{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:28:36Z","timestamp":1772065716266,"version":"3.50.1"},"reference-count":17,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,10,16]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"\n Background<\/jats:title>\n Most neonatal deaths in India occur due to a lack of timely and proper care just before and during delivery. Timely availability of an ambulance for institutional delivery has led to some decrease in this. However, the distance travelled and time taken may affect the outcome.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The objective of this retrospective observational study was to determine if the distance travelled and the call to hospital arrival time are associated with deaths in the early neonatal period (0\u20137\u2009days postnatal age), in neonates born to mothers who used a centralised emergency medical services (EMS) agency transportation at term gestation.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective observational study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n This was a secondary analysis of a de-identified patient dataset from a previous cohort study on EMS usage by pregnant women, in five Indian states in 2014.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Neonates born to mothers using EMS at \u226537\u201342 weeks gestation were included as participants. The groups of pregnant individuals with low distance (\u226410 km) and time (\u226460\u2009min) to hospital arrival vs longer distance or time to hospital arrival were then compared for neonatal death in the first 7\u2009days of life or early neonatal death (ENND), which was the primary outcome. \u03c7\n 2<\/jats:sup>\n test and logistic regression were carried out. Additional analysis was also planned to test the higher cut-offs of distance and time, if the above cut-offs were not found to have a statistically significant association with ENND.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were a total of 1180 neonates meeting the inclusion criteria. Of these, 272 (23%) were born to mothers who travelled \u226410 km (km) and took time \u226460\u2009min to reach the hospital. There were a total of 57 (4.8%) ENNDs of which 14 occurred in the low distance and time group (\u226410\u2009km and \u226460\u2009min). There was no statistically significant difference between the groups for ENND (p value=0.8). On additional univariate analysis for the different cut-offs of distance and time separately, it was found that there were lesser odds of ENND for a cut-off of distance \u226460\u2009km (OR 0.28 (95% CI 0.08 to 0.98), p value=0.046) and for a cut-off time \u2264120\u2009min (OR 0.36 (95% CI 0.17 to 0.76), p value=0.007). When adjusted for other variables found to be significant on univariate analysis (caesarean section, <4 antenatal visits, maternal tachycardia and twin gestation) a cut-off distance \u226460\u2009km had a trend towards lower odds of ENND (OR 0.31 (95% CI 0.084 to 1.12), p value=0.075) while a cut-off time of\u2264120\u2009min had a significantly lower odds of ENND (OR 0.37 (95% CI 0.167 to 0.81), p value=0.013). When both of these cut-offs were combined and analysed in the multivariable logistic regression model, the association with ENND was still significant (OR 0.33 (95% CI 0.16 to 0.72), p value=0.005).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In neonates born to mothers using EMS at term gestation in India, those with distance travelled by the mother \u226460\u2009km and time taken to reach health facility \u2264120\u2009min, had 67% lower odds of ENND compared with those with distance travelled >60\u2009km or time taken >120\u2009min. Further prospective observational studies are required to validate these cut-offs in a larger population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090491","type":"journal-article","created":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T04:51:01Z","timestamp":1731127861000},"page":"e090491","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Association of the distance travelled, and the call to hospital arrival time with early neonatal mortality in neonates born to mothers using emergency medical services at term gestation: a retrospective observational study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7342-5307","authenticated-orcid":false,"given":"Richie","family":"Dalai","sequence":"first","affiliation":[{"name":"Department of Neonatology, All India Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keshav K","family":"Pathak","sequence":"additional","affiliation":[{"name":"Department of Neonatology, All India Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudipta","family":"Sahoo","sequence":"additional","affiliation":[{"name":"Department of Neonatology, All India Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,9]]},"reference":[{"key":"2025121300160902000_14.11.e090491.1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2016.43"},{"key":"2025121300160902000_14.11.e090491.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-019937","article-title":"Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services","volume":"8","author":"Bills","year":"2018","journal-title":"BMJ Open"},{"key":"2025121300160902000_14.11.e090491.3","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.030924"},{"key":"2025121300160902000_14.11.e090491.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02816.x"},{"key":"2025121300160902000_14.11.e090491.5","unstructured":"Pinho NVR , Machado C , Roman S , et al . Effects of distances on newborn outcomes in Brazil. Repositoriofgvbr. 2023."},{"key":"2025121300160902000_14.11.e090491.6","first-page":"29","article-title":"Neonatal mortality rate reduction by improving geographic accessibility to perinatal care centers in Japan","volume":"58","author":"Aoshima","year":"2011","journal-title":"J Med Dent Sci"},{"key":"2025121300160902000_14.11.e090491.7","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1111\/aogs.14156","article-title":"Association between travel time to delivery unit and unplanned out-of-hospital birth, infant morbidity and mortality: A population-based cohort study","volume":"100","author":"\u00d6rtqvist","year":"2021","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025121300160902000_14.11.e090491.8","unstructured":"The constitution of India . Government of India ministry of law and justice legislative department, Available: https:\/\/cdnbbsr.s3waas.gov.in\/s380537a945c7aaa788ccfcdf1b99b5d8f\/uploads\/2024\/07\/20240716890312078.pdf"},{"key":"2025121300160902000_14.11.e090491.9","unstructured":"World Health Organization . Global reference list of 100 core health indicators. Geneva, Switzerland: World Health Organization, 2018. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/259951\/WHO-HIS-IER-GPM-2018.1-eng.pdf?sequence=1"},{"key":"2025121300160902000_14.11.e090491.10","doi-asserted-by":"crossref","unstructured":"Ames HM , Forsetlund L , Larun L , et al . How far is too far? a systematic review of travel distance to delivery institutions and negative maternal and natal outcomes. In Review [Preprint] 2022. doi:10.21203\/rs.3.rs-1350544\/v1","DOI":"10.21203\/rs.3.rs-1350544\/v1"},{"key":"2025121300160902000_14.11.e090491.11","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-10-762","article-title":"Distance decay in delivery care utilisation associated with neonatal mortality. A case referent study in northern Vietnam","volume":"10","author":"M\u00e5lqvist","year":"2010","journal-title":"BMC Public Health"},{"key":"2025121300160902000_14.11.e090491.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-023-09070-x","article-title":"The effect of distance to health facility on neonatal mortality in Ethiopia","volume":"23","author":"Kibret","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2025121300160902000_14.11.e090491.13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/tmi.13170","article-title":"Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population-based cross-sectional survey","volume":"24","author":"Sarrassat","year":"2019","journal-title":"Trop Med Int Health"},{"key":"2025121300160902000_14.11.e090491.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0052110","article-title":"Distance to care, facility delivery and early neonatal mortality in Malawi and Zambia","volume":"7","author":"Lohela","year":"2012","journal-title":"PLoS One"},{"key":"2025121300160902000_14.11.e090491.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1426-1","article-title":"Longer travel time to district hospital worsens neonatal outcomes: a retrospective cross-sectional study of the effect of delays in receiving emergency cesarean section in Rwanda","volume":"17","author":"Niyitegeka","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121300160902000_14.11.e090491.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245297","article-title":"The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria","volume":"16","author":"Wariri","year":"2021","journal-title":"PLoS One"},{"key":"2025121300160902000_14.11.e090491.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003943","article-title":"Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone","volume":"5","author":"van Duinen","year":"2020","journal-title":"BMJ Glob Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-090491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:16:20Z","timestamp":1765613780000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-090491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,9]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2024-090491"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-090491","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}