ArticleBMJ global health2021
Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 14 citations in OpenAlex.
- Impact of travel time to health facilities on perinatal outcomes: a systematic review with narrative synthesis and meta-analysis.Journal of global health · 2026Pooled it
- Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review.Prehospital and disaster medicine · 2023Pooled it
- Prehospital emergency response and management of pregnancy-associated haemorrhage in KwaZulu-Natal Province, South Africa: A Retrospective Cross-Sectional Study.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2025Article
- Navigating Limitations and Clinical Challenges in Indonesian Tertiary Trauma Center for Penetrating Brain Injury: A Case Report and Literature Review.Asian journal of neurosurgery · 2025Article
- Factors affecting the accuracy of prehospital triage application and prehospital scene time in simulated mass casualty incidents.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Predicting the effects of introducing an emergency transport system in low-income and middle-income countries: a spatial-epidemiological modelling study.BMJ public health · 2024Article
- Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations.Journal of clinical medicine · 2024Article
- Article
- A Strategy for Reducing Maternal Mortality in Rural Kenya.International journal of women's health · 2023Article
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Authors and funding
14 authors at 4 institutions in 3 countries.
Funding
Abstract
introductionSierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality.
methodsWe collected prehospital data of 6387 obstetric emergencies referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data.
resultsAt the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120 and 180 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%.
conclusionNEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes.
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