Academic Journal
Impact of travel time to health facilities on perinatal outcomes: a systematic review with narrative synthesis and meta-analysis.
| Τίτλος: | Impact of travel time to health facilities on perinatal outcomes: a systematic review with narrative synthesis and meta-analysis. |
|---|---|
| Συγγραφείς: | Roder-DeWan S; Dartmouth Health and Dartmouth Geisel School of Medicine, Department of Community and Family Medicine: One Medical Center Drive, Lebanon, NH, USA.; Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA.; World Bank Group, Washington, DC, USA., Ramadan M; Dartmouth Health and Dartmouth Geisel School of Medicine, Department of Community and Family Medicine: One Medical Center Drive, Lebanon, NH, USA.; Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA.; World Bank Group, Washington, DC, USA.; Alexandria University, Department of Community Medicine, Alexandria, Egypt., Ouma P; Dartmouth Health and Dartmouth Geisel School of Medicine, Department of Community and Family Medicine: One Medical Center Drive, Lebanon, NH, USA.; Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA.; World Bank Group, Washington, DC, USA., Manu A; Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana.; London School of Hygiene and Tropical Medicine, London, UK., Okiro EA; Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.; Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford: Radcliffe Primary Care Building, Oxford, UK., Strobel N; Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia., Robert BN; Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya., Odipo E; Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya., Macharia PM; Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Danso-Appiah A; Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana.; Centre for Evidence Synthesis and Policy, University of Ghana, Legon, Accra, Ghana., Goodman DC; Dartmouth Health and Dartmouth Geisel School of Medicine, Department of Community and Family Medicine: One Medical Center Drive, Lebanon, NH, USA.; Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA.; Dartmouth Geisel School of Medicine, Department of Pediatrics, Hanover, NH, USA., Dube Q; World Health Organization, Newborn and Child Health and Development Unit, Geneva, Switzerland., Gupta G; United Nations International Children's Emergency Fund, New York, NY, USA., Magge H; Brigham and Women's Hospital, Division of Global Health Equity: Boston, MA, USA.; Gates Foundation, Seattle, WA, USA., Edmond K; World Health Organization, Newborn and Child Health and Development Unit, Geneva, Switzerland. |
| Πηγή: | Journal of global health [J Glob Health] 2026 May 15; Vol. 16, pp. 04136. Date of Electronic Publication: 2026 May 15. |
| Τύπος έκδοσης: | Journal Article; Systematic Review; Meta-Analysis |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: International Society of Global Health Country of Publication: Scotland NLM ID: 101578780 Publication Model: Electronic Cited Medium: Internet ISSN: 2047-2986 (Electronic) Linking ISSN: 20472978 NLM ISO Abbreviation: J Glob Health Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2019>-: Edinburgh : International Society of Global Health Original Publication: Edinburgh : Edinburgh University Global Health Society, 2011- |
| Ιατρικοί όροι (MeSH): | Travel*/statistics & numerical data , Health Services Accessibility*/statistics & numerical data , Health Facilities* , Perinatal Mortality* , Pregnancy Outcome*, Stillbirth/epidemiology ; Humans ; Time Factors ; Female ; Infant, Newborn ; Pregnancy ; Infant Mortality |
| Περίληψη: | Background: Evidence-based global guidance on safe travel time for small or sick newborns who require transfer to health facilities after birth is lacking. A two-hour threshold is frequently cited in low- and middle-income countries (LMICs), while 30 minutes is commonly used in high-income countries (HICs). Although these thresholds are widely referenced, their empirical basis and consistency across levels of newborn care and journey types have not been systematically examined. This study synthesises the evidence linking travel time and perinatal outcomes. Methods: We conducted a systematic review with narrative synthesis and meta-analysis to assess the impact of travel time or distance (home-to-facility or interfacility) on stillbirth, perinatal mortality, and neonatal mortality. We searched Embase, MEDLINE, and Cochrane Central Register of Controlled Trials for published studies from 2014 to 2023. Given substantial methodological heterogeneity, we used narrative synthesis as the primary analytical approach and conducted random-effects meta-analyses where studies were sufficiently comparable (≥2 with similar definitions and outcome windows), pooling effect estimates for travel time thresholds of 30 minutes, 1 hour, or 2 hours and travel distances of 5, 10, and 15 km. We assessed bias using the Newcastle-Ottawa Scale for cohort and case-control studies. Results: Of 8317 screened records, 166 were eligible for full-text review, with 37 studies meeting the inclusion criteria- All but two had low or moderate risk of bias. Most studies (n = 26) came from LMICs and documented higher perinatal survival with shorter journeys. Studies from HICs demonstrated lower out-of-hospital birth, lower morbidity, and lower mortality with shorter journeys though associations were weaker. Across the narrative synthesis, shorter travel times were consistently associated with better outcomes. Exploratory pooling suggested a greater than 3-fold higher odds of survival for interfacility journeys under 30 minutes (odds ratio (OR) = 3.25; 95% confidence interval (CI) = 1.90-5.57) and over 2-fold higher odds of survival for journeys from any location to hospitals at all thresholds (OR = 2.06; 95% CI = 1.60-2.65 for 2 hours; OR = 2.20; 95% CI = 1.46-3.33 for 1 hour; OR = 1.92; 95% CI = 1.10-3.34 for 30 minutes), though prediction intervals were wide, reflecting methodological and contextual diversity. Conclusions: We found that shorter journeys were associated with better perinatal outcomes, with the highest survival rates observed for journeys under 30 minutes to the hospital. Due to substantial contextual and methodological heterogeneity, pooled estimates should be interpreted as illustrative, rather than definitive. A travel time norm of 30 minutes or one hour is preferable to the two-hour threshold currently used in LMICs. To safeguard perinatal survival rates, any travel-time standard should be balanced with corresponding quality of care standards. Registration: PROSPERO: CRD42023460423. (Copyright © 2026 by the Journal of Global Health. All rights reserved.) |
| Competing Interests: | Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests. |
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| Entry Date(s): | Date Created: 20260515 Date Completed: 20260716 Latest Revision: 20260814 |
| Update Code: | 20260814 |
| PubMed Central ID: | PMC13178054 |
| DOI: | 10.7189/jogh.16.04136 |
| PMID: | 42138261 |
| Βάση Δεδομένων: | MEDLINE |
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