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PL.40 Access to Obstetric Services in Rural Sub-Saharan Africa: A Hospital Based Survey
  1. RE Harris1,
  2. LM Staffurth1,
  3. L Irvine1,
  4. NL Hezelgrave1,
  5. S Edmunds2,
  6. AH Shennan1
  1. 1Division of Women’s Health KCL, Women’s Health Academic Centre, KHP, London, UK
  2. 2Hospitali Teule, Muheza, United Republic of Tanzania


Background Access to Emergency Obstetric Care (EmOC) is an indicator used to monitor progress towards the achievement of Millennium Development Goals 4 and 5. Lack of access or delay in transportation to hospital is recognised as part of ‘The Three Delays Model’ and is a major barrier to accessing care for pregnant women living in rural Sub-Saharan Africa.

Objective To determine time taken (minutes) by any mode of transport, to reach an obstetric facility by pregnant women in Zambia, Tanzania and Zimbabwe.

Methods A structured questionnaire in Swahili was used to interview pregnant women from 20–42 weeks gestation who presented to hospital.

Results 750 women were interviewed on the labour ward and antenatal clinics in referral hospitals served by rural antenatal clinics in Zambia (N = 128), Tanzania (N = 246) and Zimbabwe (N = 376). Median gestation was 33.4 weeks (N = 681). 38.8% were primiparous (N = 614). The mean time taken to get from home to obstetric care was 48.3 minutes (IQR = 15–60, median 30). The most common mode of transport was bus (40.6%), followed by foot (30.7%), car (19.3%), bike (9.0%) and other (0.4%) (N = 512).

Conclusion In a sample population of antenatal women who successfully reached the referral site during dry season, average time taken to travel from home to hospital was > 48 minutes. In the wet season and for women in remote rural areas, this is likely to be higher. On foot, during an obstetric emergency, this may represent a significant delay. It is vital that maternal health interventions are designed to address this.

Funder Bill Gates Foundation Grand Challenges Explorations (GCE).

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