Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jun 9;7(6):e015077.
doi: 10.1136/bmjopen-2016-015077.

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

Samiksha Singh  1 , Pat Doyle  2 , Oona Mr Campbell  3 , Laura Oakley  2 , Gv Ramana Rao  4 , Gvs Murthy  1   5
Affiliations

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

Samiksha Singh et al. BMJ Open. .

Abstract

Objective: To estimate the proportion of interfacility transfers (IFTs) transported by '108' ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of '108' services for pregnant women in India.

Design: A cross-sectional analysis of '108' ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called '108'.

Main outcomes: Proportion of all pregnancies and institutional deliveries in the population who were transported by '108', both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT.

Results: The '108' ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that '108' transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by '108' for IFTs-lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all '108' IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states.

Conclusion: Only 6% institutional deliveries made use of the '108' ambulance for IFTs in India. The vast majority did not have any complication or emergency. The '108' service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT.

Keywords: Access; Ambulance; Inter-facility transfer; Maternity Services; Obstetric complication; Obstetric emergency; Patient transport; Pregnant women; Travel time.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. National Rural Health Mission (NRHM). All India executive summary: status as on 31st March 2013. New Delhi: NRHM, Government of India, 2013.
    1. Registrar General of India. SRS: maternal Mortality Ratio Bulletin 2011-2013. New Delhi: Government of India, 2014. http://www.censusindia.gov.in/vital_statistics/mmr_bulletin_2011-13.pdf (accessed 30 September 2016).
    1. WHO. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: WHO, 2014. http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf (accessed 30 September 2016).
    1. UNICEF. Levels & Trends in Child Mortality: Report 2015. Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation United Nations Levels. New York: UNICEF, 2015. http://www.unicef.org/publications/files/Child_Mortality_Report_2015_Web... (accessed 30 September 2016).
    1. WHO. Theworld health report 2005: Make every mother and child count. Geneva: WHO, 2005. http://www.who.int/whr/2005/whr2005_en.pdf?ua=1 (accessed 30 September 2016).

MeSH terms