Article Text
Abstract
We studied the pregnant women, who requested a ‘108’ ambulance in two Indian states (Andhra Pradesh (AP) and Himachal Pradesh (HP)). We conducted a cross-sectional telephone survey to study the characteristics and outcomes of those who (1) were transported using ‘108’ ambulance, (2) were sent ‘108’ ambulance but did not use it and (3) were not assigned a ‘108’ ambulance. We conducted interviews within 24 hours of clients’ call and followed them up at 48 hours, on the 7th and 28th day. 90% of pregnant women callers in AP and only 16% in HP were from poorer socioeconomic circumstances. 22.5% of women who were not provided an ambulance in HP lived in tribal areas. A higher proportion of women who were transported using ‘108’ reported either a high-risk condition (AP, 22%; HP, 27%) or an early complication in pregnancy (AP and HP, 16%), compared with the other groups (AP, 18% and 8%; HP, 19% and 16%). In AP, women who were sent an ambulance but did not use it had higher prevalence of obstetric emergency (9.8%) compared with the other groups (ambulance used, 7.4%; not assigned, 4.1%). One-fifth of women in AP and one-seventh in HP delivered by caesarean section. One woman who called, but was not transported by ‘108’, died in AP. Ten stillbirths and 22 neonatal deaths were reported in AP and 17 and 16, respectively, in HP. Strategies are required to improve ‘108’ service for tribal areas in HP. The ‘108’ services should be improved to reduce non-use of ambulance, especially for women who report obstetric emergencies.
- health services research
- maternal health
- obstetrics
- public health
- descriptive study
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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Footnotes
Handling editor Seye Abimbola
Contributors All authors conceived and designed the protocol and contributed to the preparation of manuscript. SS, PD, OMRC and GVSM contributed to analysis plan. SS analysed and interpreted the data.
Funding This work was supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests None declared.
Patient consent Not required.
Ethics approval The research obtained ethics approval from ethics committees of both LSHTM and IIPH-Hyderabad (LSHTM Ethics Ref: 9613; IIPHH Ethics Ref: IIPHH/TRC/IEC/009/2014). As it was a telephonic survey, only verbal consent was obtained from the participants before recruiting them.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data were obtained and analysed within the premises of GVK-EMRI office under license for the current study. The data are not publically available; however, it can be available upon reasonable request to the authors and with permission from GVK-EMRI.