Delivering obstetric care to maritime migrants: The Lampedusa protocol

Abstract

Background

While Lampedusa Island has long represented the “Doorway to Europe,” migration is considered an emergent phenomenon rather than a constant occurrence. Vulnerable populations – particularly pregnant women – arriving there require both routine and urgent medical services. We describe a novel approach to triaging pregnant migrant women, observed clinical presentations, and the effects on healthcare resource utilization.

Methods

The Lampedusa Protocol was implemented in March 2023 by the Agenzia Sanitaria Provinciale (ASP) of Palermo and the Italian National Institute for Health, Migration and Poverty (INMP). Clinical and demographic data from 28 March 2023 to 31 May 2024 were collected and analyzed by cross-referencing the clinical databases of the policlinic of Lampedusa and the Italian Red Cross, the managing entity of the migrant hotspot. Resource utilization data were collected from the helicopter transfer data recorded by the emergency medical service for the island. Associations between patient characteristics and need for helicopter evacuation were assessed using multivariable logistic regression.

Findings

A total of 571 pregnant patients were assessed and treated between 3/28/2023-5/31/2024. Patients represented 23 nationalities, average age was 26 years (SD=6.6 years), and average ultrasound-estimated gestational age was 25.2 weeks (SD=9.6 weeks). The most common causes for needing helicopter transfer were late gestational age or concern for, or symptoms of, labor. Compared to the pre-implementation period, the proportion of patients requiring any flight decreased by 23% (24.5% to 18.9%, p= 0.027) and the proportion requiring dedicated urgent flights decreased by 52% (8.3% to 4.0%, p= 0.003) in the post-implementation period. No association was found between Multidimensional Global Poverty Index of origin country and requiring helicopter evacuation. Women with known nationality had reduced odds (OR = 0.49, 95% CI = 0.27-0.90, p = 0.02) of requiring urgent helicopter evacuation.

Interpretation

We demonstrate improved resource utilization with protocolized care pathways for maritime migrants in European borderlands.

Funding

Dr. Alexandra Sansosti, MD was funded in part by a research grant from the US-Italy Fulbright Commission for this project.