title: Effects of improved access to transportation on emergency obstetric care outcomes in Uganda.
abstract: Reduction in maternal mortality has not been appreciable in most low-income countries. Improved access to transport for mothers is one way to improve maternal health. This study evaluated a free-of-charge 24-hour ambulance and communication services intervention in Oyam district using 'Caesarean section rate' (CSR) and compared with the neighbouring non-intervention district. Ecological data were collected retrospectively from maternity/theatre registers in October 2010 for 3 years pre and 3 years intervention period. The average CSR in the intervention district increased from 0.57% before the intervention to 1.21% (p = 0.022) during the intervention, while there was no change in the neighbouring district (0.51% to 0.58%, p = 0.512). Hospital deliveries increased by over 50% per year with a slight reduction in the average hospital stillbirths per 1000 hospital births in the intervention district (46.6 to 37.5, p = 0.253). Reliable communication and transport services increased access to and utilization of maternal health services, particularly caesarean delivery services.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mucunguzi
authors.forename: Henry
authors.initials: H
authors.lastname: Wamani
authors.forename: Peter
authors.initials: P
authors.lastname: Lochoro
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskar
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D020380:Needs Assessment; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000601:surgery; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D014187:Transportation of Patients / Q000379:methods / Q000458:organization & administration; D014454:Uganda / Q000453:epidemiology