scholarly journals Evaluation of Comprehensive Emergency Management of Obstetric and Newborn Care Program Implementation at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Case Study Design

2021 ◽  
Author(s):  
Melak Jejaw ◽  
Ayal Debie ◽  
Lake Yazachew ◽  
Getachew Teshale
Keyword(s):  
Program Implementation ◽  
Healthcare Providers ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Program ◽  
Northwest Ethiopia ◽  
Specialized Hospital ◽  
Implementation Status

Abstract Background: Maternal healthcare service is the care given for the woman during her gestation, delivery and postpartum period. The Maternal Mortality Ratio (MMR) was remains high and a public health problem in Ethiopia. Sub-Saharan African (SSA) countries including Ethiopia account two-thirds of the total maternal deaths. To curb such high burden related with child births, comprehensive emergency obstetric care is designed as one of the strategies for maternal healthcare services. However, its implementation status was not well investigated. This study aims to evaluate the implementation of comprehensive emergency obstetric care program at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods: A case study design was employed from 01 to 30 April 2021. A total of 265 clients for acceptability, 13 key informant interviews (KIIs), 49 observations and two months document review were conducted. Availability, compliance and acceptability dimensions were evaluated using 32 indicators. Binary logistic regression model was fitted to identify factors associated with acceptability of the services. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05 were also used to identify the predictor variables associated with acceptability. The qualitative data were recorded using tape recorder, transcribed in Amharic and translated to English language. Thematic analysis was done to supplement the quantitative findings. Results: The overall implementation of comprehensive emergency obstetric and newborn care (CEmONC) was 81.6%. Moreover, acceptability, availability and care provider’s compliance with the guideline accounted 81, 88.9 and 74.8%, respectively. There were stocked-out of some essential drugs, such as methyldopa, nifidipine, gentamycin and vitamin K injection. CEmONC training gaps, inadequate number of autoclaves, shortage of water supply and long-distance delivery ward to laboratory unit were also the barriers for the CEmONC service. Short waiting time of clients (AOR=2.40; 95%CI: 1.16, 4.90) and maternal educational level (AOR= 5.50, 95%CI: 1.95, 15.60) were positively associated with acceptability of CEmONC services.Conclusion: The implementation status of CEmONC program was good as per our judgment parameter. Compliance of healthcare providers with the guideline was fair and needed improvement. Essential emergency drugs, equipment and supplies were stocked-out. The University of Gondar Comprehensive Specialized Hospital was therefore had better to give great emphasis to expand maternity rooms/ units. The hospital had better to avail the resources and provide continuous capacity building for healthcare providers to enhance the program implementation.

Performance of CEmONC Centres in Public Hospitals of Tamil Nadu

2018 ◽  
Vol 20 (3) ◽  
pp. 363-377
Author(s):  
S. Rajasulochana ◽  
Umakant Dash
Keyword(s):  
Health Care ◽  
Tamil Nadu ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Public Hospitals ◽  
Primary Study ◽  
Structured Interviews ◽  
Care Services

This case study examines the performance of public hospitals in Tamil Nadu in delivering emergency obstetric care services over a period of 8 years as well as to investigate from provider’s perspective the issues and constraints that affect performance. A mixed method approach has been adopted, integrating the descriptive analysis of administrative data on performance reports (2006–2007 to 2013–2014) of emergency obstetric and newborn care services in 46 public hospitals, along with primary study comprising of semi-structured interviews of 27 health personnel across selected public hospitals. Examination of trends in selected performance indicators shows that utilization of public hospitals for emergency obstetric and newborn care services has improved; a number of complicated and critical cases revived in the comprehensive emergency obstetric and newborn care (CEmONC) centres of public hospitals have gone up. The capability to treat complicated maternal and neonatal cases, however, is limited by inadequacy of specialist doctors, equipment maintenance issue and lack of hospital management. This case study is of interest to both public hospital administrators and health care policymakers who want to improve and develop strategies for better management in public hospitals. Specifically, there is an urgent need to (a) readdress human resource policy for health care personnel, (b) devise appropriate mechanisms for periodic inspection and preventive maintenance of hospital equipment and (c) develop management capabilities and leadership skills within public health system.

scholarly journals Process evaluation of the community-based newborn care program implementation in Geze Gofa district, south Ethiopia: a case study evaluation design

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tsegaye Gebremedhin ◽  
Dawit Wolde Daka ◽  
Yibeltal Kiflie Alemayehu ◽  
Kiddus Yitbarek ◽  
Ayal Debie
Keyword(s):  
Program Implementation ◽  
Healthcare Providers ◽  
Newborn Care ◽  
Maternal Satisfaction ◽  
Evaluation Design ◽  
Wealth Status ◽  
Community Based ◽  
Factors Associated ◽  
Study Evaluation

Abstract Background The Community-Based Newborn Care (CBNC) program is a comprehensive strategy designed to improve the health of newborns during pregnancy, childbirth, and the postnatal period through health extension workers at community levels, although the implementation has not been evaluated yet. Therefore, this study aimed to evaluate the process of the CBNC program implementation in Geze Gofa district, south Ethiopia. Methods A case study evaluation design with a mixed method was employed from May 1 to 31, 2017. A total of 321 mothers who gave birth from September 01, 2016 to February 29, 2017, were interviewed. Similarly, 27 direct observations, six-month document reviews, and 14 key informant interviews were conducted. The quantitative data were entered into Epi-Data version 3.1 and exported to SPSS version 20 for analysis. In the multivariable logistic regression analysis, variables with < 0.05 p-values and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to declare factors associated with maternal satisfaction. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall process of program implementation was measured based on pre-determined judgmental criteria. Results The overall level of the implementation process of the CBNC program was 72.7%, to which maternal satisfaction, availability of resources, and healthcare providers’ compliance with the national guideline contributed 75.0, 81.0, and 68.0%, respectively. Essential drugs and medical equipment, like vitamin K, chlorohexidine ointment, neonatal resuscitation bags, and masks used in the program were out of stock. Very severe diseases were not treated according to the national guidelines, and the identification of neonatal sepsis cases was poor. Trading occupation (AOR: 0.16, 95% CI: 0.03–0.97) and low wealth status (AOR: 3.11, 95% CI: 1.16–8.36) were factors associated with maternal satisfaction. Conclusion The process of CBNC program implementation was relatively good, although the compliance of healthcare providers with the national guideline and maternal satisfaction with the services was low. Some essential drugs and medical equipment were out of stock. Merchant and low wealth status affected maternal satisfaction. Therefore, healthcare offices should provide crucial medicines and equipment for better program implementation and improve the wealth status of mothers to enhance maternal satisfaction.

Risk perception on the labour ward: A mixed methods study

2021 ◽  
Vol 26 (2) ◽  
pp. 56-63
Author(s):  
Claire McCarthy ◽  
Sarah Meaney ◽  
Marie Rochford ◽  
Keelin O’Donoghue
Keyword(s):  
Mixed Methods ◽  
Lived Experience ◽  
Healthcare Providers ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Daily Basis ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
Staff Support ◽  
Staff Wellbeing

Healthcare providers commonly experience risky situations in the provision of maternity care, and there has been increased focus on the lived experience in recent years. We aimed to assess opinions on, understanding of and behaviours of risk on the LW by conducting a mixed methods study. Staff working in a LW setting completed a descriptive questionnaire-based study, followed by qualitative structured interviews. Statistical analysis was performed with SPSS on quantitative data and thematic analysis performed on qualitative data. Nearly two thirds of staff (64%; 73/114) completed the questionnaire, with 56.2% (n = 47) experiencing risk on a daily basis. Experiencing risk evoked feelings of apprehension (68.4%; n = 50) and worry (60.2%; n = 44) which was echoed in the qualitative work. Structured clinical assessment was utilised in risky situations, and staff described “ going on autopilot” to manage these situations. A large number of respondents reflected on their provision of care following an adverse event (87.7%; n = 64). Debriefing was mentioned as an important practice following such events by all respondents. This study describes the negative terminology prevailing in emergency obstetric care. These experiences can have a profound impact on staff. Risk reduction strategies and the provision of increased staff support and training are crucial to improve staff wellbeing in stressful scenarios.

scholarly journals Review Article on Emergency Obstetric Care

2018 ◽  
Vol 1 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Silas Ochejele
Keyword(s):  
Maternal Mortality ◽  
Low Income ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Skilled Birth Attendant ◽  
Obstetric Care ◽  
Functional Health ◽  
Low Income Countries ◽  
Mortality Reduction ◽  
Maternal Deaths

Maternal death was once a common occurrence worldwide but today, 99% of maternal deaths occur in low income countries. Most of the maternal deaths are due to direct obstetric complications. Emergency obstetric care is the intervention required to save the lives of these women. It is based on a tripod of signal functions, skilled birth attendants and a functional health system. The objective of this article was to discuss the role of Emergency obstetric care in maternal mortality reduction. A systematic review of available articles on Emergency obstetric care; and Emergency obstetric care training materials, experience and observations used/made between 2003 and 2017 in Nigeria was used for this work. Emergency obstetric care is the nucleus on which all other maternal mortality reduction activities are hinged. The paradigm evolvement of Emergency obstetric care offers the last hope for a woman with direct obstetric complication. However, the skilled birth attendant must have the right attitude in addition to her/his professional skills for effective implementation of these interventions. Women need access to and availability of Emergency obstetric care as well as a continuum of care that includes antenatal, intra-partum and postnatal care, newborn care and family planning services to reduce maternal mortality.

scholarly journals Perspectives of stakeholders on emergency obstetric care training in Kenya: a qualitative study

2019 ◽  
Vol 12 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Judith Maua ◽  
Barbara Madaj ◽  
Charles Ameh ◽  
Nynke van den Broek
Keyword(s):  
Healthcare Providers ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Staff ◽  
Group Discussions ◽  
Training Outcomes ◽  
Hands On ◽  
Care Outcomes ◽  
Care Training

Abstract Background This study explores stakeholders’ perceptions of emergency obstetric care (EmOC) ‘skills-and-drills’-type training including the outcomes, strengths, weaknesses, opportunities and threats of the intervention in Kenya. Methods Stakeholders who either benefited from or contributed to EmOC training were purposively sampled. Semi-structured topic guides were used for key informant interviews and focus group discussions. Following verbatim transcriptions of recordings, the thematic approach was used for data analysis. Results Sixty-nine trained healthcare providers (HCPs), 114 women who received EmOC and their relatives, 30 master trainers and training organizers, and six EmOC facility/Ministry of Health staff were recruited. Following training, deemed valuable for its ‘hands-on’ approach and content by HCPs, women reported that they experienced improvements in the quality of care provided. HCPs reported that training led to improved knowledge, skills and attitudes, with improved care outcomes. However, they also reported an increased workload. Implementing stakeholders stressed the need to explore strategies that help to maximize and sustain training outcomes. Conclusions The value of EmOC training in improving the capacity of HCPs and outcomes for mothers and newborns is not just ascribed but felt by beneficiaries. However, unintended outcomes such as increased workload may occur and need to be systematically addressed to maximize training gains.

scholarly journals What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal

2020 ◽  
Vol 5 (3) ◽  
pp. e001915
Author(s):  
Francesca L Cavallaro ◽  
Lenka Benova ◽  
El Hadji Dioukhane ◽  
Kerry Wong ◽  
Paula Sheppard ◽  
...  
Keyword(s):  
Rural Areas ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Cross Sectional ◽  
Public Facilities ◽  
Facility Births

IntroductionIncreases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal.MethodsFor this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans.ResultsBirths in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral.ConclusionsOur findings imply that many lower-level public facilities—the most common place of birth in Senegal—are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality.

scholarly journals Social return on investment of emergency obstetric care training in Kenya

2019 ◽  
Vol 4 (1) ◽  
pp. e001167 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Barbara Madaj ◽  
Nynke van den Broek
Keyword(s):  
Return On Investment ◽  
Social Impact ◽  
Healthcare Providers ◽  
Emergency Obstetric Care ◽  
Secondary Data ◽  
Obstetric Care ◽  
Morbidity And Mortality ◽  
Sensitivity Analyses ◽  
Social Return On Investment ◽  
The Impact

IntroductionEmergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology.MethodsMixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions.ResultsTrained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred.ConclusionEmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.

scholarly journals Reducing Maternal Mortality: an Assessment of the Availability and Quality of Emergency Obstetric and Newborn Care in Esan Central Local Government Area of Edo State

2019 ◽  
Author(s):  
Sunday Emmanuel JOMBO ◽  
Ehigha ENABUDOSO ◽  
Anthonia NJOKU ◽  
Jedidiah AFEKHOBE
Keyword(s):  
Health Care ◽  
Maternal Mortality ◽  
Health Care Providers ◽  
Maternal Death ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Providers ◽  
Referral Network

Abstract BackgroundThere is global public health burden of maternal mortality and is worse in Sub-Saharan Africa. Esan Central LGA in Nigeria has an estimated maternal mortality of 1747 per 100,000 live births which is unacceptably high. Emergency obstetric care has been advocated as a measure to avert maternal mortality as about 15% of pregnancies developed complications which may be unpredictable. There is therefore need to access the availability and quality of EmOC in the area. This study aimed to assess the availability and quality of emergency obstetric and newborn care (EmONC) services in the areaMethodsWe conducted a descriptive cross-sectional study and an in-depth interview. Data was collected using UN/AMDD assessment tools (Handbook). Forty key informants’ interviews with major facility managers, pregnant women and health care providers were also done and triangulated. Analysis was done using IBM SPSS statistics- 20, while the in-depth interviews were audio taped, transcribed and analyzed by thematic coding. In addition EmONC services indicators were calculated.ResultThe availability of EmONC services in Esan central LGA was 3.7/500,000 population. The availability of EmONC services was limited at the primary and secondary level of health care. The comprehensive EmOC was adequate (3.7/500000 population) and it is available at the tertiary health facility. The met need for EmONC was 62.6%, obstetric case fatality was 1.2%, and caesarean section rate was 24 %, while the still birth rate was 2.6%. The respondents had adequate knowledge and concern about the burden of maternal death. Major causes of maternal death reported were haemorrhage, hypertension / convulsion in pregnancy and prolong labour. Major contributing factors to maternal death are lack of money, poor antenatal care, and poor attitudes of health care providers, inappropriate referral network, lack of equipment and EmONC drugs, inadequate skill birth attendants and delay in getting treatment. Overall remark on the quality of EmONC services was poor.Conclusion There are limited EmONC services at the primary and secondary health centers that require urgent attention in effort to reducing maternal mortality. There is need for supply of equipment, emergency obstetric care drugs, training and re-training of staff. The community and the health care providers need re-orientation as to the reproductive health care requirements of the people in such a manner that is client centered and with appropriate referral network.

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