Emergency Obstetric Care Research Articles

Inequalities in geographical access to emergency obstetric and newborn care.

Inequalities in geographical access to emergency obstetric and newborn care.

Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study

BackgroundHigh rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.Materials and methodsThis was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.ResultsOf the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001).ConclusionsThe study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

Temporal trends analysis of emergency obstetric and newborn care availability and readiness index of healthcare facilities in Burkina Faso

BackgroundEnsuring healthcare services are equipped to offer; emergency obstetric and newborn care (EmONC) is crucial for improving the quality of maternal and newborn care in low- and middle-income countries. We assessed the temporal trends of the availability and readiness of the healthcare system to provide EmONC in Burkina Faso.MethodsWe analyzed the data from three national health facilities surveys, conducted in 2014, 2016 and 2018, using the WHO Service Availability and Readiness Assessment tool. We performed multivariable linear regression models to examine the trends.ResultsBetween 2014 and 2018, the percentage of healthcare facilities providing delivery service and blood transfusion significantly decreased (88.1% to 75.4% for delivery services and 67.3% to 50.2% for blood transfusion, p < 0.001). The readiness index of healthcare facilities to provide basic EmONC showed a negative trend according to public healthcare, primary healthcare, and Centre-Nord, Centre-sud, Hauts-Bassins, Nord, Plateau Central and Sud-ouest health regions.ConclusionsWe observed multiple indications of a decline in the readiness of healthcare services to offer EmONC in Burkina Faso from 2014 to 2018. As such, bolstering the capabilities of health facilities to deliver EmONC is essential for hastening the decrease in maternal mortality.

Optimising availability and geographical accessibility to emergency obstetric care within a sub-national social health insurance scheme in Nigeria.

Health insurance is a key instrument for a health system on its path to achieving universal health coverage (UHC) and protects individuals from catastrophic health expenditures, especially in health emergencies. However, there are other dimensions to care access beyond financial accessibility. In this study, we assess the geographical accessibility of comprehensive emergency obstetric care (CEmOC) within the Lagos State Health Insurance Scheme. We geocoded functional public and private CEmOC facilities, established facilities registered on the insurance panel as of December 2022, and assembled population distribution for women of childbearing age. We used Google Maps Platform's internal directions application programming interface to obtain driving times to facilities. State- and local government area (LGA)-level median travel time (MTT) and a number of CEmOC facilities reachable within 30 min were obtained for peak travel hours. Across Lagos State, MTT to the nearest public CEmOC was 25 min, reduced to 17 min with private facilities added to the insurance panel. MTT to the nearest public facility in LGAs ranged from 9 min (Lagos Island) to 51 min (Ojo) (median = 25 min). With private facilities added, MTT ranged from 5 min (Agege and Ajeromi-Ifelodun) to 36 min (Ibeju-Lekki) (median = 13 min). On average, no public CEmOC facility was reachable within 30 min of driving for women living in 6 of 20 LGAs. With private facilities included in the scheme, reachable facilities within 30 min remained zero in one LGA (Ibeju-Lekki). Our innovative approach offers policy-relevant evidence to optimise insurance coverage, support efforts in advancing UHC, ensure coverage for CEmOC, and improve health system performance.

Awareness on obstetric fistula and associated factors among women health development army, in the South Gondar zone, Amhara region, Ethiopia: A cross sectional study.

Obstetric fistula is a severe birth injury that profoundly impacts women's health, social well-being, economic stability, and psychological state. While it can be prevented with timely emergency obstetric care, a significant barrier in many developing regions, including the study area, is the lack of awareness among women. This study aimed to evaluate the level of awareness about obstetric fistula and the factors influencing it among the Women Health Development Army in the South Gondar zone of the Amhara region, Ethiopia, in 2020. A community-based cross-sectional study was done from July to December 2020, involving 633 women. Participants were selected using a multistage stratified sampling method. Data were collected using a pretested, interviewer-administered structured questionnaire. Data entry was performed using EpiData version 3.1, and analysis was conducted with SPSS version 23.0. Multivariable logistic regression models were employed to identify influencing factors, with a p < 0.05 considered statistically significant. This study found that 55.3% (95% CI, 51.6%-57.2%) of study participants had a good awareness of obstetrics fistula. Significantly associated factors include; no history of ANC (AOR = 0.52: 95% CI, 0.31, 0.86), living >30 min away from a health facility (AOR = 0.43: 95% CI, 0.23, 0.81), no history of abortion (AOR = 0.37: 95% CI, 0.19, 0.72), Injectable and implant users (AOR = 3.60: 95% CI, 1.98, 6.53), having four to six pregnancy (AOR = 1.87: 95% CI, 1.22, 2.87) and lack of communication material in the house (AOR = 0.19: 95% CI, 0.10, 0.37). This study found that 55.3% of women have a good awareness of obstetrics fistula. ANC follow-up history, abortion history, type of family planning, type of communication, number of pregnancies, availability of health facility, and distance of health facility were significantly associated with awareness of obstetric fistula. Hence, local and national efforts should be made to enhance access to information at home and basic maternal health services including antenatal care.

Health Workers Perception On The Key Drivers Of Maternal Mortality

Maternal mortality remains a critical public health issue, particularly in low- and middle-income countries. Health workers play a pivotal role in addressing this challenge, offering insights into the key drivers of maternal deaths. This study explores the perceptions of healthcare workers on the systemic, socioeconomic, cultural, and healthcare-related factors contributing to maternal mortality. Health workers identify systemic barriers, including understaffing, lack of resources, inadequate training, and inefficient referral systems, as significant contributors. Cultural and religious influences also impact maternal care, with societal norms often discouraging women from seeking professional healthcare. Additionally, socioeconomic factors like poverty, illiteracy, and unemployment further exacerbate the problem, limiting access to quality maternal care. Health workers’ insights are crucial in designing effective interventions, emphasizing the need for improved training, better healthcare infrastructure, and community engagement to address cultural barriers. This study highlights the importance of empowering healthcare professionals to deliver high-quality maternal care, suggesting that systemic reforms, including enhanced emergency obstetric care and better access to medical supplies, are essential for reducing maternal mortality rates. Understanding these perspectives can inform policies and programs aimed at improving maternal health outcomes, particularly in resource-limited settings

Standards-based audit to improve quality of maternal and newborn care-A stepped-wedge cluster randomised trial in Malawi.

Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. ISRCTN registration number: 59931298.

Key Determinants of the Comprehensive Neonatal Emergency Obstetric Services Policy

Background: Effective implementation of comprehensive emergency obstetric and neonatal care programs is vital for improving maternal and neonatal health outcomes. Specific Background: At RSU Al-Islam H.M Mawardi, various factors—including communication, resources, disposition, and bureaucratic structure—affect program implementation. Knowledge Gap: Previous research has often neglected how these factors interact and their influence on healthcare policy implementation. Aims: This study evaluates the relationship between these factors and the implementation of the emergency obstetric and neonatal care program using a quantitative survey approach. Results: Analyzing data from 54 respondents revealed significant correlations between effective communication, resource allocation, and successful policy implementation (p &lt; 0.05), with the questionnaire demonstrating high reliability (Cronbach's Alpha = 0.969). Novelty: This research contributes empirical evidence on the specific elements influencing healthcare policy implementation locally. Implications: Strengthening communication and resource management is essential for enhancing policy implementation effectiveness, ultimately improving community health outcomes. Highlights : Factor Influence: Effective communication and resource allocation significantly impact program success. Research Contribution: The study provides empirical evidence on factors affecting healthcare policy implementation locally. Health Outcomes: Strengthening implementation strategies is crucial for improving maternal and neonatal health outcomes. Keywords: obstetric care, neonatal care, policy implementation, communication, healthcare resources

Determinants to utilization of emergency obstetric care services among perinatal clients seeking care at Kajiado County Referral Hospital, Kajiado County, Kenya

Background: Worldwide, one or more potentially fatal perinatal obstetric complications affect nearly 15% of all pregnant women. There has been little research on the provision of emergency obstetric care (EmOC) services in Kenya. This study aimed to assess the determinants of EmOC services among perinatal clients seeking care at Kajiado County Referral Hospital, Kajiado County, Kenya. Methods: An analytical cross-sectional study design was embraced in this study while both systematic and simple random sampling were used to recruit study respondents for this research. Associations between the utilization of emergency obstetric care services and associated determinants were established using a Chi-square test and binary logistic regression where a p value of 0.05 or lower was considered significant. Results: The utilization of EmOC services from this research was at 74%. Study respondents aged between 18-25 years (OR=9.4, 95% CI=0.04-0.31), being knowledgeable about EmOC services (OR=3, 95% CI=0.13-9.75), and being knowledgeable about obstetric danger signs (OR=6, 95% CI=0.06-0.45), increased the odds of utilizing EmOC services while earning less than 10000 Kshs (OR=4.3, 95% CI=0.45-4.77), reduced the odds of utilizing EmOC services. Conclusions: The utilization of EmOC services from this research was at 74%. Study respondents aged between 18-25 years, being knowledgeable about EMOC services and being knowledgeable about obstetric danger signs increased the odds of utilizing emergency obstetric care services while earning less than 10000 Kshs reduced the odds of utilizing emergency obstetric care services.

Postpartum Hemorrhage in Humanitarian Settings: Implementation Insights from Using Heat-Stable Carbetocin and Tranexamic Acid

Background and Objective Maternal mortality, largely due to postpartum hemorrhage (PPH), remains high in resource-limited and crisis-affected settings, where heat-stable carbetocin (HSC) and tranexamic acid (TXA) offer promise for PPH prevention and treatment but lack evidence. This study, implemented in basic maternity facilities within humanitarian settings, explores healthcare providers’ perspectives on an HSC and TXA-inclusive PPH intervention package and related operational challenges and facilitators. Methods Based on semi-structured interview guides and using thematic analysis, this qualitative research, through 13 focus group discussions and individual interviews, investigated the perspectives of 64 healthcare staff (mostly midwives) from eight basic emergency obstetric care facilities in South Sudanese and Ugandan settings hosting large numbers of forcibly displaced populations. The PPH intervention package comprised refresher training, an online provider community, PPH readiness kits, alarm bells, and displayed algorithms. Results Findings from both countries converged, highlighting providers’ positive views on HSC and TXA. HSC effectiveness in preventing bleeding was acknowledged, bolstering staff’s confidence in its use. TXA was perceived as effective although providers reported having less experience with it due to the limited number of PPH cases. Enabling factors included the ease of administration, practical training, endorsement by national and local authorities, and the absence of a cold chain requirement. Appreciation was given to the WhatsApp community of practice as it facilitated knowledge exchange, quality improvement projects that enhanced PPH diagnosis, and innovative tools like wall clocks to record the timing of clinical actions and bells to call for assistance. Challenges included confusion between new and existing medications and record systems that inadequately capture HSC, TXA, and other PPH indicators. Conclusion and Global Health Implications HSC and TXA integrated into a PPH intervention package were overall positively valued by providers in humanitarian settings. Continued education and support are crucial. Addressing challenges like medication confusion underscores the need for ongoing education and clear guidelines for the use of HSC, TXA, oxytocin, and other drugs for PPH prevention and treatment. Our findings stress the importance of a comprehensive strategy to overcome health system barriers in PPH management, potentially improving maternal health outcomes in resource-limited and fragile contexts, with broader global implications.

Evaluating the implementation fidelity of basic emergency obstetrics and neonatal care services in Beyeda District, Northwest Ethiopia: a case study evaluation.

Worldwide, nearly 830 women die from complications of pregnancy and childbirth daily. Ninety-nine per cent of these maternal deaths take place in low and middle-income countries. Basic Emergency Obstetric Care (BEmONC) is one method of reducing maternal mortality related to pregnancy and childbirth complications. However, the status of its implementation fidelity has not been investigated. Therefore, this study sought to evaluate the implementation fidelity of BEmONC services in Beyeda District, Northwest Ethiopia. A single case study design with mixed method was employed from June 01 to July 30, 2022. 415 client exit interviews, 14 key informants' interviews and 423 retrospective document reviews were conducted. Adherence, participant responsiveness and quality of delivery dimensions from Carroll's conceptual framework, with a total of 21 indicators were used in this evaluation. The overall implementation fidelity status of BEmONC service was judged based on the pre-seated judgmental criteria as; low, medium, and high fidelity. The overall degree of implementation fidelity of the BEmONC services was 74.5%. Moreover, the implementation fidelity status of adherence, quality of delivery, and participant responsiveness dimensions were 74.7%, 77.2%, and 71.5% respectively. Uterotonic drugs were not administered as per the recommended protocol. Participants' engagement towards the neonatal resuscitation service delivery was inadequate. Likewise, healthcare providers' respect for the clients was not sufficient. Furthermore, women aged >30 years, being government employed and ANC visits four and above were variables positively associated with the quality of delivery of BEmONC services. The overall implementation fidelity of the BEmONC services was judged as implemented in medium fidelity. Moreover, the adherence, participant responsiveness and quality of delivery dimensions were found to be implemented in medium fidelity. Therefore, public health sectors at all levels should strive to enhance the implementation fidelity of BEmONC services. Moreover, healthcare providers should adhere to the BEmONC implementation protocol guideline during service delivery. Healthcare managers should facilitate a continuous awareness creation for mothers regarding the merit of neonatal resuscitation for neonatal complications. Furthermore, healthcare providers should give due respect to mothers while delivering the services.

Experiences, barriers and perspectives of midwifery educators, mentors and students implementing the updated emergency obstetric and newborn care-enhanced pre-service midwifery curriculum in Kenya: a nested qualitative study

IntroductionTo achieve quality midwifery education, understanding the experiences of midwifery educators and students in implementing a competency-based pre-service curriculum is critical. This study explored the experiences of and barriers to implementing a pre-service curriculum updated with emergency obstetric and newborn care (EmONC) skills by midwifery educators, students and mentors in Kenya.MethodsThis was a nested qualitative study within the cluster randomised controlled trial investigating the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in 20 colleges in Kenya. Following the pre-service midwifery curriculum EmONC update, capacity strengthening of educators through training (in both study arms) and additional mentoring of intervention-arm educators was undertaken. Focus group discussions were used to explore the experiences of and barriers to implementing the EmONC-enhanced curriculum by 20 educators and eight mentors. Debrief/feedback sessions with 6–9 students from each of the 20 colleges were conducted and field notes were taken. Data were analysed thematically using Braun and Clarke’s six step criteria.ResultsThemes identified related to experiences were: (i) relevancy of updated EmONC-enhanced curriculum to improve practice, (ii) training and mentoring valued as continuous professional development opportunities for midwifery educators, (iii) effective teaching and learning strategies acquired – peer teaching (teacher-teacher and student-student), simulation/scenario teaching and effective feedback techniques for effective learning and, (iv) effective collaborations between school/academic institution and hospital/clinical staff promoted effective training/learning. Barriers identified were (i) midwifery faculty shortage and heavy workload vs. high student population, (ii) infrastructure gaps in simulation teaching – inadequate space for simulation and lack of equipment inventory audits for replenishment (iii) inadequate clinical support for students due to inadequate clinical sites for experience, ineffective supervision and mentoring support, lack/shortage of clinical mentors and untrained hospital/clinical staff in EmONC and (iv) limited resources to support effective learning.ConclusionFindings reveal an overwhelmed midwifery faculty and an urgent demand for students support in clinical settings to acquire EmONC competencies for enhanced practice. For quality midwifery education, adequate resources and regulatory/policy directives are needed in midwifery faculty staffing and development. A continuous professional development specific for educators is needed for effective student teaching and learning of a competency-based pre-service curriculum.

Strategies to Sustain Interprofessional Collaboration in Emergency Obstetric and Neonatal Care in Rwanda: Perspectives of Healthcare Professionals and Hospital Managers

Strategies to Sustain Interprofessional Collaboration in Emergency Obstetric and Neonatal Care in Rwanda: Perspectives of Healthcare Professionals and Hospital Managers

A mixed-method analysis of provider adherence to integrated antenatal care guideline in BEmONC and Non BEmONC primary health center: An Indonesian case.

Provider adherence to the integrated antenatal care (ANC) procedure is an important indicator of high-quality ANC. The procedure is intended to avoid missed opportunities to detect the risk of abnormalities in pregnancy. This study aims to assess the provider's adherence to integrated ANC in Basic Emergency Obstetric and Newborn Care (BEmONC) and non-BEmONC Primary Health Center (PHC). This study employed an explanatory sequential mixed-method design. The quantitative phase reviewed 149 medical records of pregnant women in the four PHCs in Semarang from January until February 2020. The findings were used to describe the provider's adherence to the integrated ANC and lead to the contributing factors which should be explored in the qualitative phase. The study involved four in-depth interviews with midwife coordinators in four PHCs. The Mann-Whitney and Chi-square test was employed to analyse the quantitative data, while the thematic analysis was undertaken on the qualitative data. The provider's adherence to the guideline did not differ between BEmONC and non-BEmONC PHC. The general physical examination of the patients (18.81%) and dentist visits (84.6%) were not done in either BEmONC or non-BEmONC PHC. Incomplete laboratory tests were haemoglobin (28.2%) and urine protein (38.9%). The barriers to adherence to the integrated ANC guideline were related to an imbalance of resources, role and responsibility issues among doctors and midwives, and policy issues. This study found low BEmONC nor non-BEmONC PHC adherence to the integrated ANC guideline. A Periodic evaluation of the implementation of integrated ANC to ensure its high-quality implementation in Indonesia is needed.

The quality of routine data for measuring facility-based maternal mortality in public and private health facilities in Kampala City, Uganda

BackgroundRoutine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda.MethodsWe reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership.ResultsWe included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021.ConclusionsRoutine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards.

An Investigation into how Primary Care Nurses Practices affect clinical competence in Emergency Maternal Obstetric and Newborn Care skills in Nakuru County

To reduce the risks of maternal morbidity, mortality and newborn death worldwide, the use of high-quality emergency obstetric and new born care (EMONC) was proposed to ensure women and their babies receive high-quality care. The government of Kenya with non-profit health programs have jointly invested resources with the aim of achieving SDG’s goal of zero rating maternal and neonatal death cases in the country. Despite these efforts, maternal and neonatal death cases have not reduced significantly. Most of the contributing factors to the deaths occur in the lower levels of the health care delivery system. Majority of the health care providers at these levels are the primary care nurses. It is on this background that the study sought to investigate how primary care nurses practice affect clinical competency in emergency maternal, obstetric, and new born care skills in Nakuru county. Madeleine Leininger’s Transcultural Theory of Nursing anchored the study. It deployed correlational cross-sectional survey design, targeting midwives and nurses in 184 KEPH level II and III facilities in all the 11 sub counties in Nakuru County. The study used stratified sampling technique to sample 126 health facilities distributed in every Sub County. A sample size of 196 primary health care nurses from the sampled facilities were involved. Key informant interview and questionnaires were used to collect both qualitative and quantitative data. To analyze data, SPSS version 26 was used to generate inferential and descriptive statistics, correlation analysis was carried using multiple regression model to ascertain the relationship between dependent and independent variables. Results found that Maternal and newborn care practice was found to have a significant positive relationship with competence in EmONC skills. (P&lt;0.05). This was achieved through clean and safe delivery, thermal care and cord care which were carried out in KEPH level II and III facilities. It was concluded that maternal and neonatal care practices had positive significant relationship with competent EmONC. The study advised that the practice of fundamental maternal and newborn care has to be improved. The primary care nurses should be culturally competent in engaging the community members. Through community-based health care efforts, mothers need to be sensitized about delayed bathing, umbilical cord care, feeding, and thermal care for newborns. Further, County Government of Nakuru should support programs that enables primary health care nurses pursue maternal and neonatal care courses. County Government of Nakuru should ensure ambulance services are easily accessible to all, equipment availability at all time, consistent supply of all drugs needed and the need to create awareness among women, family and community members on newborn and early neonatal care

Evaluation of the implementation fidelity of comprehensive emergency obstetric and newborn care at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a mixed-method evaluation

BackgroundApproximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia.MethodA case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll’s conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria.ResultsOverall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively.Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers’ respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services.ConclusionsThe overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines.

Experiences of community reintegration after obstetric fistula repair at Jean Paul 2 hospital, Conakry, Guinea.

The study explored women's experiences of their community reintegration process after surgical repair of obstetric fistula at Jean Paul 2 Hospital in Conakry, Guinea. The study examined how lived experiences of the disease impacted on the community reintegration of treated women. Using a qualitative research methodology, ten women participated after giving informed consent. Semi- structured interviews, lasting an average of 30 to 60 minutes were guided by an interview guide. The main themes covered were experiences with the disease, perceived social support and reintegration into the community. According to the participants, delays in obstetric care were the main cause of obstetric fistula. Socio- economic, cultural and medical factors such as early marriage, lack of education and poverty contributed to these delays. Even after surgical repair, women continued to endure the physical and psychosocial consequences of the disease, exposing them to stigma, discrimination and even rejection within the community. Study participants also reported a lack of social support. The little support perceived by these women concerned food and medical needs. This made the women dependent on their families. Reintegration into the community also proved difficult due to the persistent silence and stigma surrounding their situation. The study results highlight the complexity of the challenges faced by women with obstetric fistula in their journey towards integration. Effective management of obstetric fistula requires a holistic approach victims, their communities, health professionals and decision-makers in solving this problem. So, to improve women's reintegration after treatment for obstetric fistula, it is vital to raise awareness of the causes and consequences of the disease among the women concerned and their families, and to provide rapid access to emergency obstetric care, reinforce social support and set up economic empowerment programs.

Readiness to provide comprehensive emergency obstetric and neonatal care: a cross-sectional study in 30 health facilities in Tanzania

BackgroundDespite the global progress in bringing health services closer to the population, mothers and their newborns still receive substandard care leading to morbidity and mortality. Health facilities’ capacity to deliver the service is a prerequisite for quality health care. This study aimed to assess health facilities’ readiness to provide comprehensive emergency obstetric and newborn care (CEmONC), comprising of blood transfusion, caesarean section and basic services, and hence to inform improvement in the quality of care interventions in Tanzania.MethodsA cross-sectional assessment of 30 CEmONC health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out between December 2020 and January 2021. We adapted the World Health Organization’s Service Availability and Readiness Assessment tool to assess amenities, equipment, trained staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher’s exact test; for readiness scores, differences were tested by a linear mixed model analysis, taking into account dependencies within the regions. We used p < 0.05 as our level of significance.ResultsThe overall readiness to provide CEmONC was 69.0% and significantly higher for regional hospitals followed by district hospitals. Average readiness was 78.9% for basic amenities, 76.7% for medical equipment, 76.0% for diagnosis and treatment commodities, 63.6% for staffing and 50.0% for guidelines. There was a variation in the availability of items at the individual health facility level and across levels of facilities. We found a significant difference in the availability of basic amenities, equipment, staffing, and guidelines between regional, and district hospitals and health centres (p = 0.05). Regional hospitals had significantly higher scores of medical equipment than district hospitals and health centers (p = 0.02). There was no significant difference in the availability of commodities for diagnosis and treatment between different facility levels.ConclusionFacilities’ readiness was inadequate and varied across different levels of the facility. There is room to improve the facilities’ readiness to deliver quality maternal and newborn care. The responsible authorities should take immediate actions to address the observed deficiencies while carefully choosing the most effective and feasible interventions and monitoring progress in readiness.

Factors Determining The Delay in Access to Appropriate Emergency Obstetric Care During The Lockdown Period of The COVID-19 Pandemic: An Observational Study at A Tertiary Referral Centre

Background: The WHO declared the COVID-19 pandemic as a public health emergency of inter-national concern following which many governments around the world adopted the most radical social distancing procedure, referred to as “lockdown”, to prevent the spread of the virus. As a result, unsupervised pregnancies and the absence of routine antenatal visits lead to dreaded maternal and fetal complications. This study determines the barriers to accessing emergency care by pregnant women during the lockdown period.Subjects and Method: This prospective study was conducted during the lockdown period in Delhi from 1 May 2021 to 31 May 2021. A total of 666 pregnant and postpartum patients admitted from casualty during this period were included. The variable of the study was various factors causing delays of more than 4 hours in accessing emergency care services by these patients after the onset of symptoms was assessed. This study used the conceptual model of Three Delays. The data was collected as per predesigned proforma. The demography, Obstetric profile, and various levels of delays were noted. The data was analyzed by frequencies and percentages using SPSS version 21.Results: Among 666 enrolled participants, about 55.7% were multigravida and 48.04% belonged to the upper-lower class. Nearly 43% of patients were illiterate. Antenatal delay of &gt; 4 hours was observed in 590 patients (88.6%). In Level 1 delay, the main reasons for the delay were unawareness of danger signs (45.8%) and lockdown (30.93%). The major reason for the Level 2 delay was care declined at the previous center (33.93%). Reasons for the Level 3 delay were due to either unavailability of beds or overcrowding after reaching the facility.Conclusion: The unawareness of danger signs was the most common cause of delay. Hence, effective communication and counseling during the antenatal period have to be improved upon.