A systematic review and thematic synthesis of qualitative studies on maternal emergency transport in low- and middle-income countries.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2013-06-24 · Systematic review
Abstract
BACKGROUND: Most maternal deaths are preventable with emergency obstetric care; therefore, ensuring access is essential. There is little focused information on emergency transport of pregnant women. OBJECTIVES: The literature on emergency transport of pregnant women in low- and middle-income countries (LMICs) was systematically reviewed and synthesized to explore current practices, barriers, and facilitators for transport utilization. SEARCH STRATEGY: MEDLINE, EMBASE, BNI, Cochrane Library, CINAHL, African Index Medicus, ASSIA, QUALIDATA, RHL, and Science Citation Index (inception to April 2012) were searched without language restriction. SELECTION CRITERIA: Studies using qualitative methodology and reporting on emergency transportation in LMICs were included. DATA COLLECTION AND ANALYSIS: Thematic framework and synthesis through examination and translation of common elements were used to analyze and synthesize the data. MAIN RESULTS: Twenty-nine articles were included. Eight major themes were identified: time for transport; transport options; geography; local support; autonomy; culture; finance; and ergonomics. Key issues were transport availability; transport speed; terrain; meteorology; support; dependence for decision making; cultural issues; cost; and lack of safe, comfortable positioning during transport. CONCLUSION: Themes should be appreciated within local contexts to illuminate barriers and facilitators. Potential solutions include motorcycle ambulance programs, collaboration with taxi services, community education, subsidies, and vehicle maintenance.