The use of a mobile obstetric emergency system (MORES) to improve obstetric referrals in Bong County, Liberia: a pre/post-intervention descriptive study

Objective: The purpose of this study was to examine the association between the implementation of a mobile obstetric emergency system (MORES) and referral time for obstetric emergencies as well as maternal/newborn outcomes. Design: Pre/post intervention descriptive study. Setting: Liberia’s caesarean section (CS) coverage is about 5%, lower than 9-19% coverage associated with decreased maternal mortality. Delays in the referral process from a rural health facility (RHF) to a district hospital for comprehensive emergency obstetric and newborn care (CEmONC) services such as CS contribute to the high maternal mortality. Sample: Women with referral data from both RHFs (n=20) and hospitals (n=2) within Bong County, Liberia. Methods: A pre/post descriptive analysis was conducted on data collected from RHFs and two hospitals in Bong County, Liberia. Descriptive analysis and logistic regression models examined the relationship between the intervention’s implementation and mode of delivery, maternal outcome, newborn outcome, and transfer time from RHF to district hospital. Main outcome measures: Mode of delivery, maternal outcome, newborn outcome, and transfer time. Results: Women had higher odds of undergoing a CS at endline (OR: 1.86 95%; CI: 0.99- 3.46) compared to baseline. Additionally, newborns had lower odds of showing depressive symptoms (OR: 0.31; 95%CI: 0.14-0.68), defined as a non-vigorous newborn with poor respiratory effort, muscle tone or heart rate <100 beats per minute. Conclusion: MORES is a promising means to increase timely care seeking along the referral pathway which may enhance access to caesarean section as well as improved newborn outcomes in low- and middle-income countries.