{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:22:41Z","timestamp":1791091361869,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,5,18]],"date-time":"2013-05-18T00:00:00Z","timestamp":1368835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In 2006, M\u00e9decins sans Fronti\u00e8res (<jats:styled-content style=\"fixed-case\">MSF<\/jats:styled-content>) established an emergency obstetric and neonatal care (Em<jats:styled-content style=\"fixed-case\">ONC<\/jats:styled-content>) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 2011, there were 1478 ambulance call\u2010outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the <jats:styled-content style=\"fixed-case\">MSF<\/jats:styled-content> referral facility) was 78\u00a0min (interquartile range, 52\u2013130\u00a0min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was \u20ac 85\u00a0586 (\u20ac 61\/obstetric case transferred or \u20ac 0.43\/capita\/year). Referral times exceeding 3\u00a0h were associated with a significantly higher risk of early neonatal deaths (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>, 1.9; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.1\u20133.2). <jats:styled-content style=\"fixed-case\">MSF<\/jats:styled-content> coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to Em<jats:styled-content style=\"fixed-case\">ONC<\/jats:styled-content> and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12121","type":"journal-article","created":{"date-parts":[[2013,5,18]],"date-time":"2013-05-18T07:09:08Z","timestamp":1368860948000},"page":"993-1001","source":"Crossref","is-referenced-by-count":72,"title":["An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality"],"prefix":"10.1111","volume":"18","author":[{"given":"K.","family":"Tayler\u2010Smith","sequence":"first","affiliation":[{"name":"Medical department (Operational Research) Medecins sans Frontieres Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Zachariah","sequence":"additional","affiliation":[{"name":"Medical department (Operational Research) Medecins sans Frontieres Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Manzi","sequence":"additional","affiliation":[{"name":"Medical department (Operational Research) Medecins sans Frontieres Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Van den Boogaard","sequence":"additional","affiliation":[{"name":"Medecins sans Frontieres Bujumbura Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Nyandwi","sequence":"additional","affiliation":[{"name":"Medecins sans Frontieres Bujumbura Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Reid","sequence":"additional","affiliation":[{"name":"Medical department (Operational Research) Medecins sans Frontieres Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"De Plecker","sequence":"additional","affiliation":[{"name":"Operational Centre Brussels Medecins sans Frontieres Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Lambert","sequence":"additional","affiliation":[{"name":"Operational Centre Brussels Medecins sans Frontieres Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Nicolai","sequence":"additional","affiliation":[{"name":"Operational Centre Brussels Medecins sans Frontieres Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Goetghebuer","sequence":"additional","affiliation":[{"name":"Operational Centre Brussels Medecins sans Frontieres Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Christiaens","sequence":"additional","affiliation":[{"name":"Medecins sans Frontieres Bujumbura Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Ndelema","sequence":"additional","affiliation":[{"name":"Medecins sans Frontieres Bujumbura Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kabangu","sequence":"additional","affiliation":[{"name":"Medecins sans Frontieres Bujumbura Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Manirampa","sequence":"additional","affiliation":[{"name":"Ministry of Health Kabezi Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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