Emergency Obstetric Care Services Research Articles

Identifying Barriers to Utilization of Basic Emergency Obstetric and NewBorn Care Services in Jigawa State, North-western Nigeria: A Qualitative Study

Background: Maternal mortality has remained high in northern Nigeria despite decades of effort aimed at reducing it. The number of women who deliver in Emergency Obstetric Care (EmONC) facilities is low. This study explored the barriers to utilizing Basic EmONC services in Jigawa State.
 Methods: A qualitative study was conducted among mothers of children under five years through 12 Focus Group Discussions. A purposive sampling technique was used to select participants who were categorized based on age (below 35 years, 35 years and above) and prior utilization of EmONC services. Content analysis along thematic lines was done and the findings were reported in narrative form.
 Results: The mean age of participants was 31 ± 6 years. The majority of participants had primary education and most were unemployed. Most of the participants identified obstetric danger signs, however, they opine that medical attention should be sought only when complications become serious. Participants in all groups unanimously said decision-making for seeking medical care rests with the husband and occasionally the mother-in-law. Barriers to seeking care identified by participants include lack of money, distance to the nearest health facility, fear of embarrassment by healthcare workers, and insecurity among others.
 Conclusion: Most participants were knowledgeable of obstetric danger signs, but with low risk-perception towards obstetric complications. The Jigawa State government should engage in a robust education campaign on the need for early decision-making to seek care as well as strengthen its women empowerment programs to overcome barriers to seeking care for obstetric complications.

Geographical distribution of emergency obstetric and neonatal care signal functions in Ethiopian health facilities: 2021–2022 Ethiopian service Provision Assessment (SPA)

BackgroundThe maternal mortality ratio in Ethiopia is still high, with an estimate of 412 deaths per 100,000 live births in 2016. Signal functions for emergency obstetric and neonatal care must be accessible and usable in order to successfully prevent maternal deaths. It is an important strategy to reduce maternal and newborn morbidity and mortality in countries with limited resources. Hence, an assessment of the availability of fully functioning EmONC services and their coverage per 500,000 people in Ethiopia is crucial.MethodsThis study is a retrospective analysis of data from the Ethiopian Service Provision Assessment Survey (ESPA), a national-level survey data source. Data collection for the survey took place from August 11, 2021, to February 4, 2022. For this investigation, 905 healthcare facilities in total were evaluated for the availability of emergency obstetric and new-born care (EmONC) services at all hospitals, selected health centers, and private clinics were evaluated. Descriptive data analysis was done by the using statistical package for social science version 26 (SPSS) to run frequency and cross-tabs. Global Positioning System (GPS) (arc map 10.8) Software was used for spatial distribution in order to locate the physical accessibility of EmONC providing health facilities on flat map surfaces. It was projected based on Ethiopia’s geographic coordinate system at Adindan UTM zone 370N.ResultsOf 905 health facilities, only 442 (49%) could provide fully functioning BEmONC, and 250 (27.6%) health facilities have been providing fully functioning CEmONC. The overall coverage of BEmONC ratios in Ethiopia is 1.5–3.77 per 500,000 population and CEmONC (0.83–2.1) per 500,000 populations. Regions such as Amhara, SNNPR and Addis Ababa had found to have high BEmONC ratio. The geographical distribution of the EmONC showed that the central areas of the country, such as southwest Shewa and east Shewa, the Oromia region, the northern areas of the South Nation, nationalities, and peoples regions (SNNPR), including the Gurage zone and the Wolaita-Soddo zone, and the middle areas in the Amhara region (west Gojjam or around Bahir Dar town), and the southern areas, Debra Tabor and Debre Birhane zones, all had greater access to facilities offering complete EmONC services.ConclusionComprehensive emergency obstetrics and neonatal care (CEmONC) in Ethiopia met WHO recommendations, despite basic emergency obstetric and neonatal care (BEmONC) falling below those standards in Ethiopia. There are extremely large disparities in the accessibility of both basic and comprehensive emergency obstetrics and neonatal care in Ethiopia. Thus, Strategic planning is needed to improve infrastructures and inputs for EmONC services, particularly in remote areas of the country. Additionally, private facilities ought to place a priority on the provision of these services.

Spatial and Socioeconomic Inequalities in Cesarean Section Deliveries in Urban Settings in Dakar, Senegal.

As part of an initiative aimed at reducing maternal and child mortality, Senegal implemented a policy of free Cesarean section (C-section) since 2005. Despite the implementation, C-section rates have remained low and significant large disparities in access, particularly in major cities such as Dakar. This paper aims to assess C-section rates and examines socioeconomic inequalities in C-section use in the Dakar region between 2005 and 2019. This study incorporates data from various sources, including the health routine data within District Health Information Software 2 (DHIS2) platform, government statistics on slum areas, and data from Demographic and Health Surveys (DHS). A geospatial analysis was conducted to identify locations of Comprehensive emergency obstetric and Newborn Care (CEmONC) services using the Direction des Travaux Géographiques et Cartographiques (DTGC) databases and satellite imagery from the Google Earth platform. The analytical approach encompassed univariate, bivariate, and multivariate analyses. The C-section rate fluctuated over the years, increasing from 11.1% in 2005 to 16.4% in 2011, declined to 9.8% in 2014, and then raised to 13.3% in 2019. The wealth tertile demonstrated a positive correlation with C-sections in urban areas of the Dakar region. Geospatial analyses revealed that women residing in slum areas were less likely to undergo C-section deliveries. These findings underscore the importance of public health policies extending beyond merely providing free C-section delivery services. Strategies that improve equitable access to C-section delivery services for women across all socioeconomic strata are needed, particularly targeting the poor women and those in urban slums.

Delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale zones, Ethiopia. A cross-sectional study.

Maternal mortality occurs in developing nations as a result of inadequate health care, delayed medical attention and the inability to access medical facilities. The three-delay model was employed to determine the causes of maternal death. There was limited data on maternal delay in reaching health facilities for emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the prevalence of delay in reaching health facilities for emergency obstetric care and associated factors among postpartum mothers at Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariable and multivariable analysis was done by using a binary logistic regression model to identify factors associated with delay in traveling for emergency obstetric care services. Statistical significance was declared at P-value < 0.05. In this study, the prevalence of delay in reaching health facilities during emergency obstetric care was 38.1% (95%CI: 33.3, 43). The following factors showed significant association with delay in reaching health facilities during emergency obstetric care: Average monthly income (AOR = 1.87; 95% CI: 1.12, 3.14), distance (AOR = 4.35; 95% CI: 2.65, 7.14), a referral from other health facilities (AOR = 1.77; 95% CI: 1.01, 3.11) and delay one (AOR = 2.9; 95% CI: 1.7, 4.93). This study showed that the prevalence of delay in reaching health facilities for emergency obstetric care services in the study area was high. Promoting road accessibility and transport mechanisms and strengthening referral mechanisms shall be emphasized.

Changes in health facility readiness for obstetric and neonatal care services in Nepal: an analysis of cross-sectional health facility survey data in 2015 and 2021

BackgroundNepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved.MethodsCross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs.ResultsDespite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent.ConclusionsThe slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.

Essential health services delivery and quality improvement actions under drought and food insecurity emergency in north-east Uganda

BackgroundEssential health services can be disrupted due to several naturally occurring public health emergencies such as drought, flood, earthquake and outbreak of infectious diseases. However, little evidence exists on the status of essential health services delivery under the effect of drought and food insecurity. North-east Uganda is severely affected by prolonged drought that significantly affected the livelihood of the residents. Therefore, we aimed to determine the current status of essential health services and quality improvement (QI) actions in health facilities in north-east Uganda.MethodsWe used a descriptive cross-sectional study design to assess the availability of essential health service and quality improvement activities in drought and food insecurity affected districts of north-east Uganda. We included a total of 150 health facilities from 15 districts with proportionated multistage sampling method. We interviewed health facilities’ managers and services focal persons using structured questionnaire and observation checklist. We used a descriptive statistic to analyze the data with SPSS version 22.ResultsA few health facilities (8.7%) had mental health specialist. There was also lack of capacity building training on essential health services. Considerable proportion of health facilities had no non-communicable diseases (38.3%), mental health (47.0%), and basic emergency obstetric care (40.3%) services. Stock out of essential medicines were observed in 20% of health facilities. There was lack of supportive supervision, and poor documentation of QI activities.ConclusionEssential health service and QI were suboptimal in drought and food insecure emergency affected districts. Human resource deployment (especially mental health specialist), provision of capacity building training, improving non-communicable diseases, mental health and basic emergency obstetric care services are required to improve availability of essential health services. Supporting supply chain management to minimize stock out of medicines, and promoting QI activities are also vital to assure quality of health service in drought and food insecurity affected districts in north-Eastern Uganda.

Developing policy-ready digital dashboards of geospatial access to emergency obstetric care: a survey of policymakers and researchers in sub-Saharan Africa

BackgroundDashboards are increasingly being used in sub-Saharan Africa (SSA) to support health policymaking and governance. However, their use has been mostly limited to routine care, not emergency services like emergency obstetric care (EmOC). To ensure a fit-for-purpose dashboard, we conducted an online survey with policymakers and researchers to understand key considerations needed for developing a policy-ready dashboard of geospatial access to EmOC in SSA.MethodsQuestionnaires targeting both stakeholder groups were pre-tested and disseminated in English, French, and Portuguese across SSA. We collected data on participants’ awareness of concern areas for geographic accessibility of EmOC and existing technological resources used for planning of EmOC services, the dynamic dashboard features preferences, and the dashboard's potential to tackle lack of geographic access to EmOC. Questions were asked as multiple-choice, Likert-scale, or open-ended. Descriptive statistics were used to summarise findings using frequencies or proportions. Free-text responses were recoded into themes where applicable.ResultsAmong the 206 participants (88 policymakers and 118 researchers), 90% reported that rural areas and 23% that urban areas in their countries were affected by issues of geographic accessibility to EmOC. Five percent of policymakers and 38% of researchers were aware of the use of maps of EmOC facilities to guide planning of EmOC facility location. Regarding dashboard design, most visual components such as location of EmOC facilities had almost universal desirability; however, there were some exceptions. Nearly 70% of policymakers considered the socio-economic status of the population and households relevant to the dashboard. The desirability for a heatmap showing travel time to care was lower among policymakers (53%) than researchers (72%). Nearly 90% of participants considered three to four data updates per year or less frequent updates adequate for the dashboard. The potential usability of a dynamic dashboard was high amongst both policymakers (60%) and researchers (82%).ConclusionThis study provides key considerations for developing a policy-ready dashboard for EmOC geographical accessibility in SSA. Efforts should now be targeted at establishing robust estimation of geographical accessibility metrics, integrated with existing health system data, and developing and maintaining the dashboard with up-to-date data to maximise impact in these settings.

Provision of emergency obstetric care: Midwives' knowledge and involvement in rural health facilities of Cross River State, Nigeria

BACKGROUND: Maternal Mortality (MM) in Nigeria is greatest in rural regions where access to emergency obstetric care (EmOC) services is hampered by a number of circumstances. Delay in obtaining prompt and proper care in obstetric emergency situations is a significant factor in poor mother outcomes. It is based on this premise that the researchers examined midwives' knowledge and involvement regarding provision of emergency obstetric care in rural health facilities of Cross River State. MATERIALS AND METHODS: The study adopted a cross-sectional descriptive design; a total population study of all ninety-four midwives who worked in maternal health care facilities in rural areas of CRS was utilised. Cross River state is a state in the South-South geopolitical zone of Nigeria, named after the Cross River, which passes through the state, located in the Niger Delta and occupies 20,156 square kilometers A self-developed and validated questionnaire was used for data collection. The instrument was pre-tested for reliability and result showed the reliability index ranging from 0.70 to 0.82. Quantitative data collected was analysed using Pearson product moment correlation test at 0.05 level of significance. RESULTS: The research findings revealed midwives' level of knowledge on emergency obstetric care in rural health facilities of CRS was significantly high, majority of the participants had provided some aspects of essential emergency obstetric care. The result of hypotheses revealed a significant relationship between knowledge and provision of EmOC amongst the midwives (P &lt; .05). CONCLUSION: Based on this, it was recommended that appropriate strategies such as on the job training\ supportive supervision, refresher training and mentorship should also be ensured to enhance midwives' capacity in emergency obstetric care. Finally, there is need for Community involvement/enlightenment, motivating traditional birth attendants and integrating them into maternal health care system.

Impact of quality improvement interventions on facility readiness, quality and uptake of maternal and child health services in developing regions of Ethiopia: a secondary analysis of programme data

BackgroundQuality improvement intervention (QI) was implemented from 2018 to 2021 in health facilities of developing regional states of Ethiopia. The main objective of this study was to examine the impact...

The use of a mobile obstetric emergency system to improve obstetric referrals in Bong County, Liberia: A pre-post study.

Liberia experiences an unmet need for cesarean section with about 5% population coverage, lower than 9%-19% coverage associated with improved maternal and newborn outcomes. Delays in the referral process for comprehensive emergency obstetric and newborn care (CEmONC) services due to ineffective communication between a rural health facility (RHF) and a district hospital contribute to the low CS rate. This study examined the association between mobile obstetric emergency system (MORES) implementation and referral time for obstetric emergencies as well as maternal/newborn outcomes. A pre-post descriptive analysis was conducted on data collected from 20 rural health facilities (RHFs) and two hospitals in Bong County. Women with referral data from both RHFs and hospitals were matched and information including transfer time, reasons for referral, and maternal and newborn outcomes were extracted. Descriptive analysis and logistic regression models examined the relationship between the intervention's implementation and mode of delivery, maternal outcome, newborn outcome, and transfer time from RHF to district hospital. Ethics approval was obtained from two study centers. Women had higher odds of undergoing a CS at endline (OR: 1.86 95% CI: 0.99-3.46) compared to baseline. Additionally, newborns had lower odds of showing non-vigorous symptoms (OR: 0.31; 95% CI: 0.14-0.68), defined as a newborn with poor respiratory effort, muscle tone, or heart rate. There was no significant association between the intervention's implementation and transfer time. The MORES intervention is a promising means to increase timely care seeking along the referral pathway which may enhance access to cesarean section as well as improved newborn outcome in low- and middle-income countries.

Effectiveness of a Facility-Based Health Education Intervention on Utilization of Emergency Obstetric and Newborn Care Services among Women of Reproductive Age in Nakuru County, Kenya

Purpose: Emergency obstetric and newborn care (EmONC) is the most important intervention to improve maternal survival. The study assessed facility based health education intervention on utilization of Emergency Obstetrics and Newborn care services.&#x0D; Methodology The study was a randomized control trial and utilized a mixed method. Multistage sampling was used. Key informants were purposefully selected Allocation to each study group was done on a 1:1 ratio; hence each group had 191 participants. The sample size was determined by Kelsey et al 1996 formula for calculation of sample size for randomized controlled trials and in order to take care of attrition 10% increase was done hence the sample size was 382 women. Pregnant mothers 26-32 weeks of gestation were enrolled. Structured questionnaire, focused group discussion and key informant interview schedules used. A pre-test was conducted at Kuresoi North Sub County. To ensure validity, research assistants were trained on the various research instruments. Descriptive statistics Fisher’s exact test at bivariate and odds ratio at multivariate analysis level were computed. Qualitative data was analysed using thematic content analysis. Ethical approval for the research was sought from the K.U research ethical committee, the National council for Science and Technology and Ministry of health. Informed consent was obtained from respondent prior to the study.&#x0D; Results: The intervention group had 95.93% (n =165) utilization of EmONC services in comparison to the control arm 75.29% (n = 128). There was no significance difference in the control group from base line to final survey OR 1.209, CI 0.742 to 1.969 and P-value 0.446. From the study findings the chances of EmONC services utilization after intervention was high. Those that received the intervention were seven times likely to utilize than those that did not receive the health education with an OR 7.734, 95% CI 3.363 to 17.787 and a P-value &lt; 0.001 when we compare the intervention group and the control group.&#x0D; Unique Contribution to Theory, Practice and Policy: Administration of Health education is crucial in the utilization of EmONC services thus improving maternal mortality and morbidity. This study concurs with the Theory of Planned Behavior and the theory of Reasoned Action. Health education intervention may change the behavior intention of the client hence influencing utilization of EmONC services. It is recommended stakeholders to come up with a well-structured health education program in all regions of Kenya to improve emergency obstetric and newborn care services utilization.

Factors to improve the quality of comprehensive emergency obstetric and newborn care

This study aimed to explore healthcare team members’ perspectives towards the factors that can contribute to the quality improvement of comprehensive emergency obstetric and neonatal care (CEmONC) services at a tertiary hospital. This qualitative descriptive study used convenience sampling to collect the sample. The inclusion criteria were the health workers who have worked for at least one year, in which a total of 119 participants took part in this study. The data were obtained from an online questionnaire, and the collected data were then analyzed with qualitative thematic analysis. This study revealed that three key aspects affecting the success of CEmONC services: i) health human resources (high-quality healthcare workers, in adequate proportion, with excellent teamwork, and commitment to being on time); ii) facilities and infrastructure (the availability of the intensive care unit and 24-hour laboratory, and the access to the obstetric/neonatal ward), and iii) the hospital service system (well-integrated external referral system and internal consultation). As the highest referral healthcare center, hospital managers should monitor and evaluate these three factors periodically to ensure that high-risk mothers and babies can acquire appropriate subspecialty care in the hospital and further can reduce maternal and neonatal mortality rates.

Prevalence and factors associated with utilization of emergency obstetric newborn care services among women of reproductive age in Nakuru county Kenya

Background: Emergency obstetric and newborn care (EmONC) mediates maternal survival. To prevent deaths, mothers require access to quality care and utilization of health facilities where professionals can promptly diagnose and manage emergencies related to pregnancy and childbirth. The study focused on socio-demographic, social cultural and social economic factors. Methods: The study was a randomized control trial and utilized a mixed method. Pregnant mother 26 to 32 weeks gestation and aged 15-49 years totaling to 382 respondents were enrolled in the study. Allocation to each study group was done on a 1:1 ratio; hence each group had 191 participants. The study was conducted from January to July 2020. Results: The intervention group had 95.93% (n=165) utilization of EmONC services in comparison to the control arm 75.29% (n=128). There was no discrepancy in both groups from base line to final survey OR=1.209, CI=0.742 to 1.969 and p=0.446. The level of education significantly influenced utilization at χ2=40.402 and a p&lt;0.001. Secondary education influences utilization of EmONC services at AOR=8.791, 95% CI=3.631 to 21.285 and p&lt;0.001. Respondents with tertiary education were 2.5 times likely to utilize EmONC services. Parity was significant at χ2=43.724, p&lt;0.001. There was no significant difference between socioeconomic factors, sociocultural factors and utilization of EmONC services at baseline level. Conclusions: There was an increase in utilization of EmONC services. The education level and parity of the woman determined the utilization of EmONC services.

Service availability and readiness for basic emergency obstetric and newborn care: Analysis from Nepal Health Facility Survey 2021.

Although there has been a significant focus on improving maternal and newborn health and expanding services in Nepal, the expected positive impact on the health of mothers and newborns has not been achieved to the desired extent. Nepal not only needs to focus on improving access to and coverage of services but also the quality to achieve Sustainable Development Goals (SDG) by 2030. In this context, we aimed to analyze Basic Emergency Obstetric and Neonatal Care (BEmONC) service availability and readiness in Health Facilities (HFs) of Nepal. We analyzed data from nationally representative Nepal Health Facility Survey (NHFS), 2021. BEmONC service availability and readiness in HFs was measured based on the "Service Availability and Readiness" manual of World Health Organization (WHO). We measured service availability by seven BEmONC signal functions. The readiness score was calculated for three domains- guidelines and staff training, essential equipment/supplies, and essential medicines on a scale of 100, and the average score for the three domains was the overall readiness score. We performed weighted descriptive and inferential analysis to account complex survey design of NHFS 2021. We summarized continuous variables with descriptive statistics like mean, standard deviation, median and interquartile range whereas categorical variables with percent and 95% confidence interval (CI). We applied simple, and multivariate linear regression to determine factors associated with the readiness of HFs for BEmONC services, and results were presented as beta (β) coefficients and 95% CI. Of total 804 HFs offering normal vaginal delivery services, 3.1%, 89.2%, 7.7% were federal/provincial hospitals, local HFs, and private hospitals respectively. A total of 45.0% (95% CI: 34.9, 55.6) federal/provincial hospitals, 0.3% (95% CI: 0.2, 0.6), local HFs (district hospital, primary health care centers, health posts, urban health centers) and 10.5% (95% CI: 6.6, 16.4) private hospitals, had all seven BEmONC signal functions. The overall readiness of federal/provincial hospitals, local HFs, and private hospitals were 72.9±13.6, 54.2±12.8, 53.1±15.1 respectively. In multivariate linear regression, local HFs (β = -12.64, 95% CI: -18.31, -6.96) and private hospitals had lower readiness score (β = -18.08, 95% CI: -24.08, -12.08) compared to federal/provincial level hospitals. HFs in rural settings (β = 2.60, 95% CI: 0.62, 4.58), mountain belts (β = 4.18, 95% CI: 1.65, 6.71), and HFs with external supervision (β = 2.99, 95% CI:1.08, 4.89), and quality assurance activities (β = 3.59, 95% CI:1.64, 5.54) had better readiness scores. The availability of all seven BEmONC signal functions and readiness of HFs for BEmONC services are relatively low in local HFs and private hospitals. Accelerating capacity development through training centers at the federal/provincial level, onsite coaching, and mentoring, improving procurement and supply of medicines through federal/provincial logistic management centers, and regular supportive supervision could improve the BEmONC service availability and readiness in facilities across the country.

Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of cross-sectional survey data.

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. 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. 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. 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.

Delay in receiving emergency obstetric care and associated factors among mothers who gave birth in public hospitals of Bale and East Bale zones, Oromia region, South East Ethiopia: Facility based cross-sectional study

IntroductionDelays in timely seeking care, failure to reach health institutions and receiving ineffective health care cause maternal mortality in developing countries. The three maternal delay was used to identify contributing factors to maternal death. There was limited data on the maternal delay in receiving emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the magnitude of delay in receiving emergency obstetric care and associated factors among postnatal mothers in the Bale and east Bale zones. MethodsA facility-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic random sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analyses were done by using a binary logistic regression model to identify factors associated with delay in receiving emergency obstetric care services. Statistical significance was declared at P-value < 0.05. ResultsIn this study, the magnitude of delay in receiving institutional delivery service utilization was 34.6% with [95% CI (30.0_39.5)]. Delay one was found to be statistically associated with maternal delay in receiving institutional delivery services (AOR = 2.07; 95% CI: 1.21, 3.53). Mothers with low monthly income had shown higher odds of delay (AOR = 1.79; 95% CI: 1.03, 3.10). Moreover, the delay in receiving emergency obstetric care was 89% less likely among mothers who had not been referred multiple times than among those who had been referred many times (AOR = 0.10; 95% CI: 0.06, 0.18). ConclusionThis study showed that the magnitude of the delay in receiving the utilization of emergency obstetric care services in the study area was high. Factors such as delay one, average monthly income and multiple referrals of mothers were found significant factors for delay in receiving care. Therefore, it is important to reduce delay in receiving institutional delivery by working on promoting road accessibility, transport mechanisms and building health education on key danger signs.

Innovative dashboard for optimising emergency obstetric care geographical accessibility in Nigeria: Qualitative study with technocrats

ObjectiveTo explore perspectives of public sector technocrats on the role of and considerations needed for implementing an innovative dashboard that leverages geographic information systems (GIS) in supporting optimisation of emergency obstetric care (EmOC) geographical accessibility in Nigeria. MethodsTwenty-three semi-structured interviews were conducted in person or virtually with six policymakers and 17 senior civil servants in Nigeria. Braun and Clarke's six-step approach to thematic analysis, which involved data familiarisation, initial code generation, searching for themes, reviewing themes, defining themes, and producing the report, was applied. ResultsDespite recognising the ideal of data-driven needs assessment, in reality, factors such as political pressure, persistent community advocacy, and donor funding drive decisions on siting EmOC facilities. Irregular short-term political cycles and exigencies in health systems prevent new facilities from being established or motivate a focus on facility quality over quantity. There was a strong appetite for using GIS-enabled dashboards to support planning, with enthusiasm for such technology more apparent where innovation was already part of government's philosophy. A digital dashboard that is dynamic, reflective of reality, inclusive of public and private providers, incorporates facility characteristics, and can test accessibility scenarios, was deemed particularly valuable. Its value proposition extended beyond EmOC and provider type. However, its success as a policy tool will depend on the veracity and currency of the data informing it. ConclusionsTechnocrats welcome dynamic GIS-enabled dashboards as it offers a significant step-change compared to the current practice for EmOC service planning. Value-for-money of such innovations must be considered if implemented. Public Interest SummaryPlanning and siting of emergency services used by pregnant women (EmOC) in many low-resource countries are mostly haphazard. However, there is increasing recognition that technology can refine this process. In this study, we explored perspectives of public sector technocrats in Nigeria on the role of and considerations needed for implementing an innovative digital dashboard that leverages geographic information systems in optimising EmOC geographical accessibility. We found that current planning is mainly driven by political pressure, community advocacy, and donor funding. However, there is a strong appetite in government for using GIS-enabled dashboards to inform service planning, with enthusiasm for such technology appearing to be more grounded in states where innovation was already part of the government's philosophy. Yet, concerns about data accuracy were expressed. Broadly, dashboards that are dynamic, reflective of reality, inclusive of public and private providers, incorporate facility characteristics, and can test access scenarios, were deemed particularly valuable.

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021-30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53-35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24-30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.

Policy analysis to assess the impact of inadequate Emergency Obstetric Care (EmOC) services on maternal mortality in Balochistan Pakistan

Policy analysis to assess the impact of inadequate Emergency Obstetric Care (EmOC) services on maternal mortality in Balochistan Pakistan

Improving comprehensive emergency obstetric and newborn care in Tanzania: A qualitative study

AimThe purpose of this qualitative study was to explore how health care professionals, managers and community members experienced the implementation of a training program in comprehensive emergency obstetric and neonatal care training in rural Tanzania. BackgroundGiven the high rates of maternal and newborn mortality in Tanzania, the government committed to improving maternal health by increasing access to health care; improving reproductive, maternal, newborn health; reducing maternal and neonate mortality; and increasing the number of public health centers with emergency obstetric and neonatal care. To address the gap in emergency obstetric and neonatal care amongst the health workforce, five health care facilities in rural Tanzania participated in a 3-month specialized training program. The training was geared to increase access to skilled deliveries, prevent maternal and neonate deaths, and reduce referrals to district hospitals. MethodsTwenty-four focus group discussions were held with members of Council Health Management Team, Health Facility Management Team, staff who received training, and community members. Data collection and analysis was guided by content analysis and the World Health Organization's availability, accessibility, acceptability, and quality framework. FindingsParticipants reported acquiring necessary skills that enabled them to provide quality and safe obstetric and newborn care. Five themes emerged from the analysis 1) competent and confident health care teams, 2) renewed commitment to teamwork, 3) community confidence and trust in the health team, 4) mentorship as a critical element of success, and 5) enhancing training and practice. These five emerging themes demonstrate enhanced confidence and trust by the community and increased competency of health care teams to support mothers through pregnancy and birth at the health centre. ConclusionThe competencies acquired by health care providers demonstrate an increase in staff commitment and teamwork. There is an increased number of deliveries in health centres, a declining trend of maternal and neonate deaths and referrals to other health centres because the health care providers are capable of competently and confidently providing emergency obstetric and neonatal care services.