TY - JOUR
T1 - Long travel times from health center to hospital reduce caesarean section access
T2 - a study from Kirehe District, Rwanda
AU - Miller, Hillary
AU - Rudolfson, Niclas
AU - Nkurunziza, Theoneste
AU - Cherian, Teena
AU - Kayitesi, Daniella
AU - Mazimpaka, Christian
AU - Kateera, Fredrick
AU - Riviello, Robert
AU - Hedt-Gauthier, Bethany
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Introduction: timely access to safe cesarean section (c-section) delivery can save the lives of mothers and neonates. This paper explores how distance affects c-section access in rural sub-Saharan Africa, where women in labor present to health centers before being referred to district hospitals for surgical care. Methods: this study included all adult women delivering via c-section between April 2017 and March 2018 in Kirehe District, Rwanda. We assessed the association between travel times and village-level c-section rates. Results: the estimated travel time from home-to-health center was 26 minutes (IQR: 13, 41) and from health center-to-hospital was 43 minutes (IQR: 2, 59). There was no significant association between travel time from home-to-health center and c-section rates (RR=1.01, p=0.42), but the association was significant for health center-to-hospital travel times (RR=0.96, p=0.01); for every 15-minute increase in travel time, there was a 4% decrease in c-sections for a health center catchment area. Conclusion: in the context of decentralized health services, minimizing health center to hospital referral barriers is of utmost importance for improving c-section access in rural sub-Saharan Africa.
AB - Introduction: timely access to safe cesarean section (c-section) delivery can save the lives of mothers and neonates. This paper explores how distance affects c-section access in rural sub-Saharan Africa, where women in labor present to health centers before being referred to district hospitals for surgical care. Methods: this study included all adult women delivering via c-section between April 2017 and March 2018 in Kirehe District, Rwanda. We assessed the association between travel times and village-level c-section rates. Results: the estimated travel time from home-to-health center was 26 minutes (IQR: 13, 41) and from health center-to-hospital was 43 minutes (IQR: 2, 59). There was no significant association between travel time from home-to-health center and c-section rates (RR=1.01, p=0.42), but the association was significant for health center-to-hospital travel times (RR=0.96, p=0.01); for every 15-minute increase in travel time, there was a 4% decrease in c-sections for a health center catchment area. Conclusion: in the context of decentralized health services, minimizing health center to hospital referral barriers is of utmost importance for improving c-section access in rural sub-Saharan Africa.
KW - Africa
KW - C-section
KW - decentralization
KW - global surgery
U2 - 10.11604/pamj.2023.46.30.25504
DO - 10.11604/pamj.2023.46.30.25504
M3 - Article
C2 - 38107338
AN - SCOPUS:85177170175
SN - 1937-8688
VL - 46
JO - Pan African Medical Journal
JF - Pan African Medical Journal
M1 - 30
ER -
