Influence of travel time and distance to the hospital of care on stillbirths

A retrospective facility-based cross-sectional study in Lagos, Nigeria

Bibliographic Data

ID21880925
AuthorsAduragbemi Banke-Thomas (0000-0002-4449-0131, St. Vincent's HealthCare, corresponding author), Cephas Avoka (0000-0002-7298-3670, Faculty of Public Health), Uchenna Gwacham-Anisiobi (0000-0001-5459-309X, University of Oxford), Lenka Beňová (0000-0001-8595-365X, Research Institute for Tropical Medicine)
Year2021
Volume6
Issue10
Pagese007052
Publication date2021-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-007052
PMID34615663
OpenAlexW3203754708
LanguageEN
Citations received10
References cited26

INTRODUCTION: Access to emergency obstetric care can lead to a 45%-75% reduction in stillbirths. However, before a pregnant woman can access this care, she needs to travel to a health facility. Our objective in this study was to assess the influence of distance and travel time to the actual hospital of care on stillbirth. METHODS: We conducted a retrospective cross-sectional study of pregnant women who presented with obstetric emergencies over a year across all 24 public hospitals in Lagos, Nigeria. Reviewing clinical records, we extracted sociodemographic, travel and obstetric data. Extracted travel data were exported to Google Maps, where typical distance and travel time for period-of-day they travelled were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on stillbirth. RESULTS: Of 3278 births, there were 408 stillbirths (12.5%). Women with livebirths travelled a median distance of 7.3 km (IQR 3.3-18.0) and over a median time of 24 min (IQR 12-51). Those with stillbirths travelled a median distance of 8.5 km (IQR 4.4-19.7) and over a median time of 30 min (IQR 16-60). Following adjustments, though no significant association with distance was found, odds of stillbirth were significantly higher for travel of 10-29 min (OR 2.25, 95% CI 1.40 to 3.63), 30-59 min (OR 2.30, 95% CI 1.22 to 4.34) and 60-119 min (OR 2.35, 95% CI 1.05 to 5.25). The adjusted OR of stillbirth was significantly lower following booking (OR 0.37, 95% CI 0.28 to 0.49), obstetric complications with mother (obstructed labour (OR 0.11, 95% CI 0.07 to 0.17) and haemorrhage (OR 0.30, 95%CI 0.20 to 0.46)). Odds were significantly higher with multiple gestations (OR 2.40, 95% CI 1.57 to 3.69) and referral (OR 1.55, 95% CI 1.13 to 2.12). CONCLUSION: Travel time to a hospital was strongly associated with stillbirth. In addition to birth preparedness, efforts to get quality care quicker to women or women quicker to quality care will be critical for efforts to reduce stillbirths in a principally urban low-income and middle-income setting

Cross-sectional study · Environmental health · Health facility · Health services · Kilometer · Logistic regression · Obstetrics · Odds · Odds ratio · Population · Pregnancy · Public health · Retrospective cohort study · Demography · Global Maternal and Child Health · Maternal and fetal healthcare · Medicine · Nursing · Trauma and Emergency Care Studies · Emergency Medicine · Internal Medicine · Pediatrics

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