Evaluating quality of obstetric care in low-resource settings: Building on the literature to design tailor-made evaluation instruments - an illustration in Burkina Faso

Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time.Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ).Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F(7, 433) = 11.5, p < 0.001, R2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F(1, 147) = 12.05, p = 0.001, R2 = 0.08].Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.

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Barreras en la atención de la morbilidad materna en Yaxkukul, Yucatán, México

Revista de Ciencias de la Salud ◽

10.35429/johs.2019.18.6.28.37 ◽

2019 ◽

pp. 28-37

Author(s):

Elsa RODRÍGUEZ-ANGULO ◽

Marita SOLÍS-RIVERO ◽

Ricardo OJEDA-RODRÍGUEZ ◽

Guadalupe ANDUEZA-PECH

Keyword(s):

Pregnant Women ◽

Rural Health ◽

Obstetric Care ◽

Cross Sectional ◽

Obstetric Emergency ◽

A Value ◽

Rural Health Center ◽

Quality Of Obstetric Care ◽

Three Delays

Objectives. Identify the barriers that cause delays in the route of obstetric care in pregnant women of Yaxkukul, Yucatán, from January 2016 to May 2018. Methodology. Observational, descriptive, cross-sectional and retrospective study. Pregnant women who attended prenatal control at the rural health center of Yaxkukul were interviewed and reviewed their clinical record. Sociodemographic characteristics, prenatal control were studied and the critical route of obstetric care was described, under the model of the three delays. Percentages, measures of central tendency and dispersion were calculated; as well as square chi to look for association between delays and maternal morbidity. A 95% confidence level and a value of p <0.05 were used. Contribution. The present study contributes to the prevention of maternal and perinatal mortality. Knowing the barriers that cause delays in care can identify deficiencies in the obstetric emergency protocol established in rural health units, to improve the quality of obstetric care.

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O Papel da Ocitocina na Profilaxia da Hemorragia Pós-Parto em Locais com Recursos Limitados

Acta Médica Portuguesa ◽

10.20344/amp.14258 ◽

2021 ◽

Vol 34 (13) ◽

Author(s):

Inês Ferreira ◽

Ana Reynolds

Keyword(s):

Postpartum Hemorrhage ◽

Healthcare Professionals ◽

Cultural Barriers ◽

Low Resource Settings ◽

Low Resource ◽

Widespread Access ◽

Political Economic ◽

Demand For Health ◽

Cultural Constraints

Introduction: Postpartum hemorrhage remains one of the leading causes of maternal death globally. Oxytocin is the uterotonic agent of choice for the prophylaxis of this complication. However, its use in low-resource settings is associated with clinical, political, economic and cultural constraints. The goal of this article is to describe the use of oxytocin for postpartum hemorrhage prophylaxis in low-resource settings.Material and Methods: A literature review on the topic was carried out, and 24 articles were included.Results: The information was organized into seven sections: the evaluation of the efficacy of oxytocin compared to other uterotonics, the use of oxytocin in home births, the training of healthcare professionals, the quality of the available oxytocin, the new formulations, the risks associated with the use of uterotonic and the adopted health policies.Discussion: Despite the progress achieved widespread access to oxytocin for postpartum hemorrhage prophylaxis in low-resource settings is less than desirable. The main difficulties encountered were the shortage of skilled healthcare professionals for oxytocin administration, deficiencies concerning the quality of the drug and the inadequacy of available clinical guidelines.Conclusion: In order to reduce maternal mortality caused by postpartum hemorrhage in low-resource settings, it is essential to improve the knowledge of healthcare professionals, to implement good practices on the use of uterotonics, to optimize resource management and to overcome cultural barriers that prevent the demand for health services.

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