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Int J Gynaecol Obstet. 2008 Aug;102(2):191-7. doi: 10.1016/j.ijgo.2008.04.001. Epub 2008 Jun 16.

Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: do they reduce delay and what do they cost?

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Liverpool School of Tropical Medicine, Liverpool, UK.



To assess whether motorcycle ambulances placed at rural health centers are a more effective method of reducing referral delay for obstetric emergencies than a car ambulance at the district hospital, and to compare investment and operating costs with those of a 4 wheel drive car ambulance at the district hospital.


Motorcycle ambulances were placed at 3 remote rural health centers in Malawi. Data were collected over a 1-year period, from October 2001 to September 2002, using logbooks, cashbooks, referral forms, and maternity registers.


Depending on the site, median referral delay was reduced by 2-4.5 hours (35%-76%). Purchase price of a motorcycle ambulance was 19 times cheaper than for a car ambulance. Annual operating costs were US dollars 508, which was almost 24 times cheaper than for a car ambulance.


In resource-poor countries motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for the health sector.

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