Advertisement

Maternal and Child Health Journal

, Volume 15, Issue 7, pp 1081–1087 | Cite as

Emergency Obstetrical Complications in a Rural African Setting (Kayes, Mali): The Link Between Travel Time and In-Hospital Maternal Mortality

  • Catherine McLean Pirkle
  • Pierre Fournier
  • Caroline Tourigny
  • Karim Sangaré
  • Slim Haddad
Article

Abstract

The West African country of Mali implemented referral systems to increase spatial access to emergency obstetrical care and lower maternal mortality. We test the hypothesis that spatial access- proxied by travel time during the rainy and dry seasons- is associated with in-hospital maternal mortality. Effect modification by caesarean section is explored. All women treated for emergency obstetrical complications at the referral hospital in Kayes, Mali were considered eligible for study. First, we conducted descriptive analyses of all emergency obstetrical complications treated at the referral hospital between 2005 and 2007. We calculated case fatality rates by obstetric diagnosis and travel time. Key informant interviews provided travel times. Medical registers provided clinical and demographic data. Second, a matched case–control study assessed the independent effect of travel time on maternal mortality. Stratification was used to explore effect modification by caesarean section. Case fatality rates increased with increasing travel time to the hospital. After controlling for age, diagnosis, and date of arrival, a travel time of four or more hours was significantly associated with in-hospital maternal mortality (OR: 3.83; CI: 1.31–11.27). Travel times between 2 and 4 h were associated with increased odds of maternal mortality (OR 1.88), but the relationship was not significant. The effect of travel time on maternal mortality appears to be modified by caesarean section. Poor spatial access contributes to maternal mortality even in women who reach a health facility. Improving spatial access will help women arrive at the hospital in time to be treated effectively.

Keywords

Maternal mortality Emergency obstetrical care Referral system Access West Africa 

Notes

Acknowledgments

Funding support for this project was provided by the International Development Research Centre- Governance and Equity Initiative. We would like to thank the Regional Health Authority of Kayes for opening their doors and assisting us with this study. We would also like to thank Dr. Alexandre Dumont and the anonymous reviewers for their useful comments and feedback.

References

  1. 1.
    WHO. (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF, and UNFPA. Geneva: World Health Organisation.Google Scholar
  2. 2.
    Bouvier-Colle, M. H., Ouedraogo, C., Dumont, A., Vangeenderhuysen, C., Salanave, B., & Decam, C. (2001). Maternal mortality in West Africa—Rates, causes and substandard care from a prospective survey. Acta Obstetricia et Gynecologica Scandinavica, 80(2), 113–119.PubMedGoogle Scholar
  3. 3.
    Testa, J., Ouedraogo, C., Prual, A., De Bernis, L., & Kone, B. (2002). Determinants of risk factors associated with severe maternal morbidity: Application during antenatal consultations. Journal of Gynecology Obstetrics Biology Reproductive (Paris), 31(1), 44–50.Google Scholar
  4. 4.
    Vanneste, A. M., Ronsmans, C., Chakraborty, J., & De Francisco, A. (2000). Prenatal screening in rural Bangladesh: From prediction to care. Health Policy Plan, 15(1), 1–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Ould El Joud, D., & Bouvier-Colle, M. H. (2002). Dystocia: Frequency and risk factors in seven areas in West Africa. Journal of Gynecology Obstetrics Biology Reproductive (Paris), 31(1), 51–62.Google Scholar
  6. 6.
    Paxton, A., Maine, D., Freedman, L., Fry, D., & Lobis, S. (2005). The evidence for emergency obstetric care. International Journal of Gynaecology & Obstetrics, 88(2), 181–193.CrossRefGoogle Scholar
  7. 7.
    Freedman, L. P. (2001). Using human rights in maternal mortality programs: From analysis to strategy. International Journal of Gynecology & Obstetrics, 75(1), 51–60.CrossRefGoogle Scholar
  8. 8.
    Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science and Medicine, 38(8), 1091–1110.PubMedCrossRefGoogle Scholar
  9. 9.
    Razzak, J. A., & Kellermann, A. L. (2002). Emergency medical care in developing countries: Is it worthwhile? Bulletin of the World Health Organization, 80(11), 900–905.PubMedGoogle Scholar
  10. 10.
    Le Bacq, F., & Rietsema, A. (1997). High maternal mortality levels and additional risk from poor accessibility in two districts of northern province, Zambia. International Journal of Epidemiology, 26(2), 357–363.PubMedCrossRefGoogle Scholar
  11. 11.
    Khan, A., & Bhardwaj, S. (1994). Access to health care: A conceptual framework and its relevance to health care planning. Evaluation and Health Professions, 17, 60–76.CrossRefGoogle Scholar
  12. 12.
    Althabe, F., Sosa, C., Belizan, J. M., Gibbons, L., Jacquerioz, F., & Bergel, E. (2006). Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: An ecological study. Birth, 33(4), 270–277.PubMedCrossRefGoogle Scholar
  13. 13.
    Dumont, A., de Bernis, L., Bouvier-Colle, M. H., & Breart, G. (2001). Caesarean section rate for maternal indication in sub-Saharan Africa: A systematic review. Lancet, 358(9290), 1328–1333.PubMedCrossRefGoogle Scholar
  14. 14.
    Stanton, C. K., Dubourg, D., De Brouwere, V., Pujades, M., & Ronsmans, C. (2005). Reliability of data on caesarean sections in developing countries. Bulletin of the World Health Organization, 83(6), 449–455.PubMedGoogle Scholar
  15. 15.
    Fawcus, S., Mbizvo, M., Lindmark, G., & Nystrom, L. (1996). A community-based investigation of avoidable factors for maternal mortality in Zimbabwe. Studies in Family Planning, 27(6), 319–327.PubMedCrossRefGoogle Scholar
  16. 16.
    Samai, O., & Sengeh, P. (1997). Facilitating emergency obstetric care through transportation and communication, Bo, Sierra Leone. International Journal of Gynecology & Obstetrics, 59, S157–S164.CrossRefGoogle Scholar
  17. 17.
    MacLeod, J., & Rhode, R. (1998). Retrospective follow-up of maternal deaths and their associated risk factors in a rural district of Tanzania. Tropical Medicine and International Health, 3(2), 130–137.PubMedCrossRefGoogle Scholar
  18. 18.
    Barnes-Josiah, D., Myntti, C., & Augustin, A. (1998). The “three delays” as a framework for examining maternal mortality in Haiti. Social Science and Medicine, 46(8), 981–993.PubMedCrossRefGoogle Scholar
  19. 19.
    Schmid, T., Kanenda, O., Ahluwalia, I., & Kouletio, M. (2001). Transportation for maternal emergencies in Tanzania: Empowering communities through participatory problem solving. American Journal of Public Health, 91(10), 1589–1590.PubMedCrossRefGoogle Scholar
  20. 20.
    Midhet, F., Becker, S., & Berendes, H. W. (1998). Contextual determinants of maternal mortality in rural Pakistan. Social Science and Medicine, 46(12), 1587–1598.PubMedCrossRefGoogle Scholar
  21. 21.
    Gage, A. J., & Guirlene Calixte, M. (2006). Effects of the physical accessibility of maternal health services on their use in rural Haiti. Population Studies (Camb), 60(3), 271–288.CrossRefGoogle Scholar
  22. 22.
    Hoj, L., da Silva, D., Hedegaard, K., Sandstrom, A., & Aaby, P. (2002). Factors associated with maternal mortality in rural Guinea-Bissau. A longitudinal population-based study. Bjog-an International Journal of Obstetrics and Gynaecology, 109(7), 792–799.PubMedGoogle Scholar
  23. 23.
    EDS. (2006). Enquête Démographique et de Santé (EDSM-IV): Mali 2006.Google Scholar
  24. 24.
    Ouedraogo, C., & Bouvier-Colle, M. H. (2002). Maternal mortality in West Africa: Risk, rates, and rationale. Journal of Gynecology Obstetrics Biology Reproductive (Paris), 31(1), 80–89.Google Scholar
  25. 25.
    Prual, A., Bouvier-Colle, M. H., de Bernis, L., & Breart, G. (2000). Severe maternal morbidity from direct obstetric causes in West Africa: Incidence and case fatality rates. Bulletin of the World Health Organization, 78(5), 593–602.PubMedGoogle Scholar
  26. 26.
    Kwast, B. E. (1991). Postpartum haemorrhage: Its contribution to maternal mortality. Midwifery, 7(2), 64–70.PubMedCrossRefGoogle Scholar
  27. 27.
    Ronsmans, C., Etard, J. F., Walraven, G., Hoj, L., Dumont, A., de Bernis, L., et al. (2003). Maternal mortality and access to obstetric services in West Africa. Tropical Medicine and International Health, 8(10), 940–948.PubMedCrossRefGoogle Scholar
  28. 28.
    AbouZahr, C., & Wardlaw, T. (2001). Maternal mortality at the end of a decade: Signs of progress? Bulletin of the World Health Organization, 79(6), 561–568.PubMedGoogle Scholar
  29. 29.
    Guagliardo, M. (2004). Spatial accessibility of primary care: Concepts, methods, and challenges. International Journal of Health Geographics, 3, 3–16.PubMedCrossRefGoogle Scholar
  30. 30.
    LaBossière, F. (2007). Le système de référence-évacuation pour les urgences obstétricales dans la Région de Kayes (Mali): L’éboration et l’opérationnnalisation d’un modèle logique pour une analyse d’implantation. Montréal: Université de Montréal.Google Scholar
  31. 31.
    Paxton, A., Bailey, P., Lobis, S., & Fry, D. (2006). Global patterns in availability of emergency obstetric care. International Journal of Gynaecology & Obstetrics, 93(3), 300–307.CrossRefGoogle Scholar
  32. 32.
    Etard, J. F., Kodio, B., & Traore, S. (1999). Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali. British Journal of Obstetrics and Gynaecology, 106(1), 60–65.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Catherine McLean Pirkle
    • 1
  • Pierre Fournier
    • 1
  • Caroline Tourigny
    • 1
  • Karim Sangaré
    • 2
  • Slim Haddad
    • 1
  1. 1.Unité de Santé InternationaleCentre de recherche du Centre hospitalier de l’Université de MontréalMontrealCanada
  2. 2.Direction Régionale de SantéMoptiMali

Personalised recommendations