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Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study
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  • Published on:
    Premature program release negatively impacts program sustainability, placing maternal and perinatal outcomes at risk
    • Rick Admiraal, Pediatric resident, postdoctoral researcher University Utrecht Medical Center, Utrecht; Lion Heart Medical Centre, Yele, Sierra Leone
    • Other Contributors:
      • Heleen M Koudijs, Medical Doctor Global Health and Tropical Medicine

    To the editor,

    With interest we read the recent paper by Caviglia et al, describing the relation between prehospital ambulance time and outcome in terms of maternal and perinatal outcomes in the setting of Sierra Leone1. Sierra Leone has one of the highest rates of maternal (1360 in 100.000 life births) and infant (87 in 1.000 births) mortality worldwide2. The National Emergency Medical Service (NEMS) was designed and started in this country, an effort by or in collaboration with part of the authors of the current manuscript3. The results show that longer prehospital ambulance times are associated with poor outcome. Furthermore, only in the capital and its surroundings the 2-hour target is met in a high percentage of patients, with only 24-65% of patients meeting this mark in the more rural areas of the country. The authors conclude that there are still major geographical barriers for timely access to care, and that any intervention to strengthen the existing primary health system may help reduce maternal and perinatal mortality.

    The elaborate NEMS system, including 81 fully equipped and staffed ambulances with a centralized operations centre, was operational since 2018, with the last districts connected to the service in 2019. The system was managed by the local ministry of health and sanitation (MoHS) and funded through the governmental budget, with help from the World Bank, Doctors with Africa (CUAMM, Padua, Italy), the Regional Government of Veneto (Ita...

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    Conflict of Interest:
    None declared.