote the services utilization.

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“…Advanced trauma care providers and specialty centers, including cardiac and trauma care, are increasing in number. But, it is reported that emergency patients are arriving to the treatment centers too late; after the golden hour has already passed or having already developed complications [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Trends and barriers of emergency medical service use in Addis Ababa; Ethiopia

et al. 2019

Self Cite

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Background The increasing burdens of trauma and time sensitive non-communicable disease in Addis Ababa necessitate a robust emergency medical care system. The objectives of this study were to assess the proportion of patients who used emergency medical services (EMS) and to quantitatively and qualitatively assess barriers to EMS utilization in Addis Ababa. Methods A cross-sectional quantitative and qualitative study was conducted on patients who visited five selected public hospitals in Addis Ababa with specific emergency conditions. Data were collected by trained nurses using a standardized questionnaire. Descriptive statistics and logistic regression was done on cleaned and coded quantitative data using SPSS version 20. Thematic analysis was performed on the qualitative data. Ethical approval was obtained prior to the study. Results A total of 429 participants completed the survey with a non-response rate of 5.1%. The most common emergency scene was the home ( n = 222, 51.8%) followed by road side ( n = 159, 37.1%). Only 87(20.3%) patients arrived by ambulance, though a majority (53.4%) of participants recalled at least one access number for an ambulance service and 96.3% stated that ambulances were an important part of the continuum of care for their emergency condition. A higher proportion of participants believed that ambulance transportation is generally safer ( n = 341, 78.5%) and faster ( n = 298, 69.5%) than emergency transport by taxi or private car. Patients who were non-Amharic speaking had a negative association with arriving by ambulance ( P = 0.001, OR 0.47; C.I, 0.31, 0.71). The median acceptable time to get the ambulance (according to respondent’s perception) was 16 min but actually perceived ambulance waiting time was 40 min. Conclusion EMS utilization in Addis Ababa is relatively low and emergency patients are instead being transported by taxi or private car. Perceived longer ambulance waiting time and language barriers may have contributed for low utilization. Findings of this study suggest an action to improve access by improving ambulance availability while simultaneously enhancing the public’s knowledge and perception of EMS in Addis Ababa.

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Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia

Cited by 19 publications

References 23 publications

Cost-Effectiveness of Emergency Obstetric Care in rural Kenya: Comparing Ambulance transfer and Self-referral

Cost-Effectiveness of Emergency Obstetric Care in rural Kenya: Comparing Ambulance transfer and Self-referral

Utilization, Barriers and Determinants of Emergency Medical Services in Mekelle City, Tigray, Ethiopia: A Community-Based Cross-Sectional Study

Trends and barriers of emergency medical service use in Addis Ababa; Ethiopia

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