Quality Of Maternal Health Care Research Articles

\u201cI just wish it becomes part of routine care\u201d: healthcare providers\u2019 knowledge, attitudes and perceptions of screening for maternal mental health during and after pregnancy: a qualitative study

BackgroundMaternal mental health is an international public health concern. Many women experience mental ill-health during and after pregnancy, but assessment is not part of routine maternity care in many low- and middle-income countries. Healthcare providers are in a position to identify and support women who experience mental health disorders during and after pregnancy. We sought to investigate the knowledge, attitudes and perceptions of routine screening for maternal mental health during and after pregnancy among healthcare providers providing routine maternity care in Accra, Ghana. Enabling factors, barriers and potential management options to routinely screen maternal mental health during and after pregnancy were explored.MethodsSemi-structured key informant interviews (n = 20) and one focus group discussion (n = 4) were conducted with healthcare providers working in one public hospital in Accra, Ghana. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes.ResultsMost healthcare providers are aware of the importance of maternal mental health and would be keen to help women who experience mental ill-health during and after pregnancy, if resources were available to do so. An enabling factor was the suggestion of introducing a culturally appropriate mental health screening tool. However, compromised mental health was often considered a ‘spiritual issue’ and not routinely screened for by healthcare providers, nor requested by women. Barriers to the provision of quality maternal mental health care included lack of trained staff and lack of time.ConclusionsHealthcare providers are aware of the problem of the lack of maternal mental health provision during and after pregnancy and are open to developing protocols to improve care. Currently, screening for maternal mental ill-health is not part of routine maternity care. The establishment of such a service requires the reprioritisation of workloads, further training, and a change in the attitudes and practices of healthcare providers. Education to change the attitudes of healthcare providers, women and the wider community towards mental health is needed. The development and implementation of culturally appropriate guidelines would be beneficial and result in better quality of maternity care.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study

BackgroundThis study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. MethodsWe used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. ResultsThe prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06–2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06–2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26–5.04 and OR = 4.27; 95%CI 1.80–10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26–4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58–9.42). LimitationsDisrespect and abuse experiences during childbirth were self-reported. ConclusionsDisrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Quality of maternal health care in Indonesia

Maternal Mortality Ratio (MMR) in Indonesia remains high, 190 per 100,000 live births in 2013. World Bank emphasizes that 60% of maternal death is contributed by poor quality of care. Lack of attitude, competence and compliance of midwives were found in Indonesia, which indicate poor quality of maternal health care. The objective of this study is to analyze factors influencing the quality of maternal health care in Indonesia. The literatures from 2004-2014 were selected and reviewed. The latest framework of 2014 on quality maternal health care by Renfrew et al. was used as a guide. The quality of maternal health care in Indonesia is influenced by lack of midwives’ competence, inadequate supervision and monitoring, lack of drugs and equipment supply, lack of community involvement in health services. In order to address the gaps in quality of maternal health care in Indonesia, six effective interventions are proposed; namely: maternal health audit and feedback, cultural competence, education, educational outreach visit, optimizing the role of lay health workers, group prenatal care and ensure adequate supply of drugs and equipment. The interventions needs to be carried out through a collaborative approach, policy change, pilot study and strengthen activities in implementation level.

Respectful Maternity Care in the US [15T

INTRODUCTION: To understand the status of respectful maternity care (RMC) in the U.S. METHODS: A cross-sectional survey of U.S. women age 18-50 in April 2018. SurveyMonkey Audience distributed this anonymous survey online. Women were eligible if they gave birth in the U.S. in the last 5 years. Participants were those who answered at least one question about RMC from their most recent birth. Quantitative survey data consisted of demographics and responses about RMC indicators and comments about their birth experience. RESULTS: Of 1081 eligible, 1036 women (95.8%) participated. The locations of births from this group spanned the entire U.S. Most births (95%) occurred in hospitals. 36.7% of births were cesarean deliveries. The median maternal age was 32. 19.5% of respondents felt neglected at some point during their birth experience; more than half in the postpartum phase of care only. 333 left decipherable comments. When women reported issues, they were almost always one of the following: clinical staff performance or competency, neglect, interpersonal communication issues, lack of respect for wishes, negative experience with breastfeeding services, peri-partum complications, or perceived discrimination. CONCLUSION: This is the first study on RMC from women who have delivered in the U.S. Overall, the women surveyed were treated with dignity during their birth experiences. However, this data suggests that care for women during their birth experiences can be more respectful and that women feel more neglected during the postpartum period. Strategies to improve quality of maternal health care in the U.S. should include attention to the provision of RMC.

Challenges in Providing OB Services in a Rural State: An Iowa Statewide Perinatal Care Program Study [36H

INTRODUCTION: Over half the hospitals providing maternity services to the state of Iowa are rural Level I centers. OB services at these hospitals are closing annually at an increasing rate (21 in the last 15 years with 8 in 2018). We determined the current obstetrical provider workforce and identified reasons for the closures of these rural OB services. METHODS: Current OB provider workforce data were obtained by contacting all Level I hospitals via email, SurveyMonkey®'’ or telephone. Reasons for rural hospital OB service closures were identified through a six question survey mailed to the chief executive officers of all 93 Level I Iowa hospitals. RESULTS: 46 rural level 1 hospitals provide OB services in Iowa. Only 35% have an obstetrician (OB) on staff, while 65% are staffed solely by Family Medicine (FM) physicians. Cesarean sections performed in these rural hospitals are done by FM only (5), general surgeons only (8) or a combination of FM and GS (13). Thus 56.5% of these rural hospitals have no OB on staff to perform surgical deliveries or respond to obstetrical hemorrhagic emergencies. Only 1/46 rural hospitals has an anesthesiologist on staff; 45/46 utilizes only certified registered nurse anesthetists. Primary reason for rural OB service closures was the inability to recruit or retain physicians willing or capable of providing obstetric care. Additional reasons included concerns regarding quality of obstetric care, medical-legal liability and financial concerns. CONCLUSION: Several issues must be addressed to avoid a decline in access to high quality maternal healthcare in rural Iowa.

A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes.

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

Gender inequity as a barrier to women’s access to skilled pregnancy care in rural Nigeria: a qualitative study

Maternal mortality has been an issue of global importance, with continued efforts by the international development community towards its reduction. The provision of high quality maternal healthcare has been identified as a key strategy in preventing maternal mortality. Gendered intrahousehold power structures, gendered dynamics of resource allocation and women's limited ability in decision-making can have a huge impact on maternal health-seeking behaviour and overall health status. Using a gender lens, this study explores the root causes of women's limited access to and utilisation of maternal healthcare services in rural areas of Edo State, Nigeria. This qualitative study involved the analysis of data collected from gender- and age-desegregated focus group discussions (FDGs) in 20 communities in Etsako East and Esan South East local government areas of Edo State, Nigeria. Focus group participants comprised women between the ages of 15-45 y who have been pregnant within the last 5 y and their male spouses and partners of varying ages. A total of 20 FGDs were conducted. Coded transcripts were reviewed and analysed using the gender framework as an analytical guide. Most responses indicated that women did not entirely have the power to make decisions regarding when to seek care during pregnancy. Women's experiences of access to quality care showed intersecting areas of gender and social economic status (SES) and how they impact on access to health. Many of the responses suggested high levels of economic marginalisation among women with women being financially dependent on their spouses and partners for pregnancy healthcare-related costs. Furthermore, a man's financial status determined the type of care his spouse or partner sought. Women identified a high workload as an issue during pregnancy and a barrier to accessing maternal healthcare services. The role of men within households was generally perceived as that of financial providers, therefore a husband's support was commonly constructed to solely mean financial support. This paper brings attention to the role of gender and SES in producing and sustaining limitations to women's access to quality care. Interventions geared towards supporting women's financial independence is an important step towards improving their access to skilled healthcare, more so are interventions that improve women's decision-making capacities.

Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance.

To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance. Retrospective cohort. Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011-2013). Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering. Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1-1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2-1.6; P < .0001) times the odds of those covered by private insurance. In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.

The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia.

The primary objective of this study was to estimate the costs and the incremental cost-effectiveness of maternal and newborn care associated with the Saving Mothers, Giving Life (SMGL) initiative-a comprehensive district-strengthening approach addressing the 3 delays associated with maternal mortality-in Uganda and Zambia. To assess effectiveness, we used a before-after design comparing facility outcome data from 2012 (before) and 2016 (after). To estimate costs, we used unit costs collected from comparison districts in 2016 coupled with data on health services utilization from 2012 in SMGL-supported districts to estimate the costs before the start of SMGL. We collected data from health facilities, ministerial health offices, and implementing partners for the year 2016 in 2 SMGL-supported districts in each country and in 3 comparison non-SMGL districts (2 in Zambia, 1 in Uganda). Incremental costs for maternal and newborn health care per SMGL-supported district in 2016 was estimated to be US$845,000 in Uganda and $760,000 in Zambia. The incremental cost per delivery was estimated to be $38 in Uganda and $95 in Zambia. For the districts included in this study, SMGL maternal and newborn health activities were associated with approximately 164 deaths averted in Uganda and 121 deaths averted in Zambia in 2016 compared to 2012. In Uganda, the cost per death averted was $10,311, or $177 per life-year gained. In Zambia, the cost per death averted was $12,514, or $206 per life-year gained. The SMGL approach can be very cost-effective, with the cost per life-year gained as a percentage of the gross domestic product (GDP) being 25.6% and 16.4% in Uganda and Zambia, respectively. In terms of affordability, the SMGL approach could be paid for by increasing health spending from 7.3% to 7.5% of GDP in Uganda and from 5.4% to 5.8% in Zambia.

Sociocultural Determinants of the Utilization of Maternal Health Care Services in the Tallensi District in the Upper East Region of Ghana

Introduction. The quality maternal health care that women receive during pregnancy and delivery is important for the health of both the mother and the baby. However, most pregnant women do not receive the minimum number of antenatal care (ANC) services (at least 4 times during pregnancy) as recommended by the WHO. This article sought to identify the types of maternal health care services (MHCS) received by women during pregnancy and delivery and after childbirth and women’s reasons for use and nonuse of MHCS. Methods. The study adopted the social survey design where 366 women were sampled using probability sampling technique. The data was collected through the use of questionnaire. Results. The study results revealed that some sociocultural factors such as age, religion, traditional belief system, education, and marital status influence women’s use of MHCS in the Talensi District. In addition, factors such as women’s National Health Insurance Scheme status, distance to health center, and attitude of health care professional determine their utilization of MHCS. To a large extent, these factors influence choice for traditional birth attendants over biomedically-based maternal health care services. Conclusion. The study recommended that there should be education for women on the need for them to utilize MHCS during pregnancy and delivery and after childbirth. Government should organize skill training for traditional birth attendants in the Talensi District.

Maternal mortality and the metempsychosis of user fees in Liberia: A mixed-methods analysis

ABSTRACT Liberia, a country recently afflicted by civil conflict and an epidemic of Ebola virus disease, has one of the highest rates of maternal mortality in the world. A biosocial analysis of this problem can help identify and address barriers impeding access to, and equitable delivery of, quality maternal health care. We analyzed 258 maternal death reviews reported to the National Public Health Institute of Liberia in 2017 and compared data with existing demographic and health statistics. Quantitative information on maternal death was contextualized with 44 in-depth interviews conducted among four groups of study participants. Forty percent of reported maternal deaths in 2017 occurred among women 25–34 years old; 36% were due to hemorrhage; 74% occurred at a health facility; and 29% occurred within 24 h after delivery. The number of deaths reported to the government of Liberia through maternal death reviews (n = 258) was substantially lower than the number expected based on the size of the population, crude birth rate, and the maternal mortality ratio. Qualitative findings highlighted inaccessible and unreliable transportation to health facilities; staff-related challenges, including staff attrition and burnout, inadequate training and clinical proficiency, staff absences, and neglect of patients; a lack of drugs and medical supplies; and the emergence of an inefficient and financially burdensome system of referrals by trained traditional midwives. Most notable was the finding that user fees for maternal health care in Liberia—eliminated in public facilities after the war—have resurfaced in the form of informal, out-of-pocket expenditures made by patients and their families.

Analysis of Maternal Near Miss at Tertiary Level Hospitals, Ahmedabad: A Valuable Indicator for Maternal Health Care.

Background:Complications during pregnancy and childbirth remain a leading cause of illness and death among women of reproductive age in India. In the recent years, the concept of the WHO maternal near miss (MNM) has been adopted by the tertiary level hospitals as it has an added advantage of offering a large number of cases for intervention and for the evaluation of the maternal healthcare being provided by the health-care system.Materials and Methods:In the present study, near miss criterion-based audit of MNM cases and maternal death (MD) cases, based on the WHO near miss approach and MD, was conducted from the record section of the four tertiary level hospitals. In the present study, the WHO MNM approach was adopted to assess the quality of maternal healthcare in tertiary level hospitals. Retrospective secondary data analysis from the records of record section and maternity wards pertaining to June 2015–May 2016, of the hospitals of Ahmedabad city, was conducted from January 2016 to November 2017.Results:The total number of live births of all the four hospitals under surveillance was 21,491. Severe maternal outcome cases were 326, of which 247 (75.8%) were of MNM cases and 79 (24.2%) were of MD. MNM mortality ratio was found to be 3.13:1. Eclampsia (29.45%) followed by preeclampsia (25.46%) and severe postpartum hemorrhage (22.39%) were the leading causes of potentially life-threatening conditions.Conclusion:Above finding suggests the development of a comprehensive framework for the assessment of MNM and further improvement in the quality of maternal health care.

Evaluating concordance between government administrative data and externally collected data among high-volume government health facilities in Uttar Pradesh, India

ABSTRACTBackground: Globally, opportunities to validate government reports through external audits are rare, notably in India. A cross-sectional maternal health study in Uttar Pradesh, India’s most populous state, compares government administrative data and externally collected data on maternal health service indicators.Objectives: Our study aims to determine the level of concordance between government-reported health facility data compared to externally collected health facility data on the same maternal healthcare quality indicators. Second, our study aims to explore whether the level of agreement between government administrative data versus the externally collected data differs by level of facility or by type of maternal health service.Methods: Facility assessment surveys were administered to key health staff by government-hired enumerators from January 2017 to March 2017 at nearly 750 government health facilities across UP. The same survey was re-conducted by external data collectors from August 2017 to October 2017 at 40 of the same facilities. We conduct comparative analyses of the two datasets for agreement among the same measures of maternal healthcare quality.Results: The findings indicate concordance between most indicators across government administrative data and externally collected health facility data. However, when stratified by facility-level or service type, results suggest significant over-reporting in the government administrative data on indicators that are incentivized. This finding is consistent across all levels of facilities; however, the most significant disparities appear at higher-level facilities, namely District Hospitals.Conclusion: This study has a number of important programmatic and policy implications. Government administrative health data have the potential to be highly critical in informing large-scale quality improvements in maternal healthcare quality, but its credibility must be readily verifiable and accessible to politicians, researchers, funders, and most importantly, the public, to improve the overall health, patient experience, and well-being of women and newborns.

An account for barriers and strategies in fulfilling women\u2019s right to quality maternal health care: a qualitative study from rural Tanzania

BackgroundTanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right. Nevertheless, the quality of maternal health care is disproportionately low. The current study sets to understand maternal health services’ delivery from the perspective of rural health workers’, and to understand barriers for and better strategies for realization of the right to quality maternal health care.MethodsSemi-structured in-depth interviews were conducted, involving 11 health workers mainly; medical attendants, enrolled nurses and Assistant Medical Officers from primary health facilities in rural Tanzania. Structured observation complemented data from interviews. Interview data were analyzed using thematic analysis guided by the conceptual framework of the right to health.ResultsThree themes emerged that reflected health workers’ opinion towards the quality of health care services; “It’s hard to respect women’s preferences”, “Striving to fulfill women’s needs with limited resources”, and “Trying to facilitate women’s access to services at the face of transport and cost barriers”.ConclusionHealth system has left health workers as frustrated right holders, as well as dis-empowered duty bearers. This was due to the unavailability of adequate material and human resources, lack of motivation and lack of supervision, which are essential for provision of quality maternal health care services. Pregnant women, users of health services, appeared to be also left as frustrated right holders, who incurred out-of-pocket costs to pay for services, which were meant to be provided free.

Obstetric fistula policy in Nigeria: a critical discourse analysis

BackgroundIn 2012, Nigeria’s Federal Ministry of Health published its National Strategic Framework for the Elimination of Obstetric Fistula (NSFEOF), 2011–2015. The framework has since lapsed and there is no tangible evidence that the goal of eliminating obstetric fistula was met. To further inform future policy directions on obstetric fistula in Nigeria, this paper explores how the NSFEOF conceptualized obstetric fistula and its related issues, including child marriage and early childbearing.MethodsA critical discourse analysis of the policy was performed. We examined four policies in addition to the strategic framework: the Nigerian constitution; the Marriage Act; the Matrimonial Causes Act; and the National Reproductive Health Policy. We used the three phases of critical discourse analysis: textual analysis, analysis of discourse practice, and analysis of discursive events as instances of sociocultural practice.ResultsThe analysis demonstrates that, despite its title, the policy document focuses on reduction rather than elimination of obstetric fistula. The overall orientation of the policy is downstream, with minimal focus on prevention. The policy language suggests victim blaming. Furthermore, the extent to which subnational stakeholders in government and civil society were engaged in decision-making process for developing this policy is ambiguous. Although the policy is ostensibly based on principles of social justice and equity, several rhetorical positions suggest that the Nigerian constitutional environment and justice systems make no real provisions to protect the reproductive rights of girls in accordance with the United Nations’ “2030 Agenda for Sustainable Development.”ConclusionThis analysis establishes that the Nigerian constitution, justice environment and the obstetric fistula policy itself do not demonstrate clear commitment to eradicating obstetric fistula. Specifically, a clear commitment to eradicating obstetric fistula would see the constitution and Marriage Act of Nigeria specify an age of consent that is consistent with the agenda to prevent obstetric fistula. Additionally, a policy to end obstetric fistulas in Nigeria must purposefully address the factors creating barrier to women’s access to quality maternal healthcare services. Future policies and programs to eliminate obstetric fistulas should include perspectives of nurses, midwives, researchers and, women’s interest groups.

Incidence and determinants of severe maternal outcome in Jimma University teaching hospital, south-West Ethiopia: a prospective cross-sectional study

BackgroundInvestigating cases of severe maternal morbidity (SMM) and severe maternal outcome (SMO) and the quality of maternal health care using near-miss approach has become popular over recent years. The aim of this study was to determine facility based incidence and the determinants of severe maternal outcome (SMO) using this approach.MethodsProspective cross-sectional study among all mothers who presented to study facility while pregnant, during child birth and/or within 42 days after termination of pregnancy seeking care and found to have SMM and SMO during the study period was carried out.ResultsThere were total of 2737 live births, 202 SMM and 162 SMO (138 maternal near-misses (MNM) and 24 maternal deaths (MD)) cases. The SMO ratio was 59.2 per 1000 live births and the MNM mortality ratio, mortality index (MI) and maternal mortality ratio (MMR) were: 5.8:1, 14.8% and 876.9 per 100,000 live births respectively. Close to three-fourth of all women with SMO had evidence of organ dysfunction on arrival or within 12 h of hospitalization. The commonest underlying causes for SMO were uterine rupture 27%, followed by hypertensive disorders 24% and obstetric hemorrhage 24%. The highest case fatality rate was found to be associated with eclampsia 28%. Maternal age, residential area, educational status and occupation were associated with SMO (P < 0.0001). On binary multivariable logistic regression the occurrence of any delay, intrapartal detection of complication, the mode of delivery and duration of hospitalization had statically significant association with SMO (p < 0.05). Optimal number of antenatal care (ANC) visits and delivery by emergency cesarean section (C/S) were found to be protective of SMO.ConclusionThe occurance SMO in the facility thus in the population served was high. Most of these factors associated with SMO are modifiable; some amenable to social change and the others are within the control of the health system. Thus the finding of this research calls for planning for such changes which can enhance timely and proper detection and management of pregnancy related complications.

English

Maternal satisfaction is a means of evaluating quality of maternal health care given in health facilities. The objective was to assess the level of maternal satisfaction and associated factors at Asrade Zewude Memorial Primary Hospital. Cross-sectional study was conducted on 420 clients by systematic sampling method from February 8, 2017 to September 25, 2017. Structured questionnaire that was prepared by Ethiopian Federal Ministry of Health was used. Pre-testing was done prior to the actual data collection process on a sample of 20 respondents and modified accordingly. The study was approved by Asrade Zewude Memorial Primary Hospital Senior Management Committee. The collected data were checked for completeness and consistency before being coded, entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 16. Logistic regression was used to assess the presence of association between dependent and independent variables using SPSS at 95% confidence interval (CI) and 5% margin of error. The study revealed that level of satisfaction among delivering mothers was 88%. Educational level (AOR=2.15, 95% CI=[1.02-3.71]), access to ambulance service (AOR=3.15, 95% CI=[1.02-3.78]), respectful delivery service (AOR=6.85, 95% CI=[4.35-6.95]), welcoming hospital environment (AOR=3.09, 95%CI=[2.30-2.69]), proper labor pain management (AOR=4.51, 95% CI=[3.12-5.01]) and listening to their questions (AOR=3.95, 95% CI=[2.35-4.36]) were independent predictors for maternal satisfaction. Even though most of the participants were satisfied, they still had unmet needs and expectations in the delivery service provider. The identified main determinants were level of education, access to ambulance service, welcoming hospital environment, proper pain management and listening to their questions. Therefore, there is need to improve the care given to maternity and appropriate strategy should be designed to address the unmet needs of mothers delivered in the hospital. Key words: Maternal satisfaction, associated factors, delivery, West Gojjam Zone, Ethiopia.

Satisfaction and Associated Factors among Mothers Delivered at Asrade Zewude Memorial Primary Hospital, Bure, West Gojjam, Amhara, Ethiopia: A Cross Sectional Study

Introduction: Maternal satisfaction is a means of evaluating quality of maternal health care given in health facilities. The objective was to assess the level of maternal Satisfaction and associated factors at Asrade Zewude Memorial Primary Hospital. Method: Cross-sectional study was conducted on 420 clients by systematic sampling method from February 8, 2017 to September 25, 2017. Structured questionnaire that was prepared by Ethiopian Federal Ministry of Health was used. Pre-testing was done prior to the actual data collection process on a sample of 20 respondents and modified accordingly. The study was approved by Asrade Zewude Memorial Primary Hospital Senior Management Committee. The collected data were checked for completeness and consistency before being coded, entered and analyzed using SPSS version 16. Logistic regression was used to assess the presence of association between dependent and independent variables using SPSS at 95% CI and 5% margin of error. Result: The study revealed that level of satisfaction among delivering mothers was 88%. Educational level (AOR = 2.15, 95% CI = [1.02-3.71], access to ambulance service (AOR=3.15, 95% CI=[1.02-3.78], respect full delivery service (AOR=6.85, 95%CI=[4.35-6.95], welcoming hospital environment (AOR=3.09, 95% CI = [2.30-2.69], proper labor pain management (AOR=4.51, (95% CI=(3.12-5.01) and listening to their questions [AOR=3.95, 95%CI [2.35-4.36] were independent predictors for maternal satisfaction.Conclusion and Recommendation: Even though most of the participants were satisfied, they still had unmet needs and expectations in the delivery service provider. The identified main determinants were level of education, access to ambulance service, welcoming hospital environment, proper pain management and listening to their questions. Therefore, there is a need to improve the care given to maternity and appropriate strategy should be designed to address the unmet needs of mothers delivered in the hospital.

Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P < 0.001), respectively]. In Lagos, the private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P < 0.001)]. Results indicate that the technical quality of private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan

ObjectivesThe maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has...