The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal: A Cross-sectional Survey

Abstract Background Access to and delivery of comprehensive emergency obstetric and neonatal care (CEmONC) services are often weak in low and middle-income countries affecting maternal and infant health outcomes. There are no studies on resources for maternal healthcare in the Northern region of Ghana. This knowledge is vital for health service planning and mobilising funding to address identified gaps. We investigated the available resources for managing CEmONC and referral services in the region. Methods This study involved a cross-sectional survey of maternity facilities in ten hospitals in the Northern region of Ghana, serving a population of 2,479,461, including 582,897 women aged 15–49. Public and faith-based hospitals were included in the study. We used the Service Provision Assessment tool to gather data for this study between October and December 2019. Given the small sample size, we used descriptive statistics to summarise the data using SPSS version 25 and Excel 2016. Results A total of 22,271 ANC visits from women to these hospitals occurred in the past 3 months preceding the study; however, 6072 birth events (cases) occurred within the same period. All the hospitals had less than one general medical doctor per 10,000 population (range 0.02–0.30). The number of midwives per 10,000 population ranged from 0.00 (facility H and J) to 1.87 (facility E), and none of the hospitals had a university-trained nurse designated for maternity care. Only one hospital had complete equipment for emergency obstetric and newborn care, while four others had adequate emergency obstetric care equipment. The number of maternity and delivery beds per 10,000 population was low, ranging from 0.40 to 2.13. Conclusions The management of emergency obstetric care and referrals are likely to be affected by the limited human resources and equipment in hospitals in Northern Ghana. Financial and non-financial incentives to entice midwives, obstetricians and medical officers to the Northern region should be implemented. Resources should be mobilised to improve the availability of essential equipment such as vacuum extractors and reliable ambulances to enhance referral services. Considerable health system strengthening efforts are required to achieve the required standards.

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A screening questionnaire for occupational and hobby exposures during pregnancy

Occupational Medicine ◽

10.1093/occmed/kqz094 ◽

2019 ◽

Vol 69 (6) ◽

pp. 428-435

Author(s):

C M Zachek ◽

J M Schwartz ◽

M Glasser ◽

E DeMicco ◽

T J Woodruff

Keyword(s):

Obstetric Care ◽

Protective Equipment ◽

Solvent Exposure ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Cleaning Product ◽

Occupational And Environmental Exposure ◽

Adverse Pregnancy ◽

Exposures During Pregnancy

Abstract Background Occupational and environmental exposures during the prenatal period may be associated with adverse pregnancy outcomes and lifelong health effects. Yet, identification and evaluation of these potential hazards is lacking in routine obstetric care. Aims To assess the feasibility of incorporating a self-administered occupational and environmental exposure questionnaire into obstetric clinics. Methods A cross-sectional survey assessed prenatal clinic patients at a public hospital who were currently employed and <20 weeks gestation. Questionnaires evaluated job characteristics, workplace and hobby exposures, protective equipment use and symptoms during pregnancy. Results Of 69 participants (96% response rate), 46% were predominantly Spanish-speaking. Primary occupations were caregiver (16%), cleaner (14%) and administrative assistant (14%). Overall, 93% were exposed to a workplace hazard, with most participants reporting physical stressors (82%) or organic solvent exposure (78%). Most women (74%) used some personal protective equipment. Nearly half (54%) reported at least one non-pregnancy symptom, and 52% were referred for follow-up with an occupational medicine practitioner. Household and hobby-related chemical exposures were common in our sample (91%). We observed moderate consistency between job task and chemical use responses: 67–99% of intentionally redundant questions were fully or partially matched. Closed- compared to open-ended activity questions identified a higher proportion of physical stressors (82% versus 12%) and cleaning product (76% versus 30%) exposures. Conclusions A self-administered questionnaire is an effective screening tool for identifying women with occupational and hobby-related exposures during pregnancy. Consistent incorporation of exposure assessment into prenatal care can improve clinical communications and early interventions for at-risk pregnant women.

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Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/1471-2393-11-11 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 38

Author(s):

Shamsun Nahar ◽

Morsheda Banu ◽

Hashima E Nasreen

Keyword(s):

Emergency Obstetric Care ◽

Obstetric Care ◽

Cross Sectional Study ◽

Urban Slums ◽

Sectional Study ◽

Cross Sectional ◽

Development Intervention

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Estimating the met need for emergency obstetric care (EmOC) services in three payams of Torit County, South Sudan: a facility-based, retrospective cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-018739 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018739 ◽

Cited By ~ 2

Author(s):

Pontius Bayo ◽

Imose Itua ◽

Suzie Paul Francis ◽

Kofi Boateng ◽

Elijo Omoro Tahir ◽

...

Keyword(s):

Primary Outcome ◽

Postpartum Haemorrhage ◽

South Sudan ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Cross Sectional Study ◽

Obstetric Complications ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional

ObjectiveTo determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication.DesignThis was a retrospective cross-sectional study.SettingFour primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan.ParticipantsAll admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications.Primary and secondary outcome measuresThe primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes.ResultsTwo hundred and fifty four major obstetric complications were admitted in 2015 out of 390 expected from 2602 pregnancies, representing 65.13% met need. The met need was highest (88%) for Nyong Payam, an urban area, compared with the other two rural payams, and 98.8% of the complications were treated from the hospital, while no complications were treated from three PHCCs. The most common obstetric complications were abortions (45.7%), prolonged obstructed labour (23.2%) and haemorrhage (16.5%). Evacuation of the uterus for retained products (42.5%), caesarean sections (32.7%) and administration of oxytocin for treatment of postpartum haemorrhage (13.3%) were the most common interventions.ConclusionThe met need for EmOC in Torit County is low, with 35% of women with major obstetric complications not accessing care, and there is disparity with Nyong Payam having a higher met need. We suggest more support supervision to the PHCCs to increase access for the rural population.

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A study on obstetric care in a primary health center of South Assam district, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183110 ◽

2018 ◽

Vol 5 (8) ◽

pp. 3629

Author(s):

Ajit Kumar Dey ◽

Debojit Chutia

Keyword(s):

Age Groups ◽

Multivariate Logistic Regression Analysis ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Safe Motherhood ◽

Cross Sectional ◽

Birth Prevalence ◽

Care Services ◽

Vaginal Deliveries ◽

The Mean

Background: Maternal and child health are critically important in a country that is experiencing high infant mortality and maternal mortality. Research all over the world has suggested that one of the major solutions to this problem is availability of Emergency Obstetric Care services within the reach of people. Objectives of the study were to examine profile of mothers who have delivered in health facility during a year and the interplay of various factors in child birth and newborn outcome.Methods: Retrospective cross sectional study conducted by collecting information in predesigned format from medical records. Appropriate statistical methods and test of significance performed for qualitative and quantitative variables.Results: Out of 539 women, the majority of 42.9% were in the age group 20-25 years, the mean age (SD) of mother was 24.1 years (±4.09). Out of total 539 vaginal deliveries, 56.6% cases episiotomy was performed. 41.6% deliveries occurred from 8 AM to 4 PM. The mean birth weight was 2.830 kg SD 0.439 and low birth prevalence 16.0%. Parity with time to delivery after admission in different age groups revealed significant association (X2=66.456, p=0.000). Women aged less than 20 years are 12 times more at risk of episiotomy performed. The multivariate logistic regression analysis shows 60.67% specificity and 85.59% sensitivity in predicting episiotomy.Conclusions: From study it is evident that women report to hospital late in labor hence there is urgent need to provide quality antenatal care services at village and PHC level and augment awareness among the community for promotion of safe motherhood.

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Defragmenting the Health Care System in Mexico: Universal Access For Obstetric Emergencies

International Journal of Translational Medical Research and Public Health ◽

10.21106/ijtmrph.147 ◽

2020 ◽

Vol 4 (1) ◽

pp. 80-92

Author(s):

María G. Ramírez-Rojas ◽

María G. Freyermuth-Enciso ◽

María B. Duarte-Gómez

Keyword(s):

Health Care ◽

Health Care System ◽

Emergency Services ◽

Universal Access ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Medical Emergency ◽

Cross Sectional ◽

Obstetric Emergencies ◽

Care System

Background and Objectives: This article aims to analyze how the needs of Mexican women requiring emergency obstetric care (EmOC) can be fully met through initiatives such as the General Agreement on Inter-Institutional Collaboration for Emergency Obstetric Care (the Agreement). We compared EmOCaccredited facilities operating under the Agreement with facilities outside the Agreement which, although not accredited, provide their affiliates with EmOC services. Methods: Based on an observational, descriptive, cross-sectional design, we analyzed the Agreement interinstitutional strategy within four different scenarios in order to verify whether Mexico was in compliance with United Nations (UN) recommendations on EmOC availability: five facilities, with at least one offering comprehensive services, per 500,000 inhabitants. Results: Taking into account all facilities in the Mexican health care system, we found that Mexico offered 75% of the required facilities and was therefore 25% short of compliance. According to data on hospital discharges, 734 438 cases of obstetric emergencies (OEs) were registered in Mexico in 2013, the vast majority of which were assisted by facilities unaccredited for that function. Meanwhile, the 466 accredited facilities, all operating under the Agreement, served a negligible proportion (0.07%) of these patients. Conclusion and Implications For Translation: The Agreement would undoubtedly reach its potential as a vehicle for universal EmOC coverage were its field of action not restricted to such a small number of services for women. The Mexican health care system is faced with the double challenge of increasing institutional coverage and upgrading installed EmOC infrastructure. Key words: • Medical emergency services • Mexico, Medical assistance • Hospitalization • Health regulation • Agreements. Copyright © 2020 Ramírez-Rojas et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work which is published in this journal is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

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