Healthcare workers’ knowledge and attitude towards prompt referral of women with postpartum haemorrhage in Nigeria: a community-based study

Background: Postpartum Haemorrhage (PPH) is a major contributor to maternal mortality in developing countries most especially in the rural areas where Emergency Obstetric Care (EmOC) are not available. Delay in referring women from rural health facilities to settings where EmOC services are available have been reported. This study assessed community-based healthcare workers’ (CHWs) knowledge and attitude towards the prevention, early recognition and prompt referral of women with Post-Partum Haemorrhage (PPH) for Emergency Obstetric Care (EmOC).Methods: Descriptive cross-sectional design was used. Structured questionnaire was used to collect data from 200 CHWs recruited from community-based healthcare. Data analysis was done in SPSS version 20 at significance level of 0.05.Results: Findings show that 86.5% (n=173) of the respondents had good knowledge while 12% (n=24) and 1.5% (n=3) had moderate and poor knowledge respectively. Negative attitude towards prompt referral of women affected with PPH was found among 51% (n=102) of the respondents. Unavailability of blood drapes to estimate blood loss [χ2 (1, n=200) = 4.51, p=0.03], lack of ambulance [χ2 (1, n=200) = 4.46, p=0.03], and poor state of the roads [χ2 (1, n=200) = 4.44, p=0.03] were factors linked to poor attitude of CHWs towards prompt referral of affected women.Conclusions: The study concluded that there is a need for intervention that can help improve community healthcare workers’ attitude towards prompt referral of women affected with postpartum haemorrhage. There is also a need for general overhaul of community-based facilities to effectively support prompt referral.

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Perspectives of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone

BMJ Open ◽

10.1136/bmjopen-2020-041746 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041746

Author(s):

Ryan Proos ◽

Hanna Mathéron ◽

Jonathan Vas Nunes ◽

Abdul Falama ◽

Patricia Sery Kamal ◽

...

Keyword(s):

Decision Making ◽

Maternal Mortality ◽

Sierra Leone ◽

Rural Areas ◽

Healthcare Workers ◽

Health Workers ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Obstetric Complications ◽

Structured Interviews

ObjectivesSierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes factors affecting timely and adequate referral of women with obstetric complications in rural areas of Sierra Leone as viewed by health workers in rural health facilities.DesignQualitative research with semi-structured interviews using open-ended questions. Data were analysed by systematic text condensation.SettingInterviews were held in nine peripheral health units in rural Sierra Leone.Participants19 health workers including nurses, midwives and clinical health officers participated in nine interviews.ResultsFrom the interviews, four major themes describing possible factors of delay in referral of women in need of emergency obstetric care emerged: (1) communication between healthcare workers; (2) underlying influences on decision-making; (3) women’s compliance to referral and (4) logistic constraints.Several factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among healthcare workers for having maternal deaths or severe obstetric complications occurring at their own facilities. Furthermore, decision-making of healthcare workers whether to refer a woman or not is negatively influenced by a hierarchical culture with high power distance between healthcare workers.ConclusionFactors identified that complicate timely and adequate referral of women in need of emergency obstetric care must be considered in efforts to reduce maternal mortality. Possible interventions that may reduce delay in referral include increased communication by mobile phones between health workers for advice and feedback regarding referrals, involvement of influential stakeholders to increase women’s compliance to referral, and consistent use of standardised management protocols.

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Region wise referrals to a tertiary care centre: a retrospective analysis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195201 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4678

Author(s):

Sirisha Paidi ◽

Aashritha Thonangi

Keyword(s):

Health Care ◽

Rural Areas ◽

Tertiary Care ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Urban Rural ◽

King George Hospital ◽

Tribal Areas

Background: Emergency obstetric care in health care requires a linked referral system to be effective in reducing maternal morbidity and mortality. This review is aimed at summarizing the proportion of referrals from urban, rural and tribal areas of surrounding districts to tertiary care centre, King George Hospital, Visakhapatnam for a 6 month period; from May 2018 to October 2018.Methods: Retrospective study done at a tertiary care teaching hospital, including 3157 cases referred from the surrounding urban, rural and tribal areas.Results: Out of the 3157 referred cases, most of them (1658) were from rural areas, 1030 from urban and 469 from tribal areas. Referrals done in view of post caesarean pregnancies were more in urban and rural areas whereas more preeclampsia and anaemia cases were referred from tribal areas. Various indications of referral are documented. Majority of them were unbooked cases.Conclusions: Specific guidelines regarding whom to refer, how to refer and when to refer would be helpful in making timely referral. These would also help to decrease the burden on the tertiary care centers which deal with a huge caseloads in spite of limited infrastructure and manpower. Adequate attention and better care can be given to complicated cases if the total case load is reduced. Stringent documentation in referral slip and better co-ordination are required for a strong health care system.

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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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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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Utilization of Maternity Waiting Home (MWH) to Improve Access to Health Services: Systematic Literature Review

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v7i3.art.p368-375 ◽

2020 ◽

Vol 7 (3) ◽

pp. 368-375

Author(s):

Nuraina Nuraina

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Workers ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Access To Health Services ◽

Care Services ◽

Access To Health ◽

Maternity Waiting Home ◽

Improve Access

Maternity waiting home (MWH) is a home built in the compound or near to health facilities that provides standard medical and emergency obstetric care services. MWH is considered to be a key strategy to "bridge the geographical gap" in obstetric care between rural areas with poor access to equipped facilities, and urban areas where the services are available. This study aimed to systematically review the utilization of MWH to improve access to health service. The method of finding articles in this study was in the period 2014 to 2018, free full text, human species, and scholarly journals which were then identified using an electronic database from Pubmed, Proquest and Onesearch. Three articles were carried out with thematic analysis to identify the main points. Factors associated with the utilization of MWH included (1) Distance; (2) Complication during pregnancy; and (3) Income. Barrier in the utilization of MWH were (1) Inadequate number of room and postpartum bed; (2) Lack of water and sanitation facilities; and (3) Unavailable electricity. Partnership between health workers in rural facilities, stronger role of stakeholders, and a broader health system, were expected to increase the utilization of MWH.

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Post-Partum Hemorrhage is still killing mothers in Bangladesh: Inhaled oxytocin (IHO) can help

10.21203/rs.3.rs-402427/v1 ◽

2021 ◽

Author(s):

Aminur Rahman ◽

Anne Austin ◽

Tahmina Begum ◽

Iqbal Anwar

Keyword(s):

Universal Access ◽

Post Partum ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Similar Efficacy ◽

Active Management ◽

Cold Chain ◽

Director General ◽

Skilled Attendant ◽

Third Stage

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 include the administration of oxytocin. Traditional parenteral oxytocin administration requires a consistent cold chain and for a skilled attendant to administer the injection. Inhaled oxytocin (IHO), which does not require a cold chain, has been shown to have similar efficacy to parenteral oxytocin, in preventing PPH. In Bangladesh there are non-functioning institutionalized guidelines from the Director General of Health Services on the storage of parenteral oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to consider replacing parenteral oxytocin with IHO, as the cold chain capacity in Bangladesh is strained, and institutional guidelines for injectable oxytocin are not used. In parallel, Bangladesh should also continue efforts to ensure universal access to quality AMSTL and CEmOC services.

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Rising Rates of Caesarean Section in Urban Nepal

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i41.1750 ◽

2019 ◽

Vol 16 (41) ◽

pp. 479-480 ◽

Cited By ~ 1

Author(s):

Sulochana Dhakal Rai ◽

Pramod Raj Regmi ◽

Edwin van Teijlingen ◽

Juliet Wood ◽

Ganesh Dangal ◽

...

Keyword(s):

At Risk ◽

Caesarean Section ◽

Rural Areas ◽

Emergency Obstetric Care ◽

Health Resources ◽

Obstetric Care ◽

The Other ◽

Sharp Rise ◽

Private Hospitals

The rising rate of caesarean section in urban Nepal is alarming as the lack of access for women in rural areas to emergency obstetric care, putting lives at risk. The latter is referred to as ‘Too little too late’. At the same time, the sharp rise in caesarean section rates in cities presents the other extreme: “Too much too soon”. The overuse of caesarean section causes harm, unnecessary costs, and misuse of health resources. Availability of private hospitals and increasing hospital childbirth may contribute to the rising rate of caesarean section. This article highlights the rising rate of caesarean section in urban Nepal.Keywords: Caesarean section; emergency obstetric care; Nepal.

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Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas

Human Resources for Health ◽

10.1186/1478-4491-9-28 ◽

2011 ◽

Vol 9 (1) ◽

Cited By ~ 30

Author(s):

Angelo S Nyamtema ◽

Senga K Pemba ◽

Godfrey Mbaruku ◽

Fulgence D Rutasha ◽

Jos van Roosmalen

Keyword(s):

Rural Areas ◽

Scale Up ◽

Emergency Obstetric Care ◽

Obstetric Care

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A study on training frontline health workers for prevention, early recognition and treatment or transfer of women with post-partum haemorrhage using mamanatalie

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184145 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4156

Author(s):

Nikhita B. Vadvadgi ◽

Nageshu Shailaja ◽

Lingegowda Krishna ◽

Kirtan Krishna

Keyword(s):

Rural Areas ◽

Health Workers ◽

Early Recognition ◽

Post Partum ◽

Skill Assessment ◽

Knowledge And Skills ◽

Skill Test ◽

Frontline Health Workers ◽

Post Partum Haemorrhage

Background: The objective of the present study was to train frontline health workers (FHW) on prevention, early recognition and treatment/transfer of women with post-partum haemorrhage using mamanatalie and to compare their pre-training and post training knowledge and skills, and to reassess the knowledge and skills of the trainees after six months.Methods: Training of 159 FHW belonging to the nine Primary Health Centres (PHC) of Kuppam constituency was conducted using mamanatalie. Pre and post training knowledge and skill assessment were compared using questionnaires and the mamanatalie. Reassessment of knowledge and skill was done after six months.Results: Among 159 participants 93% scored more, 3% scored same and 4% scored lesser in post training when compared to pre-training test. In the follow up knowledge assessment after six months 73 trainees were lost for follow up, among the remaining, 8% scored more, 16% scored same and 76% scored less when compared to the post training test. However, the follow up scores were higher than the pre-training scores. In the skill test, 82% scored more than 80%. Four trainees were lost for follow up skill assessment, among the remaining, 16% scored more, 23% scored same and 61% scored less when compared to the initial skill test scoresConclusions: The training increased knowledge, skill and confidence among the trainees. It has the potential to lead to improved clinical outcomes, especially in the rural areas. Revision sessions may help in better retention of knowledge and skill.

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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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