Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh

ObjectivesPakistan is one out of five countries where together half of the global neonatal deaths occur. As the provision of services and facilities is one of the key elements vital to reducing this rate as well as the maternal mortality rate, this study investigates the status of the delivery of essential obstetric care provided by the public health sector in two districts in Khyber Pakhtunkhwa in 2015 aiming to highlight areas where critical improvements are needed.SettingWe analysed data from a survey of 22 primary and secondary healthcare facilities as well as 85 community midwives (CMWs) in Haripur and Nowshera districts.ParticipantsUsing a structured questionnaire we evaluated the performance of emergency obstetric care (EmOC) signal functions and patient statistics in public health facilities. Also, 102 CMWs were interviewed about working hours, basic and specialised delivery service provision, referral system and patient statistics.Primary outcome measuresWe investigate the public provision of emergency obstetric care using seven key medical services identified by the United Nations (UN).ResultsDeliveries by public health cadres account for about 30% of the total number of births in these districts. According to the UN benchmark, only a small fraction of basic EmOC (2/18) and half of the comprehensive EmOC (2/4) facilities of the recommended minimum number were available to the population in both districts. Only a minority of health facilities and CMWs carry out several signal functions. Only 8% of the total births in one of the study districts are performed in public EmOC health facilities.ConclusionsBoth districts show a significant shortage of available public EmOC service provisions. Development priorities need to be realigned to improve the availability, accessibility and quality of EmOC service provisions by the public health sector alongside with existing activities to increase institutional births.

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Post-Partum Hemorrhage is Still Killing Mothers in Bangladesh: An Observation from the 2016 Bangladesh Maternal Mortality Survey (BMMS)

10.21203/rs.3.rs-48884/v1 ◽

2020 ◽

Author(s):

Aminur Rahman ◽

Anne Austin ◽

Tahmina Begum ◽

Iqbal Anwar

Keyword(s):

Maternal Mortality ◽

Universal Access ◽

Post Partum ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Active Management ◽

Director General ◽

Public And Private ◽

Third Stage ◽

Mortality Survey

Abstract The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC). Both of these interventions mandate the administration of oxytocin. In Bangladesh there are nonfunctioning institutionalized guidelines from the Director General of Health Services on the storage of oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to evaluate the potency of current stores of oxytocin used in both in public and private facilities, develop and enforce protocols to ensure the potency of oxytocin, and promote universal access to quality AMSTL and CEmOC services.

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Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature

Systematic Reviews ◽

10.1186/s13643-018-0842-2 ◽

2018 ◽

Vol 7 (1) ◽

Cited By ~ 15

Author(s):

Ayele Geleto ◽

Catherine Chojenta ◽

Abdulbasit Musa ◽

Deborah Loxton

Keyword(s):

Systematic Review ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Health Facilities ◽

Sub Saharan Africa ◽

Review Of Literature ◽

Barriers To Access ◽

Sub Saharan

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Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey

BMC Health Services Research ◽

10.1186/s12913-018-2980-6 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Minerva Kyei-Onanjiri ◽

Mary Carolan-Olah ◽

John Koku Awoonor-Williams ◽

Terence V. McCann

Keyword(s):

Questionnaire Survey ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Health Facilities ◽

East Region ◽

Upper East Region

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Review of obstetric fistulas in a rural hospital in South-South Nigeria

Urogynaecologia ◽

10.4081/uij.2011.e7 ◽

2011 ◽

Vol 25 (1) ◽

pp. 7

Author(s):

Aniefiok J. Umoiyoho ◽

Aniekan M. Abasiattai ◽

Okon E. Akaiso

Keyword(s):

Antenatal Care ◽

Rural Areas ◽

Formal Education ◽

Health Workers ◽

Medical Condition ◽

Obstetric Fistula ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Medical Personnel ◽

Health Facilities

Background. Obstetric fistula is a devastating medical condition associated with adverse social, psychological and reproductive health consequences. This study was carried out to review the pattern of presentation and outcome of patients with obstetric fistulas in a rural health facility in South-South Nigeria. Design and Method. A retrospective review of case notes of 51 patients with obstetric fistula that were managed at the Family Life Center, Mbribit Itam, in Itu, Local Government Area of Akwa Ibom State. Results. During the study period, 51 obstetric fistulas were repaired in the hospital. The ages of the patients ranged from 15 to 50 years with median age of 25.8 years and modal age group of 21-30 years (45.1%). The majority of the patients were of low parity (72.5%), 56.9% had no formal education and 27.5% were traders. Thirty four patients (66.7%) had their fistulas for between 1 and 6 years, 19.6% of the patients had juxta-cervical fistulas, while eight (15.7%) had circumferential loss of the urethra. Thirty-seven (72.5%) of them where unbooked and thus had no antenatal care, while 4 (7.8%) booked and had antenatal care in conventional health facilities. Thirty-four patients (66.7%) remained dry twenty-one days after surgery, thirteen (23.5%) were still wet, while 4 patients (7.8%) had stress incontinence despite repair. Conclusion. Obstetric fistulas are found most commonly among young, poorly educated women of low parity who do not avail themselves of orthodox ANC in our environment. Government, community and religious leaders must make concerted efforts to ensure women obtain formal education and when pregnant, have access to emergency obstetric care even if resident in the rural areas. Government, relevant non-Governmental organisations, community leaders and health workers should through relevant health messages enlighten women in the community about obstetric fistulas and the dangers of delivering in unorthodox health facilities. More medical personnel should be trained as the first attempt at repair is the one that is most likely to succeed.

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Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh

BMJ Open ◽

10.1136/bmjopen-2018-028670 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028670

Author(s):

Abdullah Nurus Salam Khan ◽

Farhana Karim ◽

Mohiuddin Ahsanul Kabir Chowdhury ◽

Nabila Zaka ◽

Alexander Manu ◽

...

Keyword(s):

Low Birthweight ◽

Newborn Care ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Neonatal Care ◽

Health Facilities ◽

Obstetric Complications ◽

P Value ◽

Individual Level ◽

Clinical Vignettes

BackgroundThis study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional’s characteristics and provision of MNH services in health facilities influence their competencies.Methods134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value<0.05 as statistically significant.ResultsThe competency of MNH professionals was low. About 10% and 24% of the health professionals received ‘high’ scores (>75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months.ConclusionsDespite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care.

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Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

Maternal and Child Health Journal ◽

10.1007/s10995-019-02846-w ◽

2019 ◽

Vol 24 (S1) ◽

pp. 31-38 ◽

Cited By ~ 1

Author(s):

Ashish KC ◽

Dipendra Raman Singh ◽

Madan Kumar Upadhyaya ◽

Shyam Sundar Budhathoki ◽

Abhishek Gurung ◽

...

Keyword(s):

Quality Of Care ◽

Health Facility ◽

Newborn Care ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Health Facilities ◽

Care Services ◽

Quality Of Delivery ◽

Maternal And Newborn

Abstract Introduction Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal. Methods Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities. Results Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals. Conclusions These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

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