A national programme of freely-available ambulance transportation for women in labour halves maternal mortality in Ethiopia : an operational analysis from Tigray Region

• Introduction: One of the challenges for maternal health services across Africa is physically getting women to health facilities for delivery at the appropriate time. A lack of transportation has often been cited as a major obstacle. The Ethiopian Federal Ministry of Health implemented a national programme of freely available ambulance transportation in every District from 2012, and this operational analysis investigated the effects of the ambulance programme on maternal mortality.Methods: Maternal mortality was measured in a survey of six randomly selected districts in Tigray Region over a 1-year period in 2012/13. For the same time period, data from ambulance log books from the same six Districts were captured and ambulance trips associated with deliveries extracted. Data on month, distance to health facility and mobile network coverage at local area level were included.Results: The survey identified 51 maternal deaths and 19 179 live births, corresponding to an overall maternal mortality ratio (MMR) of 266 per 100 000 live births. Districts using ambulances for at least 25% of deliveries had an MMR of 116 per 100 000 compared with 407 per 100 000 elsewhere. Distance from home to facility, the availability of a mobile telephone network and utilisation of ambulances were all independently associated with maternal mortality. When all these factors competed in a multivariable model at local area level, only utilisation of ambulances persisted as a significant factor, with a maternal mortality rate ratio of 0.51. One maternal death was estimated to have been averted for every 5000 ambulance-kilometres driven.Conclusions: Freely available ambulance transport in Ethiopia was associated with significant reductions in maternal mortality, although this was a strategy requiring substantial investment. Similar results could probably be achieved elsewhere given sufficient investment in vehicles and operational infrastructure.Acknowledgements: The Tigray Regional Health Bureau funded this operational assessment, including the maternal mortality survey and capturing the ambulance data. A collaboration grant from the Swedish Research Council facilitated analysis.Disclosure: Hagos Godefay is the Head of Tigray Regional Bureau and Kesetebirhan Admasu is the Minister of Health, Federal Democratic Republic of Ethiopia.

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MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

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