Assessment of integration of emergency obstetric and newborn care in maternal and newborn care in healthcare facilities in Osun State, Nigeria.

Abiola Olubusola Komolafe,Omolola Oladunni Irinoye,Adekemi Eunice Olowokere,Frank T Spradley

doi:10.1371/journal.pone.0249334

Abiola Olubusola Komolafe, Omolola Oladunni Irinoye + Show 2 more

Open Access

https://doi.org/10.1371/journal.pone.0249334

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Journal: PloS one	Publication Date: Apr 15, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Obafemi Awolowo University

Abstract

The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83–71)). The EmONC integration median score were 76 (IQR = 84–70), 76 (IQR = 80–68) and 78 (IQR = 84–74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87–78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.

Highlights

Maternal and newborn morbidity and mortality is a worldwide health challenge with burden disproportionately distributed and highest in developing countries
This may not be the full picture as some maternal and child complications and deaths from pregnancy and childbirth related care by untrained and inappropriately monitored birth attendants at the grassroots and rural communities go un-captured in formal national statistics. Obstetric complications such as haemorrhage, sepsis, eclampsia, obstructed labour and fetal distress remain the leading cause of deaths in women of reproductive age and neonates in low and middle-income countries. These deaths are preventable with implementation of emergency obstetric and neonatal care (EmONC) to treat and manage the obstetric complications in healthcare facilities [4,5,6,7,8]
All 505 healthcare providers and facility managers who were expected to be involved in the implementation of EmONC in the 33 healthcare facilities gave their consent to participate in the study

Summary

Introduction

Maternal and newborn morbidity and mortality is a worldwide health challenge with burden disproportionately distributed and highest in developing countries. Nigeria has been one of the major contributors to the world’s maternal and newborn deaths with 814 maternal deaths/100,000 births [2] and 38/1,000 live births formally documented [3] From anecdotal observations, this may not be the full picture as some maternal and child complications and deaths from pregnancy and childbirth related care by untrained and inappropriately monitored birth attendants at the grassroots and rural communities go un-captured in formal national statistics. This may not be the full picture as some maternal and child complications and deaths from pregnancy and childbirth related care by untrained and inappropriately monitored birth attendants at the grassroots and rural communities go un-captured in formal national statistics Obstetric complications such as haemorrhage, sepsis, eclampsia, obstructed labour and fetal distress remain the leading cause of deaths in women of reproductive age and neonates in low and middle-income countries. The BEmONC healthcare facilities are expected to implement seven of the nine signal functions while the comprehensive emergency obstetric and newborn care CEmONC implement all the nine signal functions [11]

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