Evidence map›Paper›PMID 33355267›Full record

ArticleBMJ global health2020

Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone.

Alex J van Duinen, Håvard A Adde, Ola Fredin, Hampus Holmer, Lars Hagander, Alimamy P Koroma, Michael M Koroma, Andrew Jm Leather, Arne Wibe, Håkon A Bolkan

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In one paragraph

Article in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  8. Long-term maternal outcomes 5 years after cesarean section in Sierra Leone: A prospective cohort study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
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4 · The record

Corrections and comments

  • Erratum issued
    2021
5 · Who and what money

Authors and funding

10 authors.

Alex J van DuinenInstitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway aalke.j.v.duinen@ntnu.no.ORCID 0000-0002-6943-0100
Håvard A AddeInstitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Ola FredinGeological Survey of Norway, Trondheim, Norway.
Hampus HolmerDepartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0003-3745-7402
Lars HaganderCentre for Surgery and Public Health, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden.
Alimamy P KoromaMinistry of Health and Sanitation, Freetown, Sierra Leone.
Michael M KoromaMinistry of Health and Sanitation, Freetown, Sierra Leone.
Andrew Jm LeatherKing's Centre for Global Health & Health Partnerships, King's College London, London, UK.
Arne WibeInstitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Håkon A BolkanInstitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionLonger travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance.

methodsWomen who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma

resultsThe median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001).

conclusionThe standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.

Indexed as

Cesarean SectionPerinatal MortalityFemaleHumansInfant, NewbornPerinatal DeathPregnancySierra LeoneTime FactorsTravelgeographic information systemsmaternal health

Identifiers

PMID33355267
PMCPMC7754652

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.