Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria

Banke-Thomas, Aduragbemi; Avoka, Cephas; Gwacham-Anisiobi, Uchenna; Beňová, Lenka

doi:10.1136/bmjgh-2021-007052

Cited by 20 publications

(15 citation statements)

References 25 publications

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“…This will be particularly crucial as private providers manage between 5% (Lusaka) and 64% (Lagos) of facility births in urban SSA settings 45. In addition, as every minute counts for the mother and her unborn child,46 ambulance services within the referral network need to be fully optimised to transfer women with obstetrical emergencies efficiently and effectively to hospitals that can manage them. This transfer should also be done at no cost to them, as many women already find the cost of care too high 47.…”

Section: Discussionmentioning

confidence: 99%

Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study

et al. 2022

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IntroductionPrompt access to emergency obstetrical care (EmOC) reduces the risk of maternal mortality. We assessed institutional maternal mortality by distance and travel time for pregnant women with obstetrical emergencies in Lagos State, Nigeria.MethodsWe conducted a facility-based retrospective cohort study across 24 public hospitals in Lagos. Reviewing case notes of the pregnant women presenting between 1 November 2018 and 30 October 2019, we extracted socio-demographic, travel and obstetrical data. The extracted travel data were exported to Google Maps, where driving distance and travel time data were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on maternal death.FindingsOf 4181 pregnant women with obstetrical emergencies, 182 (4.4%) resulted in maternal deaths. Among those who died, 60.3% travelled ≤10 km directly from home, and 61.9% arrived at the hospital ≤30 mins. The median distance and travel time to EmOC was 7.6 km (IQR 3.4–18.0) and 26 mins (IQR 12–50). For all women, travelling 10–15 km (2.53, 95% CI 1.27 to 5.03) was significantly associated with maternal death. Stratified by referral, odds remained statistically significant for those travelling 10–15 km in the non-referred group (2.48, 95% CI 1.18 to 5.23) and for travel ≥120 min (7.05, 95% CI 1.10 to 45.32). For those referred, odds became statistically significant at 25–35 km (21.40, 95% CI 1.24 to 36.72) and for journeys requiring travel time from as little as 10–29 min (184.23, 95% CI 5.14 to 608.51). Odds were also significantly higher for women travelling to hospitals in suburban (3.60, 95% CI 1.59 to 8.18) or rural (2.51, 95% CI 1.01 to 6.29) areas.ConclusionOur evidence shows that distance and travel time influence maternal mortality differently for referred women and those who are not. Larger scale research that uses closer-to-reality travel time and distance estimates as we have done, rethinking of global guidelines, and bold actions addressing access gaps, including within the suburbs, will be critical in reducing maternal mortality by 2030.

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Section: Discussionmentioning

confidence: 99%

Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study

et al. 2022

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“…The NDHS asked the childbirth care-seeking questions used in this analysis only of women with a live birth. There is evidence that many women needing emergency obstetric care experience stillbirth (and some women die), but these women and the pathways and modes of transport they use, if any, are not captured in this dataset [9,22,35]. Our study also did not provide details on the number of stops women might have made before arriving at their final facility [36,37].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Delays in reaching an appropriately staffed and equipped health facility increase the risk of maternal mortality [8]. Research from Nigeria also shows long travel to care is associated with maternal mortality and stillbirths [9,10].…”

Section: Introductionmentioning

confidence: 99%

Use of motorised transport and pathways to childbirth care in health facilities: Evidence from the 2018 Nigeria Demographic and Health Survey

Avoka

Banke-Thomas²,

Beňová³

et al. 2022

PLOS Glob Public Health

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In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15–49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women’s socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90–41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55–3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.

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“…6 Travel time and distance to care may lead to maternal or perinatal deaths. [7][8][9][10] There is a global consensus that understanding the reasons underpinning the death of a pregnant woman or her unborn child is an important first step in forestalling future similar deaths. To reach this understanding, in addition to being able to label the obstetric complication that led to the death(s), it is crucial to capture the pregnant woman's personal story to care and the precise circumstances around her death or that of her unborn child.…”

Section: Introductionmentioning

confidence: 99%

The potential utility of an augmented data collection approach in understanding the journey to care of pregnant women for maternal and perinatal death surveillance and response

Banke-Thomas

2022

F1000Res

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Background: The Maternal and Perinatal Death Surveillance and Response (MPDSR) proposed by the World Health Organization recognises the importance for health systems to understand the reasons underpinning the death of a pregnant woman or her newborn as an essential first step in preventing future similar deaths. Data for the surveillance component of the MPDSR process are typically collected from health facility sources and post-mortem interviews with affected families, though it may be traumatising to them. This brief report aimed to assess the potential utility of an augmented data collection method for mapping journeys of maternal and perinatal deaths, which does not require sourcing additional information from grieving family members. Methods: A descriptive analysis of maternal and perinatal deaths that occurred across all 24 public hospitals in Lagos State, Nigeria, between 1st November 2018 and 30th October 2019 was conducted. Data on their demographic, obstetric history and complication at presentation, travel to the hospital, and mode of birth were extracted from their hospital records. The extracted travel data was exported to Google Maps, where driving distance and travel time to the hospital for the period of the day of travel were also extracted. Results: Of the 182 maternal deaths, most presented during the week (80.8%), travelled 5-10 km (30.6%) and 10-29 minutes (46.9%), and travelled to the nearest hospital to their places of residence (70.9%). Of the 442 pregnant women who had perinatal deaths, most presented during the week (78.5%), travelled <5 km (26.9%) and 10-29 minutes (38.0%). For both, the least reported travel data was the mode of travel used to care (>90.0%) and the period of the day they travelled (approximately 30.0%). Conclusion: An augmented data collection approach that includes accurate and complete travel data and closer-to-reality estimates of travel time and distance can be beneficial for MPDSR purposes.

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Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria

Cited by 20 publications

References 25 publications

Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study

Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study

Use of motorised transport and pathways to childbirth care in health facilities: Evidence from the 2018 Nigeria Demographic and Health Survey

The potential utility of an augmented data collection approach in understanding the journey to care of pregnant women for maternal and perinatal death surveillance and response

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