title: A hospital-centered approach to improve emergency obstetric care in South Sudan.
abstract: OBJECTIVE
  To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system.
  
  
  METHODS
  In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge.
  
  
  RESULTS
  The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital.
  
  
  CONCLUSIONS
  A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings.
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Groppi
authors.affiliation: Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: dadosomigliana@yahoo.it.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pisani
authors.affiliation: Yirol County Hospital, Yirol, South Sudan.
authors.forename: Michelina
authors.initials: M
authors.lastname: Ika
authors.affiliation: Yirol County Hospital, Yirol, South Sudan.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mabor
authors.affiliation: Yirol County Hospital, Yirol, South Sudan.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Akec
authors.affiliation: Yirol County Hospital, Yirol, South Sudan.
authors.forename: John A
authors.initials: JA
authors.lastname: Nhial
authors.affiliation: Lakes State Ministry of Health, Rumbeck, South Sudan.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Mading
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Scanagatta
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
authors.affiliation: Doctors with Africa CUAMM, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
mesh_terms: D000552:Ambulances; D002391:Catchment Area, Health; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000592:standards*; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006766:Hospitals, County / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000628:therapy*; D066087:Perinatal Death; D011247:Pregnancy; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation; D013397:Sudan
keywords: Ambulance; Emergency obstetric care; Remote settings; Sudan