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Ngongo CJ, Raassen TJIP, van Roosmalen J, Mahendeka M, Lombard L, Bukusi E. Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi. HUMAN RESOURCES FOR HEALTH 2024; 22:43. [PMID: 38915096 PMCID: PMC11197166 DOI: 10.1186/s12960-024-00927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Physicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor. METHODS This retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity. RESULTS Associate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61-1.33). CONCLUSIONS Associate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.
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Affiliation(s)
- Carrie J Ngongo
- RTI International, Global Health Division, Research Triangle Park, United States of America.
| | | | - Jos van Roosmalen
- Leiden University Medical Centre and Athena Institute VU University, Amsterdam, Netherlands
| | | | | | - Elizabeth Bukusi
- Research Care Training Program in the Center for Microbiology Research, KEMRI, Nairobi, Kenya
- Departments of Global Health and Obstetrics and Gynecology, University of Washington, Seattle, United States of America
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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Macharia PM, Wong KLM, Beňová L, Wang J, Makanga PT, Ray N, Banke-Thomas A. Measuring geographic access to emergency obstetric care: a comparison of travel time estimates modelled using Google Maps Directions API and AccessMod in three Nigerian conurbations. GEOSPATIAL HEALTH 2024; 19. [PMID: 38801322 DOI: 10.4081/gh.2024.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
Google Maps Directions Application Programming Interface (the API) and AccessMod tools are increasingly being used to estimate travel time to healthcare. However, no formal comparison of estimates from the tools has been conducted. We modelled and compared median travel time (MTT) to comprehensive emergency obstetric care (CEmOC) using both tools in three Nigerian conurbations (Kano, Port-Harcourt, and Lagos). We compiled spatial layers of CEmOC healthcare facilities, road network, elevation, and land cover and used a least-cost path algorithm within AccessMod to estimate MTT to the nearest CEmOC facility. Comparable MTT estimates were extracted using the API for peak and non-peak travel scenarios. We investigated the relationship between MTT estimates generated by both tools at raster celllevel (0.6 km resolution). We also aggregated the raster cell estimates to generate administratively relevant ward-level MTT. We compared ward-level estimates and identified wards within the same conurbation falling into different 15-minute incremental categories (<15/15-30/30-45/45-60/+60). Of the 189, 101 and 375 wards, 72.0%, 72.3% and 90.1% were categorised in the same 15- minute category in Kano, Port-Harcourt, and Lagos, respectively. Concordance decreased in wards with longer MTT. AccessMod MTT were longer than the API's in areas with ≥45min. At the raster cell-level, MTT had a strong positive correlation (≥0.8) in all conurbations. Adjusted R2 from a linear model (0.624-0.723) was high, increasing marginally in a piecewise linear model (0.677-0.807). In conclusion, at <45-minutes, ward-level estimates from the API and AccessMod are marginally different, however, at longer travel times substantial differences exist, which are amenable to conversion factors.
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Affiliation(s)
- Peter M Macharia
- 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.
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
| | - Jia Wang
- School of Computing and Mathematical Sciences, University of Greenwich, London.
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of the Built Environment, Gweru, Midlands, Zimbabwe; Climate, Environment and Health Department, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool.
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute for Environmental Sciences, University of Geneva, Geneva.
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Human Sciences, University of Greenwich, London, United Kingdom; Maternal and Reproductive Health Research Collective, Surulere, Lagos.
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Jabeen S, Chandrima RM, Hasan M, Rahman MM, Rahman QSU, AKM TH, Dewan F, Alim A, Nadia N, Mahmud M, Sarker MH, Islam J, Islam MS, Ashrafee S, Haider MS, Chisti MJ, Sheikh MZH, Miah MS, Al-Mahmud M, Ameen S, Ahmed A, El Arifeen S, Rahman AE. A context-driven approach through stakeholder engagement to introduce a digital emergency obstetric and newborn care register into routine obstetric health care services in Bangladesh. J Glob Health 2024; 14:04098. [PMID: 38721686 PMCID: PMC11079701 DOI: 10.7189/jogh.14.04098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Emergency obstetric and newborn care (EmONC) in Bangladesh focusses on maternal health, whereby it addresses childbirth and postpartum complications to ensure women's health and well-being. It was transitioned to a digital platform to overcome challenges with the paper-based EmONC register and we conducted implementation research to assess the outcome. Here we outline the stakeholder engagement process integral to the implementation research process. Methods We adopted a four-step stakeholder engagement model based on the identification, sensitisation, involvement, and engagement of stakeholders. The approach was informed by previous experience, desk reviews, and expert consultations to ensure comprehensive engagement with stakeholders at multiple levels. Led by the Maternal Health Programme of the Government of Bangladesh, we involved high-power and high-interest stakeholders in developing a joint action plan for digitisation of the paper-based EmONC register. Finally, we demonstrated this digital EmONC register in real-life settings to stakeholders at different levels. Results The successful demonstration process fostered government ownership and collaboration with multiple stakeholders, while laying the foundation for scalability and sustainability. Nevertheless, our experience highlighted that the stakeholder engagement process is context-driven, time-consuming, resource-intensive, iterative, and dynamic, and it requires involving stakeholders with varied expertise. Effective strategic planning, facilitation, and the allocation of sufficient time and resources are essential components for successful stakeholder engagement. Conclusions Our experience demonstrates the potential of adopting the 'identification, sensitisation, involvement, and engagement' stakeholder engagement model. Success in implementing this model in diverse settings depends on leveraging knowledge gained during implementation, maintaining robust communication with stakeholders, and harnessing the patience and determination of the facilitating organisation.
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Affiliation(s)
- Sabrina Jabeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Mehedi Hasan
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Mahiur Rahman
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Tanvir Hossain AKM
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Farhana Dewan
- Obstetrical and Gynaecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
| | - Azizul Alim
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Nuzhat Nadia
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Mustufa Mahmud
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Moazzem Hossain Sarker
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Mohammad Sabbir Haider
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Md Al-Mahmud
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shafiqul Ameen
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shams El Arifeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Banke-Thomas A, Wong KLM, Olubodun T, Macharia PM, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Ogunyemi O, Gwacham-Anisiobi U, Wang J, Abejirinde IOO, Makanga PT, Azodoh N, Nzelu C, Afolabi BB, Stanton C, Beňová L. Geographical accessibility to functional emergency obstetric care facilities in urban Nigeria using closer-to-reality travel time estimates: a population-based spatial analysis. Lancet Glob Health 2024; 12:e848-e858. [PMID: 38614632 DOI: 10.1016/s2214-109x(24)00045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/17/2023] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Better accessibility for emergency obstetric care facilities can substantially reduce maternal and perinatal deaths. However, pregnant women and girls living in urban settings face additional complex challenges travelling to facilities. We aimed to assess the geographical accessibility of the three nearest functional public and private comprehensive emergency obstetric care facilities in the 15 largest Nigerian cities via a novel approach that uses closer-to-reality travel time estimates than traditional model-based approaches. METHODS In this population-based spatial analysis, we mapped city boundaries, verified and geocoded functional comprehensive emergency obstetric care facilities, and mapped the population distribution for girls and women aged 15-49 years (ie, of childbearing age). We used the Google Maps Platform's internal Directions Application Programming Interface to derive driving times to public and private facilities. Median travel time and the percentage of women aged 15-49 years able to reach care were summarised for eight traffic scenarios (peak and non-peak hours on weekdays and weekends) by city and within city under different travel time thresholds (≤15 min, ≤30 min, ≤60 min). FINDINGS As of 2022, there were 11·5 million girls and women aged 15-49 years living in the 15 studied cities, and we identified the location and functionality of 2020 comprehensive emergency obstetric care facilities. City-level median travel time to the nearest comprehensive emergency obstetric care facility ranged from 18 min in Maiduguri to 46 min in Kaduna. Median travel time varied by location within a city. The between-ward IQR of median travel time to the nearest public comprehensive emergency obstetric care varied from the narrowest in Maiduguri (10 min) to the widest in Benin City (41 min). Informal settlements and peripheral areas tended to be worse off compared to the inner city. The percentages of girls and women aged 15-49 years within 60 min of their nearest public comprehensive emergency obstetric care ranged from 83% in Aba to 100% in Maiduguri, while the percentage within 30 min ranged from 33% in Aba to over 95% in Ilorin and Maiduguri. During peak traffic times, the median number of public comprehensive emergency obstetric care facilities reachable by women aged 15-49 years under 30 min was zero in eight (53%) of 15 cities. INTERPRETATION Better access to comprehensive emergency obstetric care is needed in Nigerian cities and solutions need to be tailored to context. The innovative approach used in this study provides more context-specific, finer, and policy-relevant evidence to support targeted efforts aimed at improving comprehensive emergency obstetric care geographical accessibility in urban Africa. FUNDING Google.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; School of Human Sciences, University of Greenwich, London, UK; Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Zimbabwe; Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Zimbabwe
| | - Ngozi Azodoh
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Charles Nzelu
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria; Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Ayawine A, Asaarik MJA, Atinga RA. Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana. BMC Health Serv Res 2024; 24:461. [PMID: 38609976 PMCID: PMC11015552 DOI: 10.1186/s12913-024-10936-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Sub-Saharan Africa is unlikely to achieve sustainable development goal (SDG) 3 on maternal and neonatal health due to perceived sub-standard maternal and newborn care in the region. This paper sought to explore the opinions of stakeholders on intricacies dictating sub-standard emergency obstetric and newborn care (EmONC) in health facilities in Northern Ghana. METHODS Drawing from a qualitative study design, data were obtained from six focus group discussions (FGDs) among 42 health care providers and 27 in-depth interviews with management members, clients and care takers duly guided by the principle of data saturation. Participants were purposively selected from basic and comprehensive level facilities. Data analysis followed Braun and Clarke's qualitative thematic analysis procedure. RESULTS Four themes and 13 sub-themes emerged as root drivers to sub-standard care. Specfically, the findings highlight centralisation of EmONC, inadequate funding, insufficient experiential training, delay in recruitment of newly trained essential staff and provider disinterest in profession. CONCLUSION Setbacks in the training and recruitment systems in Ghana, inadequate investment in rural health coupled with extent of health provider inherent disposition to practice may be partly responsible for sub-standard obstetric care in the study area. Interventions targeting the afore-mentioned areas may reduce events of sub-standard care.
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Affiliation(s)
- Alice Ayawine
- School of Public Health, Catholic University of Ghana, Fiapre, Sunyani, P.O. Box 363, Ghana.
| | - Mathias J A Asaarik
- School of Nursing and Midwifery, Catholic University of Ghana, Fiapre, Sunyani, P.O. Box 363, Ghana
| | - Roger A Atinga
- Department of Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Mengist B, Semahegn A, Yibabie S, Amsalu B, Tura AK. Barriers to proper maternal referral system in selected health facilities in Eastern Ethiopia: a qualitative study. BMC Health Serv Res 2024; 24:376. [PMID: 38532445 DOI: 10.1186/s12913-024-10825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Appropriate maternal referral system plays an essential role in curbing maternal mortality. Although the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system is crucial to facilitate the women to have access to timely lifesaving interventions. Nonetheless, little is known about the barriers to maternal referral system in the eastern Ethiopia. Therefore, this study aimed to explore the barriers to maternal referral system at selected referral hospitals in eastern Ethiopia. METHODS Key informant interviews and in-depth interviews were conducted among purposively selected respondents who had a role in maternal referral processes. A total of 12 key informants that comprised of liaison officers, healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented by note taking. Then audio recorded interviews were transcribed as per verbatim and imported to NVivo for coding and merging. The data were thematically synthesized. RESULTS The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most commonly reported barriers were lack of pre-referral communication and feedback, using informal communication, incomplete referral forms, poor ambulance service including misuse of ambulances, lack of skilled healthcare escort and lack of medical equipment at emergency, unnecessary self-referrals, poor referral skills and limited number of health professions. CONCLUSIONS The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse of available ambulance, poor communication, and limited seeking of feedback. Regular consultative meeting with relevant stakeholders and uptake of feedback are crucial to improve referral communication, proper use of ambulance and building capacity of health workforce about referral are essential to improve maternal referral system.
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Affiliation(s)
- Betelhem Mengist
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Agumasie Semahegn
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Shegaye Yibabie
- School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Bezabih Amsalu
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Wong KLM, Banke-Thomas A, Olubodun T, Macharia PM, Stanton C, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Ogunyemi O, Gwacham-Anisiobi U, Wang J, Abejirinde IOO, Makanga PT, Afolabi BB, Beňová L. Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria. COMMUNICATIONS MEDICINE 2024; 4:34. [PMID: 38418903 PMCID: PMC10902387 DOI: 10.1038/s43856-024-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Better geographical accessibility to comprehensive emergency obstetric care (CEmOC) facilities can significantly improve pregnancy outcomes. However, with other factors, such as affordability critical for care access, it is important to explore accessibility across groups. We assessed CEmOC geographical accessibility by wealth status in the 15 most-populated Nigerian cities. METHODS We mapped city boundaries, verified and geocoded functional CEmOC facilities, and assembled population distribution for women of childbearing age and Meta's Relative Wealth Index (RWI). We used the Google Maps Platform's internal Directions Application Programming Interface to obtain driving times to public and private facilities. City-level median travel time (MTT) and number of CEmOC facilities reachable within 60 min were summarised for peak and non-peak hours per wealth quintile. The correlation between RWI and MTT to the nearest public CEmOC was calculated. RESULTS We show that MTT to the nearest public CEmOC facility is lowest in the wealthiest 20% in all cities, with the largest difference in MTT between the wealthiest 20% and least wealthy 20% seen in Onitsha (26 vs 81 min) and the smallest in Warri (20 vs 30 min). Similarly, the average number of public CEmOC facilities reachable within 60 min varies (11 among the wealthiest 20% and six among the least wealthy in Kano). In five cities, zero facilities are reachable under 60 min for the least wealthy 20%. Those who live in the suburbs particularly have poor accessibility to CEmOC facilities. CONCLUSIONS Our findings show that the least wealthy mostly have poor accessibility to care. Interventions addressing CEmOC geographical accessibility targeting poor people are needed to address inequities in urban settings.
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Affiliation(s)
- Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- School of Human Sciences, University of Greenwich, London, UK.
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
- Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Pebolo PF, Okot J, Bongomin F, Awor S, Arwinyo B, Ojara S, Opee J, Jackline A, Ssennuni E, Ouma S. Efficacy of the Gulu University Reproductive Health Simulation Training for final year medical students and interns: a before-and-after study. Ther Adv Reprod Health 2024; 18:26334941241251967. [PMID: 38800825 PMCID: PMC11127575 DOI: 10.1177/26334941241251967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country. Objectives The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda. Design A before-and-after study. Methods A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample t-tests was used to test the difference in pre- and post-test scores. Independent sample t-tests compared median post-test results between interns and students, with a p-value <0.05 considered significant. Results A total of 153 participants were enrolled, the majority being males (78.4%, n = 120) and medical students (73.9%, n = 113). Among the 40 interns, 55% (n = 22) were doctors, 30% (n = 12) were midwives, and 15% (n = 6) were nurses. The study participants showed an increase in knowledge, with median post-test scores higher than pre-test scores for all participants [63% (interquartile ranges, IQR: 57-71%) versus 49% (42-54%), with a median difference of 14% (8-23%), p < 0.001]. Conclusion The SBT effectively imparts key knowledge competencies to the interns and fifth-year medical students. We recommend that SBT be included as part of the course units that students should take and for continuous medical education for qualified healthcare workers in resource-limited settings.
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Affiliation(s)
| | - Jerom Okot
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Silvia Awor
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Baifa Arwinyo
- Department of Obstetrics and Gynecology, Gulu Regional Referral Hospital, Gulu, Uganda
| | - Sande Ojara
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Jimmyy Opee
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | | | - Simple Ouma
- Research Department, The Aids Support Organisation, Kampala, Uganda
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Solnes Miltenburg A, Kvernflaten B, Meguid T, Sundby J. Towards renewed commitment to prevent maternal mortality and morbidity: learning from 30 years of maternal health priorities. Sex Reprod Health Matters 2023; 31:2174245. [PMID: 36857112 PMCID: PMC9980022 DOI: 10.1080/26410397.2023.2174245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Andrea Solnes Miltenburg
- Associate Professor in Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Resident in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | - Birgit Kvernflaten
- Researcher, Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tarek Meguid
- Associate Professor, Consultant Obstetrician & Gynaecologist, Department of Maternal and Child Health, University of Namibia, Windhoek, Namibia
| | - Johanne Sundby
- Professor, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Macharia PM, Wong KLM, Olubodun T, Beňová L, Stanton C, Sundararajan N, Shah Y, Prasad G, Kansal M, Vispute S, Shekel T, Gwacham-Anisiobi U, Ogunyemi O, Wang J, Abejirinde IOO, Makanga PT, Afolabi BB, Banke-Thomas A. A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations. Sci Data 2023; 10:736. [PMID: 37872185 PMCID: PMC10593805 DOI: 10.1038/s41597-023-02651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
Travel time estimation accounting for on-the-ground realities between the location where a need for emergency obstetric care (EmOC) arises and the health facility capable of providing EmOC is essential for improving pregnancy outcomes. Current understanding of travel time to care is inadequate in many urban areas of Africa, where short distances obscure long travel times and travel times can vary by time of day and road conditions. Here, we describe a database of travel times to comprehensive EmOC facilities in the 15 most populated extended urban areas of Nigeria. The travel times from cells of approximately 0.6 × 0.6 km to facilities were derived from Google Maps Platform's internal Directions Application Programming Interface, which incorporates traffic considerations to provide closer-to-reality travel time estimates. Computations were done to the first, second and third nearest public or private facilities. Travel time for eight traffic scenarios (including peak and non-peak periods) and number of facilities within specific time thresholds were estimated. The database offers a plethora of opportunities for research and planning towards improving EmOC accessibility.
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Affiliation(s)
- Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Population & Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Ogun, Nigeria
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | | | - Jia Wang
- School of Computing & Mathematical Sciences, University of Greenwich, London, UK
| | - Ibukun-Oluwa Omolade Abejirinde
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Canada
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
- Climate and Health Division, Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Bosede B Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria.
- School of Human Sciences, University of Greenwich, London, UK.
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Alaleit OD, Kajjimu J, Joseph K, Namirembe MS, Agaba PK, Kintu A. Description and analysis of the emergency obstetric interfacility ambulance transfers (IFTs) to Kawempe National Referral Hospital in Uganda. Afr J Emerg Med 2023; 13:183-190. [PMID: 37483678 PMCID: PMC10359711 DOI: 10.1016/j.afjem.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/28/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction In Uganda, 2% of women die from maternal causes with a mortality rate of 336 maternal deaths per 100,000 live births. According to the World Health Organization Uganda is one of the top three contributors to maternal mortality in sub-Saharan Africa. Uganda has parallel weak ambulance systems, government, and non-government-owned, that transport obstetric emergencies to higher-level facilities. These two operations lack standards of medical care and inter-facility transfer (IFT) protocols to direct care. Limited studies exist which assess the state of Emergency Care Services in Uganda and none has been performed to assess the ambulance referral services utilized to address obstetric emergencies. Objective The present study was performed to describe the ambulance transfer processes of obstetric emergencies by analyzing cases arriving at Kawempe National Referral Hospital (KNRH) from outlying health facilities. Methods The study was based at KNRH in Kampala, Uganda. It was a descriptive and analytic cross-sectional study. Trained research assistants enrolled participating patients who met the inclusion criteria consecutively on arrival by ambulance at the hospital. Utilizing a questionnaire, quantitative data was collected from the ambulance driver, the sending facility referral form, and the receiving hospital's ambulance log book for each case. The sample size was 215. Results The median age was 27 years and the majority of patients were referred because of hypertensive disorders (34.9%), obstructed labor (26.5%) and hemorrhage (20.9%). The median total response time for transfer of obstetric emergencies was 50 min, from ambulance activation until the mother was received at KNRH. Differences were identified between government and non-government-owned ambulances in regards to the method of activation, medical escort staffing, number of vital signs recorded, and ambulance onboard medical care. Ambulances parked at the facility took the shortest transfer time and EMT-supported ambulances had the greatest number of vital signs taken. Conclusions Recommendations are to develop an integrated ambulance system for both government and non-government ambulances with standards especially in regards to standardized scripted call-center calls analysis, dispatch activation time, response-to-patient time, and trained ambulance professional staffing and medical care whenever in patient transport mode.
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Affiliation(s)
- Okong Doreen Alaleit
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Kajjimu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kalanzi Joseph
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Magara Stella Namirembe
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter K. Agaba
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kintu
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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12
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Rai P, Ackerman IN, O’Connor DA, Gorelik A, Buchbinder R. Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of cross-sectional survey data. PLoS One 2023; 18:e0289443. [PMID: 37549152 PMCID: PMC10406287 DOI: 10.1371/journal.pone.0289443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES To determine the availability and readiness of health facilities to provide family planning, antenatal care and basic emergency obstetric and newborn care in Nepal in 2021. Secondary objectives were to identify progress since 2015 and factors associated with readiness. METHOD This is a secondary analysis of cross-sectional Nepal Health Facility Survey (NHFS) data collected in 2015 and 2021. The main outcome measures were availability and readiness of family planning, antenatal care, and basic emergency obstetric and newborn care services. Readiness indices were calculated using WHO-recommended service availability and readiness assessment (SARA) methods (score range 0 to 100%, with 100% indicating facilities are fully prepared to provide a specific service). We used independent t-tests to compare readiness indices in 2015 and 2021. Factors potentially associated with readiness (rurality setting, ecological region, managing authority, management meeting, quality assurance activities, and external supervision) were explored using multivariable linear regression. RESULTS There were 940 and 1565 eligible health facilities in the 2015 and 2021 surveys, respectively. Nearly all health facilities provided family planning (2015: n = 919 (97.8%); 2021: n = 1530 (97.8%)) and antenatal care services (2015: n = 920 (97.8%); 2021: n = 1538 (98.3%)) in both years, but only half provided delivery services (2015: n = 457 (48.6%); 2021: n = 804 (51.4%)). There were suboptimal improvements in readiness indices over time: (2015-21: family planning 68.0% to 70.9%, p<0.001, antenatal care 49.5% to 54.1%, p<0.001 and basic emergency obstetric and newborn care 56.7% to 58.0%, p = 0.115). The regression model comprising combined datasets of both NHFSs indicates facilities with regular management meetings and/or quality assurance activities had significantly greater readiness for all three indices. Similarly, public facilities had greater readiness for family planning and basic emergency obstetric and newborn care while they had lower readiness for antenatal care. CONCLUSIONS Readiness to deliver family planning, antenatal care and basic emergency obstetric and newborn care services in Nepal remains inadequate, with little improvement observed over six years.
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Affiliation(s)
- Pramila Rai
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ilana N. Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Denise A. O’Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Ramesh S, Chakraborty S, Adanu RM, Bandoh DAB, Berrueta M, Gausman J, Khan N, Kenu E, Langer A, Nigri C, Odikro MA, Pingray V, Saggurti N, Vázquez P, Williams CR, Jolivet RR. Authorization of midwives to perform basic emergency obstetric and newborn care signal functions in Argentina, Ghana, and India: A multi-country validation study of a key global maternal and newborn health indicator. PLoS One 2023; 18:e0283029. [PMID: 37079621 PMCID: PMC10118111 DOI: 10.1371/journal.pone.0283029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/28/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Midwives' authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives' skills and actual provision of services. In this study, we aimed to validate the data reported in global monitoring frameworks (criterion validity) and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity). METHODS We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the reported data on midwives' authorization to provide BEmONC services, we reviewed national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent Health Policy Survey. To assess whether authorization demonstrates convergent validity with midwives' skills, training, and performance of BEmONC signal functions, we surveyed 1257 midwives/midwifery professionals and assessed variance. RESULTS We detected discrepancies between data reported in the global monitoring frameworks and the national regulatory framework in all three countries. We found wide variations between midwives' authorization to perform signal functions and their self-reported skills and actual performance within the past 90 days. The percentage of midwives who reported performing all signal functions for which they were authorized per country-specific regulations was 17% in Argentina, 23% in Ghana, and 31% in India. Additionally, midwives in all three countries reported performing some signal functions that the national regulations did not authorize. CONCLUSION Our findings suggest limitations in criterion and construct validity for this indicator in Argentina, Ghana, and India. Some signal functions such as assisted vaginal delivery may be obsolete based on current practice patterns. Findings suggest the need to re-examine the emergency interventions that should be included as BEmONC signal functions.
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Affiliation(s)
| | | | - Richard M. Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Delia A. B. Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jewel Gausman
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carolina Nigri
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Magdalene A. Odikro
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Paula Vázquez
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Health Science, Kinesiology, and Rehabilitation, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Caitlin R. Williams
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - R. Rima Jolivet
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Ayawine A, Atinga RA. “We know it is not good, but we are constrained”: A study on quality of emergency obstetric and newborn care in Northern Ghana. Heliyon 2023; 9:e15250. [PMID: 37095927 PMCID: PMC10121449 DOI: 10.1016/j.heliyon.2023.e15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To explore the quality of emergency obstetric and newborn care provided to newly delivered women in rural Ghana. Methods A multiple case study design, involving in-depth face to face interviews, was deployed to draw evidence from essential health providers, clients and caretakers. Data were further derived from non-participant observation by means of an observation guide and analysis of physical artifacts using the room-by-room walk-through tool. Data analysis followed Yin's five phase process to case study analysis. Results Quality of care was compromised by non-adherence to standard practices, inadequate monitoring, crude treatment procedures, lack of basic care needs and poor health providers' relational behaviours. Limited supplies of drugs, equipment and essential care providers further weakened the provision of quality emergency obstetric and newborn care. Conclusion Inadequate supply of essential logistics and skill gaps on the part of health providers in some maternal and newborn care components adversely produced poor maternal and neonatal outcomes in rural Ghana. Elements of disrespectful care for women suggest violations of their rights in the maternal and newborn care encounter.
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Affiliation(s)
- Alice Ayawine
- School of Public Health and Allied Sciences, Catholic University of Ghana, Fiapre-Sunyani, Ghana
- Corresponding author.
| | - Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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15
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:214-226.e1. [PMID: 37055148 DOI: 10.1016/j.jogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates. TARGET POPULATION Providers working to improve health care for Canadian women and their families; patients and their families. OUTCOMES Simulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition. BENEFITS, HARMS, AND COSTS This modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time. EVIDENCE Articles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords "simulation" and "simulator." The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care professionals working to improve Canadian women's health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs. RECOMMENDATIONS
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16
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Sansregret A, Garber A, Freire-Lizama T, Monton L, Mueller V, Papalia N, Ruiter PJA, Shore EM, Suri M. Déclaration de consensus n o 434 : Simulation en obstétrique et gynécologie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:227-240.e1. [PMID: 37055149 DOI: 10.1016/j.jogc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Sonnie M, Kella F, Stern A, Mannino CA, Adelman S, Fuller L, Forbush L, Mann J, van de Water B, Falahee B, Sayeed S, Ewing H, Kerry V. A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting. Ann Glob Health 2023; 89:10. [PMID: 36819968 PMCID: PMC9936905 DOI: 10.5334/aogh.3970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023] Open
Abstract
Objective Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. Methods The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. Results The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. Conclusion The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.
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18
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Singh R, Agarwal M, Sinha S, Sinha HH, Anant M. Modified WHO Partograph in Labour Room: A Quality Improvement Initiative to Find Out Concerns, Challenges and Solutions. Cureus 2022; 14:e30851. [PMID: 36337778 PMCID: PMC9622032 DOI: 10.7759/cureus.30851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 06/16/2023] Open
Abstract
Every day many women die in pregnancy and childbirth, most of which are preventable. Regular and timely labour monitoring by partograph is of utmost importance. The aim of this study was to increase partograph use by residents in the Department of Obstetrics and Gynecology in all eligible women from existing 25% to 90% over six months through a quality improvement (QI) process. A team of six members including consultants, residents, and staff nurses did a root cause analysis through fishbone analysis to identify why the rate of use of partograph is only 25% of all cases. Many strategies were implemented through Plan-Do-Study-Act (PDSA) cycles for the cause identified. The interventions were allocation of triage area for timely identification of eligible women in the active phase of labour, training of residents, involving interns and nurses for use in shortage of staff, making departmental written policy, and assigning checking authority, to shift patients with attached partograph only; partograph has to be attached in the file right from the beginning when sisters make women admission file. These were done in five PDSA cycles and the outcome was measured by a control chart. The rate of partograph use increased from 25% to 92% over the study period of six months from September 2020 to February 2021. Regular audits were conducted to maintain the results. It can thus be concluded that partograph appears easy to implement and inexpensive, but its use still has enormous difficulties. But a QI approach can help in improving adherence to partograph use, by solving the root cause of the concern and challenges.
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Affiliation(s)
- Ritu Singh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Mukta Agarwal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Sudwita Sinha
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Hemali H Sinha
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Monika Anant
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Patna, IND
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Banke-Thomas A, Macharia PM, Makanga PT, Beňová L, Wong KLM, Gwacham-Anisiobi U, Wang J, Olubodun T, Ogunyemi O, Afolabi BB, Ebenso B, Omolade Abejirinde IO. Leveraging big data for improving the estimation of close to reality travel time to obstetric emergency services in urban low- and middle-income settings. Front Public Health 2022; 10:931401. [PMID: 35968464 PMCID: PMC9372297 DOI: 10.3389/fpubh.2022.931401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Maternal and perinatal mortality remain huge challenges globally, particularly in low- and middle-income countries (LMICs) where >98% of these deaths occur. Emergency obstetric care (EmOC) provided by skilled health personnel is an evidence-based package of interventions effective in reducing these deaths associated with pregnancy and childbirth. Until recently, pregnant women residing in urban areas have been considered to have good access to care, including EmOC. However, emerging evidence shows that due to rapid urbanization, this so called “urban advantage” is shrinking and in some LMIC settings, it is almost non-existent. This poses a complex challenge for structuring an effective health service delivery system, which tend to have poor spatial planning especially in LMIC settings. To optimize access to EmOC and ultimately reduce preventable maternal deaths within the context of urbanization, it is imperative to accurately locate areas and population groups that are geographically marginalized. Underpinning such assessments is accurately estimating travel time to health facilities that provide EmOC. In this perspective, we discuss strengths and weaknesses of approaches commonly used to estimate travel times to EmOC in LMICs, broadly grouped as reported and modeled approaches, while contextualizing our discussion in urban areas. We then introduce the novel OnTIME project, which seeks to address some of the key limitations in these commonly used approaches by leveraging big data. The perspective concludes with a discussion on anticipated outcomes and potential policy applications of the OnTIME project.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, United Kingdom
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- *Correspondence: Aduragbemi Banke-Thomas
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Prestige Tatenda Makanga
- Surveying and Geomatics Department, Faculty of Science and Technology, Midlands State University, Gweru, Zimbabwe
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kerry L. M. Wong
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Jia Wang
- School of Computing and Mathematical Sciences, University of Greenwich, London, United Kingdom
| | - Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Centre Abeokuta, Abeokuta, Nigeria
| | | | - Bosede B. Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Ibukun-Oluwa Omolade Abejirinde
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Integrated Maternal Care Strategies in Low- and Middle-Income Countries: A Systematic Review. Int J Integr Care 2022; 22:26. [PMID: 35812798 PMCID: PMC9231572 DOI: 10.5334/ijic.6254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background and aim: Ineffective organisation of care leads to increased morbidity and mortality in neonates and their mothers. We aimed to identify and describe strategies used in low- and middle-income countries that attempt to deliver coherent, coordinated, and continuous services (i.e., integrated care) and how the various strategies affect the organisation of care. Methods: We conducted a systematic literature review to identify, appraise, and synthesise relevant evidence about strategies for integrating maternal care in low- and middle-income countries, searching multiple electronic databases. Results: Fourteen studies met our inclusion criteria. We identified five types of integration strategies: 1) organisational, 2) service/professional, 3) functional, 4) organisational combined with normative strategies, and 5) clinical combined with functional integration strategies. The most frequent types of strategies were organisational, and service/professional integration strategies. We did not identify any publications describing systemic integration strategies implemented in low- and middle-income countries. Conclusions: Most types of strategies described in theory have been implemented and studied in low- and middle-income countries. Our findings suggest that different types of strategies may lead to comparable organisational outcomes. For example, organisational integration strategies and professional or service integration strategies may similarly influence inter-organisational collaboration. Inter-organisational collaboration may play a particularly important role in the context of maternal care integration.
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Banke-Thomas A, Avoka CKO, Gwacham-Anisiobi U, Omololu O, Balogun M, Wright K, Fasesin TT, Olusi A, Afolabi BB, Ameh C. Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study. BMJ Glob Health 2022; 7:bmjgh-2022-008604. [PMID: 35487675 PMCID: PMC9058694 DOI: 10.1136/bmjgh-2022-008604] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Prompt access to emergency obstetrical care (EmOC) reduces the risk of maternal mortality. We assessed institutional maternal mortality by distance and travel time for pregnant women with obstetrical emergencies in Lagos State, Nigeria. Methods We conducted a facility-based retrospective cohort study across 24 public hospitals in Lagos. Reviewing case notes of the pregnant women presenting between 1 November 2018 and 30 October 2019, we extracted socio-demographic, travel and obstetrical data. The extracted travel data were exported to Google Maps, where driving distance and travel time data were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on maternal death. Findings Of 4181 pregnant women with obstetrical emergencies, 182 (4.4%) resulted in maternal deaths. Among those who died, 60.3% travelled ≤10 km directly from home, and 61.9% arrived at the hospital ≤30 mins. The median distance and travel time to EmOC was 7.6 km (IQR 3.4–18.0) and 26 mins (IQR 12–50). For all women, travelling 10–15 km (2.53, 95% CI 1.27 to 5.03) was significantly associated with maternal death. Stratified by referral, odds remained statistically significant for those travelling 10–15 km in the non-referred group (2.48, 95% CI 1.18 to 5.23) and for travel ≥120 min (7.05, 95% CI 1.10 to 45.32). For those referred, odds became statistically significant at 25–35 km (21.40, 95% CI 1.24 to 36.72) and for journeys requiring travel time from as little as 10–29 min (184.23, 95% CI 5.14 to 608.51). Odds were also significantly higher for women travelling to hospitals in suburban (3.60, 95% CI 1.59 to 8.18) or rural (2.51, 95% CI 1.01 to 6.29) areas. Conclusion Our evidence shows that distance and travel time influence maternal mortality differently for referred women and those who are not. Larger scale research that uses closer-to-reality travel time and distance estimates as we have done, rethinking of global guidelines, and bold actions addressing access gaps, including within the suburbs, will be critical in reducing maternal mortality by 2030.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, London, UK .,School of Human Sciences, University of Greenwich, Greenwich, London, UK.,Maternal and Reproductive Health Research Collective, Lagos, Nigeria
| | - Cephas Ke-On Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | | | - Olufemi Omololu
- Department of Obstetrics and Gynaecology, Lagos Island Maternity Hospital, Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Kikelomo Wright
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Tolulope Temitayo Fasesin
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Adedotun Olusi
- Department of Obstetrics and Gynaecology, Federal Medical Centre Ebute-Metta, Ebute-Metta, Lagos, Nigeria
| | - Bosede Bukola Afolabi
- Maternal and Reproductive Health Research Collective, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Charles Ameh
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
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22
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Dominico S, Serbanescu F, Mwakatundu N, Kasanga MG, Chaote P, Subi L, Maro G, Prasad N, Ruiz A, Mongo W, Schmidt K, Lobis S. A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00485. [PMID: 35487553 PMCID: PMC9053146 DOI: 10.9745/ghsp-d-21-00485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Efforts to increase the availability and utilization of high-quality emergency obstetric and newborn care and routine delivery care services in Kigoma were successful and subsequently contributed to significant reductions in maternal and perinatal mortality in the region. Introduction: To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand. Methods: Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities. Results: Between 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status. Conclusion: Decentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.
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Affiliation(s)
| | - Florina Serbanescu
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA.
| | | | | | - Paul Chaote
- President's Office Regional Administration and Local Government, Health Social Welfare and Nutrition Division, Dodoma, Tanzania
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | | | - Alicia Ruiz
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA
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23
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Aji B, Anandari D, Soetikno H, Sumawan H. Sustaining maternal and child health programs when donor funding ends: A case study of stakeholder involvement in Indonesia. Int J Health Plann Manage 2022; 37:2049-2062. [DOI: 10.1002/hpm.3448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 12/07/2021] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Budi Aji
- School of Public Health Faculty of Health Sciences Jenderal Soedirman University Purwokerto Indonesia
| | - Dian Anandari
- School of Public Health Faculty of Health Sciences Jenderal Soedirman University Purwokerto Indonesia
| | | | - Herman Sumawan
- Faculty of Medicine Jenderal Soedirman University Purwokerto Indonesia
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24
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Amsalu B, Aragaw A, Sintayehu Y, Sema A, Belay Y, Tadese G, Kassie N, Guta A, Tibebu A, Tiruye G. Respectful maternity care among laboring women in public hospitals of Benishangul Gumuz Region, Ethiopia: A mixed cross-sectional study with direct observations. SAGE Open Med 2022; 10:20503121221076995. [PMID: 35173967 PMCID: PMC8841920 DOI: 10.1177/20503121221076995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Promoting respectful maternity care is a fundamental strategy for enhancing facility birth, which significantly reduces maternal and newborn mortality and morbidity. Despite these effects, disrespect and abusive childbirth care remain a challenge in Ethiopia. Therefore, this study aimed to determine the prevalence of respectful maternity care and its associated factors among laboring women in public hospitals of Benishangul Gumuz region, Ethiopia. Methods: A facility-based cross-sectional study design was employed, and trained external assessors observed the care provided to 404 laboring women in public hospitals using structured observation checklists. A focus group discussion and two key informant interviews were also conducted. A structured pre-tested questionnaire and a semi-structured guide were used to generate quantitative and qualitative data, respectively. Seven verification criteria were employed, and the mean value and above for each criterion were used to measure respectful maternity care. Results: Of the 404 client–provider interaction observations during childbirth, only 12.6% ( n = 51) participants received respectful maternity care. Being from an urban area (adjusted odds ratio = 3.34, 95% confidence interval: 1.39, 8.08), giving childbirth at daytime (adjusted odds ratio = 2.59, 95% confidence interval: 1.26, 5.33), receiving the service from compassionate and respectful care trained provider (adjusted odds ratio = 4.54, 95% confidence interval: 1.63, 12.66), giving childbirth at general hospital (adjusted odds ratio = 3.03, 95% confidence interval: 1.39, 6.65) were positively associated with respectful maternity care. Staff workload, shortage of supply and equipment, partiality in providing timely care, yelling and insulting at clients and birth companions were also barriers to respectful maternity care. Conclusion: The observed respectful maternity care practices were low in the study area. Therefore, the findings of this study suggest that addressing respectful maternity care would require increased compassionate and respectful care trained providers, and sustained efforts to improve access to basic equipment and supply for maternity care with an emphasis on primary hospitals. Tailored interventions aimed at improving respectful maternity care should also target rural residents and nighttime parturients.
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Affiliation(s)
- Bezabh Amsalu
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Amanu Aragaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yitagesu Sintayehu
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alekaw Sema
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yalelet Belay
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Getasew Tadese
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Nigus Kassie
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alemu Guta
- Department of Midwifery, College of Medicine & Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Abel Tibebu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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25
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Sharma B, Raina A, Kumar V, Mohanty P, Sharma M, Gupta A. Counting stillbirth in a community - To understand the burden. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Saleh H, Monsoori ZA, Serour A, Oniya O, Konje JC. Improving Emergency Care Through a Dedicated Redesigned Obstetrics and Gynecology Emergency Unit at the Women's Hospital, Doha, Qatar. AJOG GLOBAL REPORTS 2022; 2:100053. [PMID: 36275495 PMCID: PMC9563527 DOI: 10.1016/j.xagr.2022.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND OBJECTIVE STUDY DESIGN RESULTS CONCLUSION
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Affiliation(s)
- Huda Saleh
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar (Dr Saleh, Dr Al Monsoori and Dr Serour)
| | - Zeena Al Monsoori
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar (Dr Saleh, Dr Al Monsoori and Dr Serour)
| | - A. Serour
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar (Dr Saleh, Dr Al Monsoori and Dr Serour)
| | - Olubunmi Oniya
- Women's Clinical Services Management Group, Sidra Medical and Research Centre, Weill Cornell Medicine-Qatar, Doha, Qatar (Ms Oniya)
| | - Justin C. Konje
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom and Weill Cornell Medicine, Qatar (Dr Konje)
- Corresponding author: Justin C. Konje, MD.
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27
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Proceed with reasonable care: When legal principles inform training to prevent harm during the childbirth. Best Pract Res Clin Obstet Gynaecol 2021; 80:105-113. [DOI: 10.1016/j.bpobgyn.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
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28
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Banke-Thomas A, Avoka C, Olaniran A, Balogun M, Wright O, Ekerin O, Benova L. Patterns, travel to care and factors influencing obstetric referral: Evidence from Nigeria's most urbanised state. Soc Sci Med 2021; 291:114492. [PMID: 34662765 DOI: 10.1016/j.socscimed.2021.114492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022]
Abstract
The criticality of referral makes it imperative to study its patterns and factors influencing it at a health systems level. This study of referral in Lagos, Nigeria is based on health records of 4181 pregnant women who presented with obstetric emergencies at one of the 24 comprehensive emergency obstetric care (EmOC) facilities in the state between November 2018 and October 2019 complemented with distance and time data extracted from Google Maps. Univariate, bivariate, and multivariate analyses were conducted. About a quarter of pregnant women who presented with obstetric emergencies were referred. Most referrals were from primary health centres (41.9 %), private (23.5 %) and public (16.2 %) hospitals. Apart from the expected low-level to high-level referral pattern, there were other patterns observed including non-formal, multiple, and post-delivery referrals. Travel time and distance to facilities that could provide needed care increased two-fold on account of referrals compared to scenarios of going directly to the final facility, mostly travelling to these facilities by private cars/taxis (72.8 %). Prolonged/obstructed labour was the commonest obstetric indication for referral, with majority of referred pregnant women delivered via caesarean section (52.9 %). After adjustment, being married, not being registered for antenatal care at facility of care, presenting at night or with a foetus in distress increased the odds of referral. However, parity, presentation in the months following the commissioning of a new comprehensive EmOC facility or with abortion reduced the likelihood of being referred. Our findings underscore the need for health systems strengthening interventions that support women during referral and the importance of antenatal care and early booking to aid identification of potential pregnancy complications whilst establishing robust birth preparedness plans that can minimise the need for referral in the event of emergencies. Indeed, there are context-specific influences that need to be addressed if effective referral systems are to be designed.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, London, United Kingdom; Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
| | - Cephas Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Abimbola Olaniran
- Infectious Disease and Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ololade Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria; Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olabode Ekerin
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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29
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Banke-Thomas A, Wong KLM, Collins L, Olaniran A, Balogun M, Wright O, Babajide O, Ajayi B, Afolabi BB, Abayomi A, Benova L. An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria. Health Policy Plan 2021; 36:1384-1396. [PMID: 34424314 PMCID: PMC8505861 DOI: 10.1093/heapol/czab099] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify ‘hotspots’ of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2–240 minutes (without referral) and 7–320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.,Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria
| | - Kerry L M Wong
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Lindsey Collins
- School of Geographical Sciences and Urban Planning, Arizona State University, South Myrtle Avenue, Tempe, Arizona 85281, USA
| | - Abimbola Olaniran
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi Araba, PMB 12003, Lagos, Nigeria
| | - Ololade Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria
| | - Opeyemi Babajide
- Department of Epidemiology and Medical Statistics, University of Ibadan, Oduduwa Road, 200132, Ibadan, Nigeria
| | - Babatunde Ajayi
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Oba Akinjobi Street, Ikeja, P.M.B. 21266, Lagos, Nigeria.,Office of the Commissioner, Lagos State Ministry of Health, Secretariat, Alausa, Lagos, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Idi Araba, P.M.B 12003, Lagos, Nigeria
| | - Akin Abayomi
- Office of the Commissioner, Lagos State Ministry of Health, Secretariat, Alausa, Lagos, Nigeria
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerpen, Belgium
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30
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Radovich E, Banke-Thomas A, Campbell OMR, Ezeanochie M, Gwacham-Anisiobi U, Ande ABA, Benova L. Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria. BMC Health Serv Res 2021; 21:927. [PMID: 34488752 PMCID: PMC8420846 DOI: 10.1186/s12913-021-06945-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The highest risk of maternal and perinatal deaths occurs during and shortly after childbirth and is preventable if functional referral systems enable women to reach appropriate health services when obstetric complications occur. Rising numbers of deliveries in health facilities, including in high mortality settings like Nigeria, require formalised coordination across the health system to ensure that women and newborns get to the right level of care, at the right time. This study describes and critically assesses the extent to which referral and its components can be captured using three different data sources from Nigeria, examining issues of data quality, validity, and usefulness for improving and monitoring obstetric care systems. METHODS The study included three data sources on referral for childbirth care in Nigeria: a nationally representative household survey, patient records from multiple facilities in a state, and patient records from the apex referral facility in a city. We conducted descriptive analyses of the extent to which referral status and components were captured across the three sources. We also iteratively developed a visual conceptual framework to guide our critical comparative analysis. RESULTS We found large differences in the proportion of women referred, and this reflected the different denominators and timings of the referral in each data source. Between 16 and 34% of referrals in the three sources originated in government hospitals, and lateral referrals (origin and destination facility of the same level) were observed in all three data sources. We found large gaps in the coverage of key components of referral as well as data gaps where this information was not routinely captured in facility-based sources. CONCLUSIONS Our analyses illustrated different perspectives from the national- to facility-level in the capture of the extent and components of obstetric referral. By triangulating across multiple data sources, we revealed the strengths and gaps within each approach in building a more complete picture of obstetric referral. We see our visual framework as assisting further research efforts to ensure all referral pathways are captured in order to better monitor and improve referral systems for women and newborns.
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Affiliation(s)
- Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Ezeanochie
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Adedapo B A Ande
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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31
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MacDonald T, Dorcely O, Ewusie JE, Darling EK, Moll S, Mbuagbaw L. The effect of a new maternity unit on maternal outcomes in rural Haiti: an interrupted time series study. BMC Pregnancy Childbirth 2021; 21:601. [PMID: 34481461 PMCID: PMC8418005 DOI: 10.1186/s12884-021-04062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Haiti where there are high rates of maternal and neonatal mortality, efforts to reduce mortality and improve maternal newborn child health (MNCH) must be tracked and monitored to measure their success. At a rural Haitian hospital, local surveillance efforts allowed for the capture of MNCH indicators. In March 2018, a new stand-alone maternity unit was opened, with increased staff, personnel, and physical space. We aimed to determine if the new maternity unit brought about improvements in maternal and neonatal outcomes. METHODS We conducted an interrupted time series analysis using data collected between July 2016 and October 2019 including 20 months before the opening of the maternity unit and 20 months after. We examined maternal-neonatal outcomes such as physiological (vaginal) births, caesarean birth, postpartum hemorrhage (PPH), maternal deaths, stillbirths and undesirable outcomes (eclampsia, PPH, perineal laceration, postpartum infection, maternal death or stillbirth). RESULTS Immediately after the opening of the new maternity, the number of physiological births decreased by 7.0% (β = - 0.070; 95% CI: - 0.110 to - 0.029; p = 0.001) and there was an increase of 6.7% in caesarean births (β = 0.067; 95% CI: 0.026 to 0.107; p = 0.002). For all undesirable outcomes, preintervention there was an increasing trend of 1.8% (β = 0.018; 95% CI: 0.013 to 0.024; p < 0.001), an immediate 14.4% decrease after the intervention (β = - 0.144; 95% CI: - 0.255 to - 0.033; p = 0.012), and a decreasing trend of 1.8% through the postintervention period (β = - 0.018; 95% CI: - 0.026 to - 0.009; p < 0.001). No other significant level or trend changes were noted. CONCLUSIONS The new maternity unit led to an upward trend in caesarean births yet an overall reduction in all undesirable maternal and neonatal outcomes. The new maternity unit at this rural Haitian hospital positively impacted and improved maternal and neonatal outcomes.
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Affiliation(s)
- Tonya MacDonald
- Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,School of Midwifery, Laurentian University, Sudbury, ON, Canada
| | | | - Joycelyne E Ewusie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth K Darling
- Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada.,McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8N 4K1, Canada. .,Centre for the Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon. .,Biostatistics Unit/The Research Institute, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada. .,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
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Mizerero SA, Wilunda C, Musumari PM, Ono-Kihara M, Mubungu G, Kihara M, Nakayama T. The status of emergency obstetric and newborn care in post-conflict eastern DRC: a facility-level cross-sectional study. Confl Health 2021; 15:61. [PMID: 34380531 PMCID: PMC8356431 DOI: 10.1186/s13031-021-00395-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Pregnancy-related mortality remains persistently higher in post-conflict areas. Part of the blame lies with continued disruption to vital care provision, especially emergency obstetric and newborn care (EmONC). In such settings, assessment of EmONC is essential for data-driven interventions needed to reduce preventable maternal and neonatal mortality. In the North Kivu Province (NKP), the epicentre of armed conflict in eastern Democratic Republic of the Congo (DRC) between 2006 and 2013, the post-conflict status of EmONC is unknown. We assessed the availability, use, and quality of EmONC in 3 health zones (HZs) of the NKP to contribute to informed policy and programming in improving maternal and newborn health (MNH) in the region. Method A cross-sectional survey of all 42 public facilities designated to provide EmONC in 3 purposively selected HZs in the NKP (Goma, Karisimbi, and Rutshuru) was conducted in 2017. Interviews, reviews of maternity ward records, and observations were used to assess the accessibility, use, and quality of EmONC against WHO standards. Results Only three referral facilities (two faith-based facilities in Goma and the MSF-supported referral hospital of Rutshuru) met the criteria for comprehensive EmONC. None of the health centres qualified as basic EmONC, nor could they offer EmONC services 24 h, 7 days a week (24/7). The number of functioning EmONC per 500,000 population was 1.5. Assisted vaginal delivery was the least performed signal function, followed by parenteral administration of anticonvulsants, mainly due to policy restrictions and lack of demand. The 3 HZs fell short of WHO standards for the use and quality of EmONC. The met need for EmONC was very low and the direct obstetric case fatality rate exceeded the maximum acceptable level. However, the proportion the proportion of births by caesarean section in EmONC facilities was within acceptable range in the HZs of Goma and Rutshuru. Overall, the intrapartum and very early neonatal death rate was 1.5%. Conclusion This study provides grounds for the development of coordinated and evidence-based programming, involving local and external stakeholders, as part of the post-conflict effort to address maternal and neonatal morbidity and mortality in the NKP. Particular attention to basic EmONC is required, focusing on strengthening human resources, equipment, supply chains, and referral capacity, on the one hand, and on tackling residual insecurity that might hinder 24/7 staff availability, on the other.
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Affiliation(s)
- Serge-André Mizerero
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan.
| | - Calistus Wilunda
- African Population and Health Research Centre, Manga Close, P.O. Box 10787-00100, Nairobi, Kenya
| | - Patou Masika Musumari
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.,International Institute of Socio-Epidemiology, Kitagosho-cho, Sakyo-ku, Kyoto, 606-8336, Japan
| | - Masako Ono-Kihara
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Gerrye Mubungu
- Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Masahiro Kihara
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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Ifeanyichi M, Broekhuizen H, Cheelo M, Juma A, Mwapasa G, Borgstein E, Kachimba J, Gajewski J, Brugha R, Pittalis C, Bijlmakers L. Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia. BMC Health Serv Res 2021; 21:728. [PMID: 34301242 PMCID: PMC8299644 DOI: 10.1186/s12913-021-06709-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. METHODS We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. RESULTS At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. CONCLUSION Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case - besides equitable access to healthcare - for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.
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Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands. .,EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands.
| | - Henk Broekhuizen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Adinan Juma
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Gerald Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Musaba MW, Ndeezi G, Barageine JK, Weeks AD, Wandabwa JN, Mukunya D, Waako P, Odongkara B, Arach A, Tulya-Muhika Mugabe K, Kasede Napyo A, Nankabirwa V, Tumwine JK. Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study. Matern Health Neonatol Perinatol 2021; 7:13. [PMID: 34266492 PMCID: PMC8281707 DOI: 10.1186/s40748-021-00133-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. METHODS Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death. RESULTS Of the 623 women diagnosed with obstructed labour, 584 met the eligibility criteria. There were 24 fresh still births (FSB) and 32 early neonatal deaths (ENND) giving an FSB rate of 43.8 (95% CI 28.3-64.4) deaths per 1000 total births; early neonatal death rate of 58.4 (95% CI 40.3-81.4) deaths per 1000 and an overall perinatal mortality rate of 102.2 (95% CI 79.4-130.6) deaths in the first 7 days of life. A mother being referred in active labour adjusted risk ratio of 2.84 (95% CI: 1.35-5.96) and having high blood lactate levels at recruitment adjusted risk ratio 2.71 (95% CI: 1.26-4.24) were the determinants of perinatal deaths. CONCLUSIONS The incidence of perinatal death was four times the regional and national average. Babies to women referred in active labour and those with high maternal blood lactate were more likely to die.
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Affiliation(s)
- Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda.
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D Weeks
- Sanyu Research Unit, University of Liverpool/Liverpool Women's Hospital, Liverpool, UK
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - David Mukunya
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Waako
- Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Agnes Arach
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | | | - Agnes Kasede Napyo
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Intervention Science and Maternal Child health (CISMAC), Center for International Health, University of Bergen, Bergen, Norway
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Banke-Thomas A, Abejirinde IOO, Ayomoh FI, Banke-Thomas O, Eboreime EA, Ameh CA. e-income countries from a provider's perspective: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-002371. [PMID: 32565428 PMCID: PMC7309188 DOI: 10.1136/bmjgh-2020-002371] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Maternal health services are effective in reducing the morbidity and mortality associated with pregnancy and childbirth. We conducted a systematic review on costs of maternal health services in low-income and middle-income countries from the provider's perspective. METHODS We searched multiple peer-reviewed databases (including African Journal Online, CINAHL Plus, EconLit, Popline, PubMed, Scopus and Web of Science) and grey literature for relevant articles published from year 2000. Articles meeting our inclusion criteria were selected with quality assessment done using relevant cost-focused criteria of the Consolidated Health Economic Evaluation Reporting Standards checklist. For comparability, disaggregated costs data were inflated to 2019 US$ equivalents. Costs and cost drivers were systematically compared. Where heterogeneity was observed, narrative synthesis was used to summarise findings. RESULTS Twenty-two studies were included, with most studies costing vaginal and/or caesarean delivery (11 studies), antenatal care (ANC) (9) and postabortion care (PAC) (8). Postnatal care (PNC) has been least costed (2). Studies used different methods for data collection and analysis. Quality of peer-reviewed studies was assessed average to high while all grey literature studies were assessed as low quality. Following inflation, estimated provision cost per service varied (ANC (US$7.24-US$31.42); vaginal delivery (US$14.32-US$278.22); caesarean delivery (US$72.11-US$378.940; PAC (US$97.09-US$1299.21); family planning (FP) (US$0.82-US$5.27); PNC (US$5.04)). These ranges could be explained by intercountry variations, variations in provider type (public/private), facility type (primary/secondary) and care complexity (simple/complicated). Personnel cost was mostly reported as the major driver for provision of ANC, skilled birth attendance and FP. Economies of scale in service provision were reported. CONCLUSION There is a cost savings case for task-shifting and encouraging women to use lower level facilities for uncomplicated services. Going forward, consensus regarding cost component definitions and methodologies for costing maternal health services will significantly help to improve the usefulness of cost analyses in supporting policymaking towards achieving Universal Health Coverage.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | | | - Francis Ifeanyi Ayomoh
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | | | | | - Charles Anawo Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Banke-Thomas A, Wong KLM, Ayomoh FI, Giwa-Ayedun RO, Benova L. "In cities, it's not far, but it takes long": comparing estimated and replicated travel times to reach life-saving obstetric care in Lagos, Nigeria. BMJ Glob Health 2021; 6:bmjgh-2020-004318. [PMID: 33495286 PMCID: PMC7839900 DOI: 10.1136/bmjgh-2020-004318] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Travel time to comprehensive emergency obstetric care (CEmOC) facilities in low-resource settings is commonly estimated using modelling approaches. Our objective was to derive and compare estimates of travel time to reach CEmOC in an African megacity using models and web-based platforms against actual replication of travel. METHODS We extracted data from patient files of all 732 pregnant women who presented in emergency in the four publicly owned tertiary CEmOC facilities in Lagos, Nigeria, between August 2018 and August 2019. For a systematically selected subsample of 385, we estimated travel time from their homes to the facility using the cost-friction surface approach, Open Source Routing Machine (OSRM) and Google Maps, and compared them to travel time by two independent drivers replicating women's journeys. We estimated the percentage of women who reached the facilities within 60 and 120 min. RESULTS The median travel time for 385 women from the cost-friction surface approach, OSRM and Google Maps was 5, 11 and 40 min, respectively. The median actual drive time was 50-52 min. The mean errors were >45 min for the cost-friction surface approach and OSRM, and 14 min for Google Maps. The smallest differences between replicated and estimated travel times were seen for night-time journeys at weekends; largest errors were found for night-time journeys at weekdays and journeys above 120 min. Modelled estimates indicated that all participants were within 60 min of the destination CEmOC facility, yet journey replication showed that only 57% were, and 92% were within 120 min. CONCLUSIONS Existing modelling methods underestimate actual travel time in low-resource megacities. Significant gaps in geographical access to life-saving health services like CEmOC must be urgently addressed, including in urban areas. Leveraging tools that generate 'closer-to-reality' estimates will be vital for service planning if universal health coverage targets are to be realised by 2030.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, London, UK .,Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Lagos, Nigeria
| | - Kerry L M Wong
- Infectious Disease and Epidemiology, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Francis Ifeanyi Ayomoh
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Nishimwe A, Nyssen M, Ibisomi L, Nozizwe Conco D. Clinical decision making in basic emergency obstetric and newborn care among nurses and midwives: the role of the safe delivery mhealth application_pre-post-intervention study (research protocol). Inform Health Soc Care 2021; 46:126-135. [PMID: 33427540 DOI: 10.1080/17538157.2020.1869007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Most maternal and newborn deaths in low-income countries, including Rwanda, are attributable to preventable causes. Timely access to Basic Emergency Obstetric and Newborn Care (BEmONC) guidelines to support clinical decisions could lead to better obstetric care thus reduction of maternal and newborn deaths. Besides, innovative methods such as the usage and reference to healthcare guidelines using mobile devices (mhealth) may support clinical decision making. However, there is little evidence about mhealth that focuses on the clinical decision support process. This proposal aims to investigate the effect of the Safe Delivery mhealth Application(SDA) on nurses' and midwives' clinical decision making, so as to inform mhealth interventions for work in specific contexts. The study adopts a quasi-experimental design. Convergent parallel mixed - methods will be used to collect, analyze and interpret data. A pre-intervention assessment of the BEmONC outcomes: Apgar score and PPH progressions, and related knowledge, skills, and perceptions of nurses and midwives will be conducted. The intervention will take place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months' post-intervention, the effect of the SDA on BEmONC outcomes and the nurses' and midwives' knowledge and skills will be evaluated.
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Affiliation(s)
- Aurore Nishimwe
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, South Africa
| | - Marc Nyssen
- Department of Biomedical Statistics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Latifat Ibisomi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, South Africa.,Nigerian Institute of Medical Research, Lagos, Yaba, Nigeria
| | - Daphney Nozizwe Conco
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, South Africa
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Keshri VR, Garg BS. Operational Barriers in Providing Comprehensive Emergency Obstetric Care by Task Shifting of Medical Officers in Selected States of India. Indian J Community Med 2021; 46:252-257. [PMID: 34321736 PMCID: PMC8281838 DOI: 10.4103/ijcm.ijcm_563_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 02/15/2021] [Indexed: 11/05/2022] Open
Abstract
Background: A network of first referral unit (FRU) is set up to improve the availability and accessibility of comprehensive emergency obstetric care (CEmOC) services. To fill the gap of the scarcity of obstetricians and anesthetists at FRU, two short-term trainings in CEmOC and anesthesia were started for in-service medical officers. Objective: This study aimed to assess the operational status of FRU in providing CEmOC services by task shifting of trained medical officers in selected states of India. Materials and Methods: The study was done in seven states of India. A team of experts assessed conveniently selected health facilities designated as FRU by using a semi-structured, predesigned, and pretested checklist for CEmOC functionality status. A total of 50 designated FRUs were assessed and data were systematically analyzed. Results: We documented the availability of five key elements for the operationalization of CEmOC services at FRU. Out of 50 facilities, 9 (18%) reported conducting operative delivery and 11 (22%) of the facilities were fully operational with all elements available. At 9 (18%) facilities, one element and, at 17 (34%) facilities, two elements were missing. The blood storage unit was the most important missing element (68%) followed by operative facilities (36%). The challenges of FRUs remained uniform across states. Barriers identified to operationalize FRU were the availability of trained doctors in cesarean section and anesthesia together, lack of operative facilities, and blood storage units. Conclusions: To operationalize the network of FRU for CEmOC services by task shifting of medical officer, it is important to ensure the availability of all five key elements together at all facilities.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, New Delhi, India.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bishan Swarup Garg
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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Parsons MA. Toward an ethics of global health (de)funding: Thoughts from a maternity hospital project in Kabul, Afghanistan. Glob Public Health 2021; 17:1136-1151. [PMID: 33977857 DOI: 10.1080/17441692.2021.1924821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Funding and defunding decisions in global health are often not subject to ethical scrutiny although they carry the potential for iatrogenic violence. The funding and defunding of a maternal health project in Kabul, Afghanistan during the 2000s reveals the post 9/11 science-politics dynamics that resulted in the emergence of maternal mortality in Afghanistan as a humanitarian object. Despite concerns raised by the Afghan Ministry of Public Health, U.S. Department of Health and Human Services subcontractors renovated one of four public maternity hospitals in Kabul, doubling the number of births per year and increasing the rate of caesarean sections. Project defunding in 2011 was due to a confluence of primarily political factors. Project actors - Afghan and internationals - expressed ethical concerns about the abrupt defunding and the particular risks to women undergoing emergency caesarean sections at the hospital. The analysis presented here has wider relevance for the global surgery movement and concerns about fluctuations in donor funding in global health. There is a need for an ethics of global health funding and defunding decisions that encompasses policies, relationships, stronger local public health systems and civic participation. Global health (de)funding must be made more of an object of ethical deliberation and negotiation.
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Joudeh A, Ghosh R, Spindler H, Handu S, Sonthalia S, Das A, Gore A, Mahapatra T, Walker D. Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India. PLoS One 2021; 16:e0247260. [PMID: 33735280 PMCID: PMC7971704 DOI: 10.1371/journal.pone.0247260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Maternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assessed diagnoses and management of postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, birth asphyxia (BA), and low birth weight (LBW), as part of the CARE’s AMANAT program in 22 District Hospitals in Bihar, between 2015 and 2017. Physicians and nurse mentors conducted clinical instruction, simulations and teamwork and communication activities, infrastructure and management support, and data collection for 6 consecutive months. Analysis of diagnosis included 11,259 non-referred and management included 11,800 total (non-referred and referred) admissions that were observed. Data were analyzed using the chi-square test for trend. PPH was diagnosed in 3.7% with no significant trend but diagnosis of hypertensive disorders increased from 1.0% to 1.7%, (ptrend = 0.04), over the 6 months. BA was diagnosed in 5.8% with no significant trend but LBW diagnoses increased from 11% to 16% (ptrend<0.01). Among PPH patients, 96% received fluids, 85% received uterotonics and 11% received Tranexamic Acid (TXA). There was a significant positive trend in the number of patients receiving TXA for PPH (6% to 13.8%, ptrend = 0.03). Of all neonates with BA, there were statistically significant increases in the proportion who were initially warmed, dried, and stimulated (78% to 94%, ptrend = 0.02), received airway suction (80% to 93%, ptrend = 0.03), and supplemental oxygen without positive pressure ventilation (73% to 86%, ptrend = 0.05). Diagnoses of hypertensive disorders and LBW as well as initial management of BA increased during the AMANAT program. However, underdiagnoses of PPH and hypertensive disorders relative to population levels remain critical barriers to improving maternal morbidity and mortality.
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Affiliation(s)
- Ammar Joudeh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California, United States of America
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Seema Handu
- PRONTO International, State RMNCH+A, Patna, India
| | | | | | | | | | - Dilys Walker
- School of Medicine and Department of Obstetrics-Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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YILAR ERKEK Z, ALPARSLAN Ö, ÖZTÜRK ALTINAYAK S. THE EFFECT OF SIMULATION-BASED TRAINING ABOUT EMERGENCIES IN AND APPROACHES TO DELIVERY GIVEN TO EMERGENCY PERSONNEL. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.770975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Desta M, Admas M, Yeshitila Y, Meselu B, Bishaw K, Assemie M, Yimer N, Kassa G. Effect of Preterm Birth on the Risk of Adverse Perinatal and Neonatal Outcomes in Ethiopia: A Systematic Review and Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211064125. [PMID: 34907788 PMCID: PMC8802133 DOI: 10.1177/00469580211064125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite remarkable progress in the reduction of under-five mortality, the rate of perinatal and neonatal mortality is still high especially in developing countries. The adverse outcome associated with preterm birth is one of the major public health challenges in Africa. However, there are limited and inconsistent studies conducted on the effect of preterm birth on adverse perinatal and neonatal outcomes in Ethiopia. Therefore, this systematic review and meta-analysis aimed to investigate the association between preterm birth and its adverse perinatal and neonatal outcomes in Ethiopia. We systematically searched several electronic databases like PubMed, Web of Science, SCOPUS, CINAHL, Google Scholar, African Journals Online databases and Science Direct. All identified observational studies were included. The I1 statistics were used to assess the heterogeneity among the studies. A random-effects model was computed to estimate the pooled effect of preterm birth on adverse perinatal and neonatal outcomes. Thirty-three studies with a total of 20 109 live births were included in the final meta-analysis. Our meta-analysis showed that preterm birth increased the odds of perinatal mortality by 10-folds [POR = 9.56 (95% CI: 5.47, 19.69)] and there was a 5.44-folds risk of stillbirth [Odds Ratio = 5.44 (95% CI: 3.57, 8.28)] among women who gave birth before 37 weeks of gestation. In addition, preterm birth was significantly associated with neonatal hypothermia [OR=3.54 (95% CI: 2.41, 5.21)], neonatal mortality [OR= 3.16 (95% CI: 1.57, 6.34). The sub-group analysis of this meta-analysis showed that there was an increased risk of neonatal sepsis [OR=2.33 (95% CI: 1.15, 4.71)] among preterm babies. Preterm births significantly increased the risk of adverse perinatal and neonatal outcomes in Ethiopia. Therefore, scale-up strategies and improving the quality of maternal and child health care providers should be an area of intervention to reduce adverse outcomes associated with preterm birth. The Federal Ministry of Health and concerned bodies should work towards the prevention of preterm birth and its adverse outcomes.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Admas
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Yordanos Yeshitila
- Departments of Nursing, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belsity Meselu
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Keralem Bishaw
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Moges Assemie
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | - Nigus Yimer
- Department of Midwifery, Woldia University, Woldia, Ethiopia
| | - Getachew Kassa
- Debre Markos University College of Health Science, Debre Markos, Ethiopia
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Banke-Thomas A, Makwe CC, Balogun M, Afolabi BB, Alex-Nwangwu TA, Ameh CA. Utilization cost of maternity services for childbirth among pregnant women with coronavirus disease 2019 in Nigeria's epicenter. Int J Gynaecol Obstet 2020; 152:242-248. [PMID: 33098673 PMCID: PMC9087483 DOI: 10.1002/ijgo.13436] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate utilization costs of spontaneous vaginal delivery (SVD) and cesarean delivery (CD) for pregnant women with coronavirus disease 2019 (COVID-19) at the largest teaching hospital in Lagos, the pandemic's epicenter in Nigeria. METHODS We collected facility-based and household costs of all nine pregnant women with COVID-19 managed at the hospital. We compared their mean facility-based costs with those paid by pregnant women pre-COVID-19, identifying cost-drivers. We also estimated what would have been paid without subsidies, testing assumptions with a sensitivity analysis. RESULTS Total utilization costs ranged from US $494 for SVD with mild COVID-19 to US $4553 for emergency CD with severe COVID-19. Though 32%-66% of facility-based cost were subsidized, costs of SVD and CD during the pandemic have doubled and tripled, respectively, compared with those paid pre-COVID-19. Of the facility-based costs, cost of personal protective equipment was the major cost-driver (50%). Oxygen was the major driver for women with severe COVID-19 (48%). Excluding treatment costs for COVID-19, mean facility-based costs were US $228 (SVD) and US $948 (CD). CONCLUSION Despite cost exemptions and donations, utilization costs remain prohibitive. Regulation of personal protective equipment and medical oxygen supply chains and expansion of advocacy for health insurance enrollments are needed in order to minimize catastrophic health expenditure.
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Affiliation(s)
| | - Christian Chigozie Makwe
- Department of Obstetrics and Gynecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynecology, College of Medicine of the University of Lagos, Lagos, Nigeria
| | | | - Charles Anawo Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Kozhimannil KB, Interrante JD, Tuttle MS, Gilbertson M, Wharton KD. Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services. J Rural Health 2020; 37:385-393. [PMID: 33200829 DOI: 10.1111/jrh.12539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rural hospitals are closing obstetric units, and limited information is available about local emergency obstetric preparedness and capacity in rural communities where hospitals do not routinely provide this care. OBJECTIVE To describe emergency obstetric capacity at rural US hospitals that do not routinely offer childbirth services. METHODS Data from the 2018 American Hospital Association Annual Survey were used to identify a random sample of rural hospitals that did not offer obstetric services. A survey was developed based on World Health Organization criteria for obstetric emergencies. With data collected from 69 rural hospital emergency departments (48% response rate), we analyzed local capacity to support childbirth. RESULTS Most responding hospitals (65%) were located 30 or more miles away from a hospital with obstetric services. Some reported having emergency room births in the past year (28%), an unanticipated adverse birth outcome (32%), and/or a delay in urgent transport for a pregnant patient (22%). More than 90% of responding hospitals had capacity for blood transfusion, intravenous antibiotics or anticonvulsants, and basic neonatal resuscitation. However, less than one-fifth had capacity to perform surgery (16%), remove retained products of delivery (17%), or had a policy for emergency cesarean (18%). Almost all respondents (80%) reported the need for additional training or resources to handle emergency obstetric situations. CONCLUSION Many rural hospitals do not have basic capacity to provide emergency obstetric services. Programs and policies to improve this may focus on surgical care, clinician and staff training, transportation, and coordination with nearby hospitals that provide obstetric services.
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Affiliation(s)
- Katy B Kozhimannil
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Julia D Interrante
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Mariana S Tuttle
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Mary Gilbertson
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Kristin DeArruda Wharton
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Quality and women's satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review. BMC Pregnancy Childbirth 2020; 20:682. [PMID: 33176732 PMCID: PMC7656726 DOI: 10.1186/s12884-020-03339-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/15/2020] [Indexed: 01/23/2023] Open
Abstract
Background sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women. Methods Six electronic databases were systematically searched for primary data studies (2009–2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility. Results Seventeen articles were included in the study. Most studies were quantitative (n = 11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals. Trial registration Systematic review registration: PROSPERO registration CRD42018114261. Supplementary information Supplementary information accompanies this paper at 10.1186/s12884-020-03339-3.
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Shiferaw BB, Modiba LM. Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia. BMC Pregnancy Childbirth 2020; 20:633. [PMID: 33076867 PMCID: PMC7574439 DOI: 10.1186/s12884-020-03312-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 10/06/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia. METHODS This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps. RESULTS Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility. CONCLUSIONS This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service.
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Affiliation(s)
- Biruhtesfa Bekele Shiferaw
- Department of Health Studies, University of South Africa, Addis Ababa, Ethiopia. .,Department of Health Studies, University of South Africa, Pretoria, South Africa.
| | - Lebitsi Maud Modiba
- Department of Health Studies, University of South Africa, Addis Ababa, Ethiopia.,Department of Health Studies, University of South Africa, Pretoria, South Africa
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Walsh CM, Mwase T, De Allegri M. How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II. Int J Health Plann Manage 2020; 35:1571-1592. [PMID: 33030271 DOI: 10.1002/hpm.3055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022] Open
Abstract
Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.
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Affiliation(s)
- Caitlin M Walsh
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Takondwa Mwase
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Manuela De Allegri
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
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Kim C, Tappis H, McDaniel P, Soroush MS, Fried B, Weinberger M, Trogdon JG, Kristen Hassmiller Lich, Delamater PL. National and subnational estimates of coverage and travel time to emergency obstetric care in Afghanistan: Modeling of spatial accessibility. Health Place 2020; 66:102452. [PMID: 33011490 DOI: 10.1016/j.healthplace.2020.102452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022]
Abstract
In Afghanistan, the risk of maternal death is among the highest in the world, with wide variation across the country. One explanation may be wide geographic disparities in access and use of maternal health care services. This study describes the spatial distribution of public facilities providing maternal health care in Afghanistan, specifically emergency obstetric care (EmOC), and the differences in travel time estimates using different transportation modes from 2010 to 2015 at the national and subnational levels. We conducted mapping and spatial analyses to measure the proportion of pregnant women able to access any EmOC health facility within 2 h by foot, animal, motor vehicle and a combination of transport modes. In 2015, adequate coverage of active public health facilities within 2 h of travel time was 36.6% by foot and 71.2% by a combination of transport modes. We found an 8.3% and 63.2% increase in access to EmOC facilities within 2 h of travel time by a combination of transport modes and by foot only, respectively, by 2015. Access to a combination of transportation options such as motor vehicles and animals may benefit pregnant women in reaching health facilities efficiently. Afghanistan made impressive gains in maternal healthcare access; despite these improvements, large disparities remain in geographic access by province and overall access to facilities is still poor.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hannah Tappis
- Technical Leadership and Innovations Department, Jhpiego, Baltimore, MD, USA.
| | - Philip McDaniel
- Davis Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Paul L Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Banke-Thomas A, Balogun M, Wright O, Ajayi B, Abejirinde IOO, Olaniran A, Giwa-Ayedun RO, Odusanya B, Afolabi BB. Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa's largest megacity. Reprod Health 2020; 17:145. [PMID: 32977812 PMCID: PMC7519554 DOI: 10.1186/s12978-020-00996-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/17/2020] [Indexed: 11/14/2022] Open
Abstract
Background The consequences of delays in travel of pregnant women to reach facilities in emergency situations are well documented in literature. However, their decision-making and actual experiences of travel to health facilities when requiring emergency obstetric care (EmOC) remains a ‘black box’ of many unknowns to the health system, more so in megacities of low- and middle-income countries which are fraught with wide inequalities. Methods This in-depth study on travel of pregnant women in Africa’s largest megacity, Lagos, is based on interviews conducted between September 2019 and January 2020 with 47 women and 11 of their relatives who presented at comprehensive EmOC facilities in situations of emergency, requiring some EmOC services. Following familiarisation, coding, and searching for patterns, the data was analysed for emerging themes. Results Despite recognising danger signs, pregnant women are often faced with conundrums on “when”, “where” and “how” to reach EmOC facilities. While the decision-making process is a shared activity amongst all women, the available choices vary depending on socio-economic status. Women preferred to travel to facilities deemed to have “nicer” health workers, even if these were farther from home. Reported travel time was between 5 and 240 min in daytime and 5–40 min at night. Many women reported facing remarkably similar travel experiences, with varied challenges faced in the daytime (traffic congestion) compared to night-time (security concerns and scarcity of public transportation). This was irrespective of their age, socio-economic background, or obstetric history. However, the extent to which this experience impacted on their ability to reach facilities depended on their agency and support systems. Travel experience was better if they had a personal vehicle for travel at night, support of relatives or direct/indirect connections with senior health workers at comprehensive EmOC facilities. Referral barriers between facilities further prolonged delays and increased cost of travel for many women. Conclusion If the goal, to leave no one behind, remains a priority, in addition to other health systems strengthening interventions, referral systems need to be improved. Advocacy on policies to encourage women to utilise nearby functional facilities when in situations of emergency and private sector partnerships should be explored.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- LSE Health, London School of Economics and Political Science, WC2A 2AE, London, UK. .,Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Ololade Wright
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Babatunde Ajayi
- Centre for Reproductive Health Research and Innovation, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibukun-Oluwa Omolade Abejirinde
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Abimbola Olaniran
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bilikisu Odusanya
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine of the University of Lagos, Idi-Araba, Lagos, Nigeria
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Namayi I, Makokha A, Echoka E. Health providers´ knowledge on maternal and newborn care: implications on health systems strengthening in Vihiga County, Kenya. Pan Afr Med J 2020; 37:73. [PMID: 33244336 PMCID: PMC7680226 DOI: 10.11604/pamj.2020.37.73.24597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/10/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction pregnant women need access to skilled attendance at birth and emergency obstetric care (EmOC) to avert maternal deaths. While poor EmOC services may explain the high maternal mortality, inadequate knowledge of providers is also part of the problem. This forms the basis of this paper, in a setting where 50.2% of women deliver in a health facility but maternal mortality remains high at 531/100,000 live births, compared to the national average of 362/100,000 in Kenya. Methods a facility based cross-sectional survey was conducted in 2018 with a set of knowledge questions extracted from the averting maternal death and disability toolkit. Providers knowledge for maternal and newborn health (MNH) was assessed by interviewing nurses on duty in the maternity units. Data were entered in Ms Access and exported to R version 3.6.2 for descriptive and logistic regression analysis. Ethical clearance was obtained from Kenya Medical Research Unit. Results a total of 55 nurses were interviewed. Majority (71%) of the respondents were diploma nurses. The overall knowledge score for MNH among the providers was adequate with a score of (64%). Generally, the midwives and higher diploma nurses consistently scored higher than diploma nurses in all the topic areas of MNH. In the mixed linear regression, determinants of knowledge score were seen in provider-level variables. Conclusion overall, the providers scores were higher on intrapartum and newborn care compared to scores on care for complications. We conclude that in-service training on EmOC to providers is critical to reduction of maternal mortality.
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Affiliation(s)
- Imelda Namayi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Anselimo Makokha
- Department of Food Science, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Elizabeth Echoka
- Centre of Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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