HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India.
Health Promotion Division, Public Health Foundation of India, New Delhi, India.
Int J Health Policy Manag. 2015 Jan 14;4(2):99-106. doi: 10.15171/ijhpm.2015.14. eCollection 2015 Feb.
An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP).
A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths.
It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours.
The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.
有效的紧急转诊运输系统是孕妇家庭与提供基本或全面紧急产科护理的医疗机构之间的联系。本研究试图探讨在北方邦乌纳奥区与产妇死亡相关的紧急运输的作用。
通过社区为基础的产妇死亡审查（MDR）使用死因推断，对北方邦乌纳奥区的产妇死亡原因和导致产妇死亡的因素进行了描述性研究，在 2009 年 6 月 1 日至 2010 年 5 月 31 日期间，对 57 例产妇死亡进行了样本调查。还对 16 个街区和地区卫生设施中的 15 个设施进行了设施审查，以收集有关设施治疗产科并发症（包括转诊运输）准备情况的信息。使用比率和百分比对基本设施的可用性进行描述性分析，这些设施可能导致产妇死亡。
发现，在 15 个设施中仅配备了 10 辆救护车，而根据印度公共卫生标准（IPHS）需要 19 辆。大约 47%的死亡发生在设施中，30%发生在前往医疗机构的途中，23%发生在家庭中。25%的妇女被送往一个设施，32%的妇女被送往两个设施，25%的妇女被送往三个设施，而 19%的妇女在死亡前没有被送往任何设施。16%的孕妇无法安排交通到达任何医疗机构。从家庭到设施-1 和设施-1 到设施-3 的旅行安排平均时间为 3.1 小时，而从设施-1 到设施-2 则为 9.9 小时。从家庭到设施-1 的平均旅行时间为 1 小时，从设施-1 到设施-2 为 1.4 小时，从设施-2 到设施-3 为 1.6 小时。
公共卫生设施审查和 MDR 清楚地表明，设施之间的转院是否恰当和及时是北方邦乌纳奥区产妇死亡的主要因素。北方邦政府除了加强整个地区的紧急产科和新生儿护理（EmONC）和基本紧急产科和新生儿护理（BEmONC）服务外，还需要优先重点发展一个功能齐全和有效的转诊系统，以减少乌纳奥区的产妇死亡。
