24 results
Search Results
2. Causes of Maternal Mortality Decline in Matlab, Bangladesh
- Author
-
Mahbub Elahi Chowdhury, Marge Koblinsky, Anisuddin Ahmed, and Nahid Kalim
- Subjects
Maternal mortality ,Emergency Medical Services ,Health Knowledge, Attitudes, Practice ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,Total fertility rate ,Population ,Maternal Welfare ,Fertility ,Midwifery ,Health Services Accessibility ,Pregnancy ,Cause of Death ,Environmental health ,Health care ,Odds Ratio ,Humans ,Medicine ,Maternal Health Services ,Obstetric care ,education ,Causes of death ,media_common ,Reproductive health ,Bangladesh ,education.field_of_study ,business.industry ,Healthcare ,Public Health, Environmental and Occupational Health ,Health facilities ,Abortion, Induced ,Health services ,Pregnancy Complications ,Contraception ,Standardized mortality ratio ,Risk factors ,Socioeconomic Factors ,Family Planning Services ,Papers ,Educational Status ,Female ,Maternal health ,Clinical Competence ,Rural area ,business ,Delivery ,Food Science - Abstract
Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor of the maternal mortality decline in both the areas. Possible explanations for the maternal mortality decline in Matlab are: better access to comprehensive EmOC services, reduction in the total fertility rate, and improved education of women. To achieve the Millenium Development Goal 5 targets, policies that bring further improved comprehensive EmOC, strengthened family-planning services, and expanded education of females are essential.
- Published
- 2009
3. Maternal Healthcare Financing: Gujarat’s Chiranjeevi Scheme and Its Beneficiaries
- Author
-
Ramesh Bhat, Dileep Mavalankar, Neelu Singh, and Prabal V. Singh
- Subjects
Maternal mortality ,Program evaluation ,Emergency Medical Services ,Economic growth ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,India ,Developing country ,Public-Private Sector Partnerships ,Chiranjeevi scheme ,Cost Savings ,Pregnancy ,Health care ,Humans ,Medicine ,Maternal Health Services ,Obstetric care ,education ,education.field_of_study ,Poverty ,business.industry ,Public sector ,Public Health, Environmental and Occupational Health ,Delivery, Obstetric ,Private sector ,Socioeconomic Factors ,Emergency obstetric care ,Papers ,Female ,business ,Delivery ,Private-public relationship ,Food Science - Abstract
Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government's inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3,000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available.
- Published
- 2009
4. Quality of Obstetric Care in Public-sector Facilities and Constraints to Implementing Emergency Obstetric Care Services: Evidence from High- and Low-performing Districts of Bangladesh
- Author
-
Iqbal Anwar, Nahid Kalim, and Marge Koblinsky
- Subjects
Program evaluation ,Emergency Medical Services ,Health, Toxicology and Mutagenesis ,Population ,Context (language use) ,Regional Medical Programs ,Regional Health Planning ,Nursing ,Pregnancy ,Health care ,medicine ,Emergency medical services ,Humans ,Obstetric care ,education ,Quality of Health Care ,Bangladesh ,education.field_of_study ,Public Sector ,business.industry ,Public sector ,Quality of care ,Health Plan Implementation ,Public Health, Environmental and Occupational Health ,Health facilities ,Rural health services ,Service provider ,Delivery, Obstetric ,medicine.disease ,Health services ,Obstetric Labor Complications ,Obstetrics ,Maternal Mortality ,Emergency obstetric care ,Papers ,Maternal health services ,Female ,Maternal health ,Medical emergency ,Rural area ,business ,Food Science - Abstract
This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted.
- Published
- 2009
5. Maternal Health in Gujarat, India: A Case Study
- Author
-
Parvathy Sankara Raman, Mudita Upadhyaya, Dileep Mavalankar, Bharati Sharma, K. V. Ramani, and Kranti Suresh Vora
- Subjects
Maternal mortality ,Emergency Medical Services ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,India ,Midwifery ,Nursing ,Pregnancy ,Health care ,medicine ,Emergency medical services ,Humans ,Maternal Health Services ,education ,Government ,education.field_of_study ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Health indicator ,Health services ,Obstetric Labor Complications ,Obstetrics ,Management capacity ,Papers ,Blood Banks ,Female ,Public Health ,Maternal health ,Morbidity ,Rural area ,business ,Food Science - Abstract
Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.
- Published
- 2009
6. Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care.
- Author
-
Hussein, Julia, Hirose, Atsumi, Owolabi, Oluwatoyin, Imamura, Mari, Kanguru, Lovney, and Okonofua, Friday
- Subjects
OBSTETRICAL emergencies ,MATERNAL health services ,ACADEMIC medical centers ,AUDITING ,BLOOD transfusion ,CESAREAN section ,CINAHL database ,EMERGENCY medical services ,HEALTH services accessibility ,MEDICAL information storage & retrieval systems ,MAGNESIUM sulfate ,MEDICAL quality control ,MEDICAL referrals ,MEDLINE ,MATERNAL mortality ,QUALITY assurance ,RESEARCH funding ,SYSTEMATIC reviews ,TRANSPORTATION of patients ,HOSPITAL ancillary services ,TREATMENT delay (Medicine) ,TERTIARY care ,THERAPEUTICS - Abstract
Background: Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria's high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care. Methods: We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000-2014. A 'best-fit' framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score. Results: Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services. Conclusions: Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
7. The dominance of the private sector in the provision of emergency obstetric care: studies from Gujarat, India.
- Author
-
Salazar, Mariano, Vora, Kranti, and De Costa, Ayesha
- Subjects
PRENATAL care ,OBSTETRICAL emergencies ,CESAREAN section ,CHILDBIRTH ,LABOR (Obstetrics) ,MATERNAL mortality ,DELIVERY (Obstetrics) ,EMERGENCY medical services ,HEALTH facility administration ,HEALTH services accessibility ,MATERNAL health services ,PRIVATE sector ,PUBLIC sector ,CROSS-sectional method ,STANDARDS - Abstract
Background: India has experienced a steep rise in institutional childbirth. The relative contributions of public and private sector facilities to emergency obstetric care (EmOC) has not been studied in this setting. This paper aims to study in three districts of Gujarat state, India:(a) the availability of EmOC facilities in the public and private sectors; (b) the availability and distribution of human resources for birth attendance in the two sectors; and (c) to benchmark the above against 2005 World Health Report benchmarks (WHR2005).Methods: A cross-sectional survey of obstetric care facilities reporting 30 or more births in the last three months was conducted (n = 159). Performance of EmOC signal functions and availability of human resources were assessed.Results: EmOC provision was dominated by private facilities (112/159) which were located mainly in district headquarters or small urban towns. The number of basic and comprehensive EmOC facilities was below WHR2005 benchmarks. A high number of private facilities performed C-sections but not all basic signal functions (72/159). Public facilities were the main EmOC providers in rural areas and 40/47 functioned at less than basic EmOC level. The rate of obstetricians per 1000 births was higher in the private sector.Conclusions: The private sector is the dominant EmOC provider in the state. Given the highly skewed distribution of facilities and resources in the private sector, state led partnerships with the private sector so that all women in the state receive care is important alongside strengthening the public sector. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
8. Has Chiranjeevi Yojana changed the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India?
- Author
-
Vora, Kranti Suresh, Yasobant, Sandul, Patel, Amit, Upadhyay, Ashish, and Mavalankar, Dileep V.
- Subjects
EMERGENCY medical services ,HEALTH planning ,HEALTH services accessibility ,MATERNAL health services ,POPULATION geography ,SOCIAL participation ,PRIVATE sector ,COMMUNITY-based social services ,EVALUATION of human services programs - Abstract
The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public–private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY's effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India. Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method. Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance. This paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
9. Feasibility of task-sharing with community health workers for the identification, emergency management and referral of women with pre-eclampsia, in Mozambique.
- Author
-
Sevene, Esperança, Boene, Helena, Vidler, Marianne, Valá, Anifa, Macuacua, Salésio, Augusto, Orvalho, Fernandes, Quinhas, Bique, Cassimo, Macete, Eusébio, Sidat, Mohsin, von Dadelszen, Peter, Munguambe, Khátia, CLIP Feasibility Working Group, Pires, Rosa, Nhamirre, Zefanias, Chiaú, Rogério, Matavele, Analisa, Tembe, Adérito, Machai, Lina, and Payne, Beth
- Subjects
PREECLAMPSIA diagnosis ,MATERNAL health services ,HEALTH facility administration ,RESEARCH methodology ,SELF-evaluation ,SATISFACTION ,MEDICAL screening ,INTERVIEWING ,LABOR demand ,PRIMARY health care ,DOCUMENTATION ,EMERGENCY medical services ,MEDICAL referrals ,INTERPROFESSIONAL relations ,QUESTIONNAIRES ,PREGNANCY complications ,DRUGS ,DESCRIPTIVE statistics ,DATA analysis software ,THEMATIC analysis ,WOMEN'S health services ,REPRODUCTIVE health ,DISEASE management - Abstract
Background: Maternal mortality is an important public health problem in low-income countries. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited evidence on the role of community health workers in the management of pregnancy complications. This study aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and document healthcare facility preparedness to respond to referrals. Method: The study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial. This was a mixed-methods study. The quantitative data was collected through self-administered questionnaires completed by community health workers and a health facility survey; this data was analysed using Stata v13. The qualitative data was collected through focus group discussions and in-depth interviews with various community groups, health care providers, and policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community health worker policies, guidelines, reports and manuals. Results: Community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for referrals, no transport was available from the community to the healthcare facility. Conclusions: This study showed that task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia were deemed feasible and acceptable at the community-level, but an effort should be in place to address challenges at the health system level. Plain Language Summary: Maternal mortality is an important public health problem in Mozambique. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. We conducted a study to describe the feasibility of task-sharing the screening and initiation of management for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and to document healthcare facility preparedness to respond to referrals. The study was done to inform a future intervention trial known as the Community-Level Interventions for Pre-eclampsia (CLIP) study. We interviewed community health workers, women, various community groups, health care providers, and policymakers and assessed health facilities in Maputo and Gaza provinces, Mozambique. Our results showed that community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they were not trained or equipped to provide obstetric emergencies care prior to referral. Nurses at primary health facilities were supportive of task-sharing with community health workers; however, some barriers mentioned include a lack of equipment, shortage of supervisors, and irregular drug availability. Local stakeholders emphasized the need for comprehensive training and supervision of community health workers to take on new tasks. Task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia was deemed feasible at the community level in southern Mozambique, but still, to be addressed some health system level barriers to the management of pregnancies complications. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. A woman's worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa.
- Author
-
Anto-Ocrah, Martina, Cushman, Jeremy, Sanders, Mechelle, and De Ver Dye, Timothy
- Subjects
MATERNAL mortality ,EMERGENCY medicine ,MATERNAL health ,AMBULANCES ,MATERNAL health services ,EMERGENCY medical services - Abstract
Background: Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for "timely access to emergency obstetric care." This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region. Access, however, is a complicated notion and is part of a larger framework of care delivery that constitutes the approachability of the proposed service, its acceptability by the target user, the perceived availability and accommodating nature of the service, its affordability, and its overall appropriateness. Without contextualizing each of these aspects of access to healthcare services within communities, utilization and sustainability of any EC intervention-be it ambulances or simple toll-free numbers to dial and activate EMS-will be futile.Main Text: In this article, we propose an access framework that integrates the Three Delays Model in maternal health, with emergency care interventions. Within each of the three critical time points, we provide reasons why intended interventions should be contextualized to the needs of the community. We also propose measurable benchmarks in each of the phases, to evaluate the successes and failures of the proposed EC interventions within the framework. At the center of the framework is the pregnant woman, whose life hangs in a delicate balance in the hands of personal and health system factors that may or may not be within her control.Conclusions: The targeted SDGs for reducing maternal mortality in sub-Saharan Africa are unlikely to be met without a tailored integration of maternal health service delivery with emergency medicine. Our proposed framework integrates the fields of maternal health with emergency medicine by juxtaposing the three critical phases of emergency obstetric care with various aspects of healthcare access. The framework should be adopted in its entirety, with measureable benchmarks set to track the successes and failures of the various EC intervention programs being developed across the African continent. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
11. Perceptions of isolation during facility births in Haiti - a qualitative study.
- Author
-
Dev, Alka, Kivland, Chelsey, Faustin, Mikerlyne, Turnier, Olivia, Bell, Tatiana, and Leger, Marie Denise
- Subjects
CHILDBIRTH at home ,ATTENTION ,ATTITUDE (Psychology) ,COMMUNICATION ,DECISION making ,DELIVERY (Obstetrics) ,EMERGENCY medical services ,EMOTIONS ,FOCUS groups ,HEALTH facilities ,HEALTH services accessibility ,INTERVIEWING ,MATERNAL health services ,MEDICAL ethics ,MEDICAL personnel ,METROPOLITAN areas ,MATERNAL mortality ,MOVEMENT disorders ,PREGNANCY complications ,PREGNANCY & psychology ,PRIVACY ,RURAL conditions ,SOCIAL stigma ,PAIN management ,QUALITATIVE research ,THEMATIC analysis ,SECONDARY care (Medicine) ,TERTIARY care ,DISEASE risk factors - Abstract
Background: Haiti's maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision. Methods: We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any. Results: All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women's negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term "isolation," which encompasses feelings of being isolated in the hospital during delivery. Conclusion: Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
12. 'It needs a complete overhaul...' district manager perspectives on the capacity of the health system to support the delivery of emergency obstetric care in an urban South African district.
- Author
-
Thwala, Siphiwe Bridget Pearl, Blaauw, Duane, and Ssengooba, Freddy
- Subjects
ATTITUDE (Psychology) ,CONCEPTUAL structures ,EMERGENCY medical services ,PSYCHOLOGY of executives ,INTERVIEWING ,LABOR turnover ,LEADERSHIP ,MATERNAL health services ,MEDICAL care ,EVALUATION of medical care ,MEDICAL quality control ,MEDICAL personnel ,METROPOLITAN areas ,MATERNAL mortality ,OBSTETRICAL emergencies ,PUBLIC officers ,JUDGMENT sampling ,THEMATIC analysis - Abstract
Background: A high maternal mortality ratio persists in South Africa despite developments in emergency obstetric care (EmOC), a known effective intervention against direct causes of maternal deaths. Strengthening the health systems is one of the focus areas identified by the National Committee for Confidential Enquiries into Maternal Deaths in South Africa. District managers as immediate overseers of the frontline health system are uniquely positioned to provide insight into the overall health system processes that influence the delivery of EmOC. Objective: We sought to identify health system enablers and barriers to the delivery EmOC from the perspective of district managers. This would potentially unearth aspects of the health system that require strengthening to better support EmOC and improve maternal outcomes. Methods: Face-to-face audio-recorded key informant interviews were conducted with 19 district managers in charge of the delivery of EmOC in one urban district. Interviews were transcribed and coded. Related codes were inductively grouped into emerging themes. Deductive thematic analysis was then applied to categorise emergent themes into the WHO health system building blocks. Results: Themes included a weaknesses in the organisation of health services; a high vacancy and turnover of senior management; poor clinical accountability from EmOC providers; inadequate resources (including infrastructure, staffing, and funding); and the need to improve district health information system indicators. Conclusion: The functioning of the district health system was weak, affecting the delivery of EmOC. Unless staffing is effectively addressed, the health system is unlikely to reduce maternal mortality to the desired level. Coordination of EmOC services by managers needs to be strengthened to limit fragmentation of care and improve the continuity EmOC. Furthermore, a high turnover of senior leadership affects implementation priorities and continuity in the overall strategic direction of EmOC. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
13. Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study
- Author
-
Angelo S, Nyamtema, Heather, Scott, John C, LeBlanc, Elias, Kweyamba, Janet, Bulemela, Allan, Shayo, Omary, Kilume, Zabron, Abel, and Godfrey, Mtey
- Subjects
Emergency Medical Services ,Maternal Mortality ,Pregnancy ,Infant, Newborn ,Humans ,Obstetrics and Gynecology ,Female ,Maternal Health Services ,Prospective Studies ,Delivery, Obstetric ,Tanzania - Abstract
Background One of the key strategies to reducing maternal mortality is provision of emergency obstetric care services. This paper describes the results of improving availability of, and access to emergency obstetric care services in underserved rural Tanzania using associate clinicians. Methods A prospective cohort study of emergency obstetric care was implemented in seven health centres in Morogoro region, Tanzania from July 2016 to June 2019. In early 2016, forty-two associate clinicians from five health centres were trained in teams for three months in emergency obstetric care, newborn care and anaesthesia. Two health centres were unexposed to the intervention and served as controls. Following training, virtual teleconsultation, quarterly on-site supportive supervision and continuous mentorship were implemented to reinforce skills and knowledge. Results The met need for emergency obstetric care increased significantly from 45% (459/1025) at baseline (July 2014 – June 2016) to 119% (2010/1691) during the intervention period (Jul 2016 – June 2019). The met need for emergency obstetric care in the control group also increased from 53% (95% CI 49–58%) to 77% (95% CI 74–80%). Forty maternal deaths occurred during the baseline and intervention periods in the control and intervention health centres. The direct obstetric case fatality rate decreased slightly from 1.5% (95% CI 0.6–3.1%) to 1.1% (95% CI 0.7–1.6%) in the intervention group and from 3.3% (95% CI 1.2–7.0%) to 0.8% (95% CI 0.2–1.7%) in the control group. Conclusions When emergency obstetric care services are made available the proportion of obstetric complications treated in the facilities increases. However, the effort to scale up emergency obstetric care services in underserved rural areas should be accompanied by strategies to reinforce skills and the referral system.
- Published
- 2022
14. HasChiranjeevi Yojanachanged the geographic availability of free comprehensive emergency obstetric care services in Gujarat, India?
- Author
-
Dileep Mavalankar, Sandul Yasobant, Kranti Vora, Ashish Upadhyay, Amit Patel, and Karolinska Institutet
- Subjects
Adult ,Rural Population ,Gujarat ,Program evaluation ,Emergency Medical Services ,Economic growth ,Population ,India ,CEmOC ,Health Systems ,Community Health ,Population Healt ,RA771-771.7 ,Public-Private Sector Partnerships ,Health Services Accessibility ,03 medical and health sciences ,Underserved Population ,2FCA ,0302 clinical medicine ,Pregnancy ,Emergency medical services ,Humans ,Medicine ,Maternal Health Services ,030212 general & internal medicine ,education ,education.field_of_study ,maternal mortality ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Public sector ,1. No poverty ,Public Health, Environmental and Occupational Health ,public private partnership ,Chiranjeevi Yojana ,GIS ,lcsh:RA1-1270 ,Delivery, Obstetric ,Private sector ,3. Good health ,Public–private partnership ,Geographic Information Systems ,Female ,Original Article ,Catchment area ,0305 other medical science ,business - Abstract
Background : The high rate of maternal mortality in India is of grave concern. Poor rural Indian women are most vulnerable to preventable maternal deaths primarily because they have limited availability of affordable emergency obstetric care (EmOC) within reasonable geographic proximity. Scarcity of obstetricians in the public sector combined with financial barriers to accessing private sector obstetrician services preclude this underserved population from availing lifesaving functions of comprehensive EmOC such as C-section. In order to overcome this limitation, Government of Gujarat initiated a unique public–private partnership program called Chiranjeevi Yojana (CY) in 2005. The program envisaged leveraging private sector providers to increase availability and thereby accessibility of EmOC care for vulnerable sections of society. Under CY, private sector providers render obstetric care services to poor women at no cost to patients. This paper examines the CY’s effectiveness in improving availability of CEmOC services between 2006 and 2012 in three districts of Gujarat, India. Methods : Primary data on facility locations, EmOC functionality, and obstetric bed availability were collected in the years 2012 and 2013 in three study districts. Secondary data from Census 2001 and 2011 were used along with required geographic information from Topo sheets and Google Earth maps. ArcGIS version 10 was used to analyze the availability of services using two-step floating catchment area (2SFCA) method. Results : Our analysis suggests that the availability of CEmOC services within reasonable travel distance has greatly improved in all three study districts as a result of CY. We also show that the declining participation of the private sector did not result in an increase in distance to the nearest facility, but the extent of availability of providers for several villages was reduced. Spatial and temporal analyses in this paper provide a comprehensive understanding of trends in the availability of EmOC services within reasonable travel distance. Conclusions : This paper demonstrates how GIS could be useful for evaluating programs especially those focusing on improving availability and geographic accessibility. The study also shows usefulness of GIS for programmatic planning, particularly for optimizing resource allocation. Keywords: maternal mortality; India; Gujarat; CEmOC; 2FCA; public private partnership; Chiranjeevi Yojana; GIS (Published: 6 October 2015) Citation: Glob Health Action 2015, 8 : 28977 - http://dx.doi.org/10.3402/gha.v8.28977
- Published
- 2015
15. Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal.
- Author
-
Maru, Sheela, Bangura, Alex Harsha, Mehta, Pooja, Bista, Deepak, Borgatta, Lynn, Pande, Sami, Citrin, David, Khanal, Sumesh, Banstola, Amrit, and Maru, Duncan
- Subjects
BIRTH rate ,OBSTETRICAL emergencies ,PUBLIC health ,MATERNAL mortality ,NEONATAL death ,EMERGENCY medical services ,HEALTH facilities ,HEALTH services accessibility ,MATERNAL health services ,RESEARCH funding ,RURAL health services ,RURAL population ,QUALITATIVE research ,LOGISTIC regression analysis ,SOCIOECONOMIC factors ,PATIENTS' attitudes - Abstract
Background: Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear.Methods: In this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization.Results: Institutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors.Conclusion: Comprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
16. Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011.
- Author
-
Mukengeshayi Ntambue, Abel, Kaj Malonga, Françoise, Cowgill, Karen D., Dramaix-Wilmet, Michèle, Donnen, Philippe, Ntambue, Abel Mukengeshayi, and Malonga, Françoise Kaj
- Subjects
OBSTETRICAL emergencies ,INFANT health services ,MATERNAL health services ,ANTIBIOTICS ,MAGNESIUM sulfate ,OBSTETRICS statistics ,TREATMENT of pregnancy complications ,CLINICAL medicine ,EMERGENCY medical services ,HEALTH facilities ,HEALTH service areas ,HEALTH services accessibility ,INFANT mortality ,MATERNAL mortality ,OBSTETRICS ,KEY performance indicators (Management) ,CROSS-sectional method - Abstract
Background: While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi.Methods: This cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards.Results: The availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one. In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities.Conclusion: Audits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
17. The status of maternal and newborn health care services in Zanzibar.
- Author
-
Fakih, Bakar, Nofly, Azzah A. S., Ali, Ali O., Mkopi, Abdallah, Hassan, Ali, Ali, Ali M., Ramsey, Kate, John Kabuteni, Theopista, Mbaruku, Godfrey, Mrisho, Mwifadhi, and Kabuteni, Theopista John
- Subjects
OBSTETRICAL emergencies ,PREGNANCY complications ,PERINATAL care ,MATERNAL health services ,CHILD health services ,MEDICAL education ,CLINICAL medicine ,DELIVERY (Obstetrics) ,EMERGENCY medical services ,HEALTH facilities ,HEALTH services accessibility ,MEDICAL personnel ,MATERNAL mortality ,RESEARCH funding ,SURVEYS ,KEY performance indicators (Management) ,CROSS-sectional method - Abstract
Background: It is estimated that 287,000 women worldwide die annually from pregnancy and childbirth-related conditions, and 6.9 million under-five children die each year, of which about 3 million are newborns. Most of these deaths occur in sub-Saharan Africa. The maternal health situation in Tanzania mainland and Zanzibar is similar to other sub-Saharan countries. This study assessed the availability, accessibility and quality of emergency obstetric care services and essential resources available for maternal and child health services in Zanzibar.Methods: From October and November 2012, a cross-sectional health facility survey was conducted in 79 health facilities in Zanzibar. The health facility tools developed by the Averting Maternal Death and Disability program were adapted for local use.Results: Only 7.6 % of the health facilities qualified as functioning basic EmONC (Emergency Obstetric and Neonatal Care) facilities and 9 % were comprehensive EmONC facilities. Twenty-eight percent were partially performing basic EmONC and the remaining 55.7 % were not providing EmONC. Neonatal resuscitation was performed in 80 % of the hospitals and only 17.4 % of the other health facilities that were surveyed. Based on World Health Organisation (WHO) criteria, the study revealed a gap of 20 % for minimum provision of EmONC facilities per 500,000 population. The met need at national level (proportion of women with major direct obstetric complications treated in a health facility providing EmONC) was only 33.1 % in the 12 months preceding the survey. The study found that there was limited availability of human resources in all visited health facilities, particularly for the higher cadres, as per Zanzibar minimum staff requirements.Conclusion: There is a need to strengthen human resource capacity at primary health facilities through training of health care providers to improve EmONC services, as well as provision of necessary equipment and supplies to reduce workload at the higher referral health facilities and increase geographic access. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
18. Improving emergency obstetric care and reversing the underutilisation of vacuum extraction: a qualitative study of implementation in Tete Province, Mozambique
- Author
-
C. V. Manjate, M. Sitoe, O. Matsinhe, C. Mosse Lazaro, M. I. Lampião Cardoso, V. de Deus, Diederike Geelhoed, and P. I. Pinto Matsena
- Subjects
Maternal mortality ,Emergency Medical Services ,Vacuum Extraction, Obstetrical ,media_common.quotation_subject ,Psychological intervention ,Context (language use) ,Audit ,Vacuum extraction ,lcsh:Gynecology and obstetrics ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Medicine ,Humans ,Systems thinking ,Maternal Health Services ,030212 general & internal medicine ,Empowerment ,Perinatal Mortality ,Qualitative Research ,Mozambique ,lcsh:RG1-991 ,Accreditation ,media_common ,Quality of Health Care ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Monitoring and evaluation ,Stillbirth ,Delivery, Obstetric ,Emergency obstetric care ,Female ,business ,Delivery of Health Care ,Qualitative research ,Research Article - Abstract
Background Maternal and perinatal mortality in Mozambique were declining at a slow pace, despite progress in coverage of institutional childbirth. Implementation of quality emergency obstetric care including vacuum extraction remained inadequate. In 2015–2017, Tete Province achieved remarkable progress in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, with encouraging results for maternal and perinatal outcomes, despite severe resource constraints. This paper presents the experience of Tete Province, generating a rich, contextualised understanding, which might provide generalizable insights and lessons. Methods This qualitative study design is used to present Tete’s experience in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, drawing on principles from implementation science and applying a systems thinking approach. Sources include routine data, documents, social media messages, and the lived experience of the authors, all intimately involved in the implementation process during 2014–2017. Iterative learning and analysis, involving all authors, led to the final interpretations. Results Within a context of severe resource constraints, Tete applied 4 interventions (training, accreditation, audit, monitoring and evaluation with feedback) to improve the implementation of emergency obstetric care. Considerable progress was achieved in vacuum extraction and other signal functions of emergency obstetric care and in the decision-making process for caesarean sections, contributing to important reductions in the provincial institutional maternal mortality and stillbirth rates. Facilitating factors include attributes of the vacuum extraction itself, of the structural and organisational environments in which it was introduced, of the people involved in implementation, and of the process through which the implementation was rolled-out. Conclusions The lessons from implementation science and systems thinking can contribute to surprising results in the improvement of emergency obstetric care including the use of vacuum extraction, even in a severely resource-constrained setting. The creation of conditions for real change, with empowerment of the staff and managers at the front-line of day-to-day practice in Tete may inspire others in similar conditions and circumstances. The underutilisation of vacuum extraction in middle- and low-income countries is indeed a missed opportunity. Its reversion is possible and provides a good chance to make considerable difference in maternal and perinatal outcomes.
- Published
- 2018
19. The magnitude and factors related to facility-based maternal mortality in Mozambique
- Author
-
Osvaldo Loquiha, Leonardo Chavane, Olivier Degomme, Marleen Temmerman, Martinho Dgedge, Marc Aerts, Chavane, Leonardo, Dgedge, Martinho, Degomme, Olivier, LOQUIHA, Osvaldo, AERTS, Marc, and Temmerman, Marleen
- Subjects
Emergency Medical Services ,medicine.medical_specialty ,Nurse Midwives ,Maternal-Child Health Centers ,Psychological intervention ,Staffing ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Pregnancy ,Risk Factors ,Surveys and Questionnaires ,Environmental health ,Health care ,medicine ,Emergency medical services ,Humans ,Childbirth ,Maternal Health Services ,030212 general & internal medicine ,Mozambique ,Quality of Health Care ,030219 obstetrics & reproductive medicine ,business.industry ,Public health ,Obstetrics and Gynecology ,Obstetric transition ,Hospitals ,Maternal Mortality ,Female ,business ,Maternal mortality ,health facility-based ,geographical distribution - Abstract
Facility-based maternal mortality remains an important public health problem in Mozambique. A number of factors associated with health system functioning can be described behind the occurrence of these deaths. This paper aimed to evaluate the magnitude of the health facility-based maternal mortality, its geographical distribution and to assess the health facility factors implicated in the occurrence of these deaths. A secondary analysis was done on data from the survey on maternal health needs performed by the Ministry of Health of Mozambique in 2008. During the study period 2.198 maternal deaths occurred out of 312.537 deliveries. According to the applied model the availability of Maternal and Child Health (MCH) nurses performing Emergency Obstetric Care functions was related to the reduction of facility-based maternal mortality by 40%. No significant effects were observed for the availability of medical doctors, surgical technicians and critical delivery room equipment. Impact statement Is largely known that the availability of skilled attendants assisting every delivery and providing Emergency Obstetric Care services during the pregnancy, labor and Childbirth is key for maternal mortality reduction. This study add the differentiation on the impact of different cadres of health services providers working on maternal and child health services on the facility based maternal mortality. In this setting the study proven the high impact of the midlevel skilled maternal and child health nurses on the reduction of maternal mortality. Another important add from this study is the use of facility based maternal mortality data to inform the management process of maternal healthcare services. The findings from this study have potential to impact on the decision of staffing prioritization in setting like the study setting. The findings support the policy choice to improve the availability of maternal and child health nurses.
- Published
- 2017
20. Socio-economic improvements and health system strengthening of maternity care are contributing to maternal mortality reduction in Cambodia
- Author
-
Jerker Liljestrand and Mean Reatanak Sambath
- Subjects
Emergency Medical Services ,Health Knowledge, Attitudes, Practice ,Population ,Developing country ,Midwifery ,Health Services Accessibility ,Pregnancy ,Health care ,Humans ,Medicine ,Maternal Health Services ,education ,Socioeconomics ,Health policy ,education.field_of_study ,Cesarean Section ,business.industry ,Communication ,Attendance ,Obstetrics and Gynecology ,Health equity ,Maternal Mortality ,Socioeconomic Factors ,Reproductive Medicine ,Family planning ,Family Planning Services ,Abortion, Legal ,Women's Health ,Female ,Cambodia ,business ,Live birth ,Public Health Administration - Abstract
Maternal mortality has been falling significantly in Cambodia since 2005 though it had been stagnant for at least 15 years before that. This paper analyzes the evolution of some major societal and health system factors based on recent national and international reports. The maternal mortality ratio fell from 472 per 100,000 live births in 2000–2005 to 206 in 2006–2010. Background factors have included peace and stability, economic growth and poverty reduction, improved primary education, especially for girls, improved roads, improved access to information on health and health services via TV, radio and cellphones, and increased ability to communicate with and within the health system. Specific health system improvements include a rapid increase in facility-based births and skilled birth attendance, notably investment in midwifery training and numbers of midwives providing antenatal care and deliveries within an expanding primary health care network, a monetary incentive for facility-based midwives for every live birth conducted, and an expanding system of health equity funds, making health care free of cost for poor people. Several major challenges remain, including post-partum care, family planning, prevention and treatment of breast and cervical cancer, and addressing sexual violence against women, which need the same priority attention as maternity care.
- Published
- 2012
21. Obstetric emergency simulation training course: experience of a private-public partnership in Brazil.
- Author
-
Siaulys, Monica Maria, da Cunha, Lissandra Borba, Torloni, Maria Regina, and Kondo, Mario Macoto
- Subjects
NURSING education ,EDUCATION of physicians ,EDUCATION of practical nurses ,MATERNAL mortality ,MATERNAL health services ,ABILITY ,CUSTOMER satisfaction ,ECLAMPSIA ,EMERGENCY medical services ,HEMORRHAGE ,INTERPROFESSIONAL relations ,SCIENTIFIC observation ,PREECLAMPSIA ,PROFESSIONS ,QUESTIONNAIRES ,RESUSCITATION ,SEPSIS ,TRAINING ,PUBLIC sector ,COURSE evaluation (Education) ,MANN Whitney U Test ,KRUSKAL-Wallis Test ,FRIEDMAN test (Statistics) ,PREVENTION - Abstract
Background: Lack of skills on how to diagnose and manage obstetric emergencies contribute to substandard institutional care and preventable maternal deaths in Brazil. Simulation-based obstetric emergency team training can reduce adverse maternal outcomes. However, this type of training is expensive and not widely available, especially in low resource settings. We present the experience of a private-public partnership that offered a two-day obstetric emergency simulation-training course to hundreds of Brazilian professionals working in the public sector. We also present participants´ short-term learning outcomes (Kirkpatrick's level 2) and satisfaction (Kirkpatrick's level 1). Methods: This was a non-experimental before-and-after study. The free 16-h course was held over a 14 months period in a large private hospital's simulation center using multidisciplinary scenario and model-based training. The training sessions consisted of four (4-h) modules on pre-eclampsia/eclampsia, hemorrhage, sepsis and resuscitation. An anonymous questionnaire collected participants´ satisfaction at the end of each module. Learning outcomes were assessed by comparing differences in participants´ pre- versus immediate post-course test scores. Wilcoxon, Kruskal-Wallis and Friedman tests were used for statistical analyses. P < 0.05 was considered significant. Results: 340 professionals (117 doctors, 179 registered nurses-RN and 44 licensed practical nurses-LPN) working in 33 public Brazilian hospitals were trained. There was a significant increase in post-course test scores in all four modules. On average, scores increased 55% in the hypertension and 65–69% in the hemorrhage, sepsis and resuscitation modules (p = 0.019). Knowledge acquisition of RN and LPN was similar in the hypertension, hemorrhage and sepsis modules and significantly higher than doctors´ (p < 0.05). On a 0 to 10 scale, mean overall satisfaction ranged from 9.6 (for the hypertension module) to 9.8 (for the resuscitation module). Conclusions: This successful experience of a private-public partnership to offer obstetric emergency simulation training required strategic organization and a strong commitment from both sides. This promising private-public partnership model could be replicated in similar settings. The training course obtained high satisfaction scores and significantly improved the knowledge of public-sector health professionals on how to manage the main causes of maternal mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
22. Reducing maternal mortality: better monitoring, indicators and benchmarks needed to improve emergency obstetric care. Research summary for policymakers
- Author
-
Guy, Collender, Sabine, Gabrysch, and Oona M R, Campbell
- Subjects
Obstetrics ,Benchmarking ,Emergency Medical Services ,Health Services Needs and Demand ,Maternal Mortality ,Pregnancy ,Humans ,Zambia ,Female ,Maternal Health Services ,Policy Making ,Sri Lanka - Abstract
Several limitations of emergency obstetric care (EmOC) indicators and benchmarks are analysed in this short paper, which synthesises recent research on this topic. A comparison between Sri Lanka and Zambia is used to highlight the inconsistencies and shortcomings in current methods of monitoring EmOC. Recommendations are made to improve the usefulness and accuracy of EmOC indicators and benchmarks in the future.
- Published
- 2012
23. Relating the construction and maintenance of maternal ill-health in rural Indonesia
- Author
-
Lucia D'Ambruoso and Bill & Melinda Gates Foundation, UK Department for International Development, European Commission and USAID.
- Subjects
Program evaluation ,Rural Population ,Emergency Medical Services ,Financing, Personal ,Population ,Maternal Welfare ,audit ,Midwifery ,Care provision ,Health Services Accessibility ,maternal morbidity ,Nursing ,quality of care ,Medicine ,Humans ,Maternal Health Services ,Social determinants of health ,education ,Maternal mortality ,access to care ,Indonesia ,decentralisation ,health systems ,Quality of Health Care ,education.field_of_study ,Insurance, Health ,business.industry ,maternal mortality ,lcsh:Public aspects of medicine ,Health Policy ,Public Health, Environmental and Occupational Health ,Public Health, Global Health, Social Medicine and Epidemiology ,lcsh:RA1-1270 ,Delivery, Obstetric ,PhD REVIEWS ,Verbal autopsy ,Disadvantaged ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Female ,Rural area ,business - Abstract
Background: Estimates suggest that over 350,000 deaths and more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. Death and disability occur predominately among disadvantaged women in resource-poor settings and are largely preventable with adequate delivery care.Objectives: This paper presents the substantive findings and policy implications from a programme of PhD research, of which the overarching objective was to assess quality of, and access to, care in obstetric emergencies.Methods: Three critical incident audits were conducted in two rural districts on Java, Indonesia: a confidential enquiry, a verbal autopsy survey, and a community-based review. The studies examined cases of maternal mortality and severe morbidity from the perspectives of local service users and health providers.Results: A range of inter-related determining factors was identified. When unexpected delivery complications occurred, women and families were often uninformed, unprepared, found care unavailable, unaffordable, and many relied on traditional providers. Midwives in villages made important contributions by stabilising women and facilitating referrals but were often scarce in remote areas and lacked sufficient clinical competencies and payment incentives to treat the poor. Emergency transport was often unavailable and private transport was unreliable and incurred costs. In facilities, there was a reluctance to admit poorer women and those accepted were often admitted to illequipped, under-staffed wards. As a result, referrals between hospitals were also common. Otherwise, social health insurance, designed to reduce financial barriers, was particularly problematic, constraining quality and access within and outside facilities. Health workers and service users provided rich and explicit assessments of care and outcomes. These were used to develop a conceptual model in which quality and access are conceived of as social processes, observable through experience and reflective of the broader relationships between individuals and health systems. According to this model, differential quality and access can become both socially legitimate (imposed by structural arrangements) and socially legitimised (reciprocally maintained through the actions of individuals). This interpretation suggests that in a context of commodified care provision, adverse obstetric outcomes will occur and recur for disadvantaged women.Conclusion: Health system reform should focus on the unintended effects of market-based service provision to exclude those without the ability to pay for delivery care directly.Keywords: maternal mortality; maternal morbidity; audit; quality of care; access to care; Indonesia; decentralisation; health systems(Published: 3 August 2012)Citation: Glob Health Action 2012, 5: 17989 - http://dx.doi.org/10.3402/gha.v5i0.17989
- Published
- 2012
24. Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.
- Author
-
Jat, Tej Ram, Deo, Prakash R., Goicolea, Isabel, Hurtig, Anna-Karin, and Sebastian, Miguel San
- Subjects
EMERGENCY medical services ,HUMAN rights ,MATERNAL health services ,MEDICAL care ,MEDICAL quality control ,MATERNAL mortality ,PUBLIC welfare ,RURAL conditions ,SELF-efficacy ,QUALITATIVE research ,SOCIOECONOMIC factors ,THEMATIC analysis - Abstract
Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery–related dimensions of maternal deaths in rural central India using a human rights lens. Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens. All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. The study highlighted various socio-cultural and service delivery–related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.