Access to care solutions in healthcare for obstetric care in Africa: A systematic review

Abstract

Background Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context. Methods The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach. Findings A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention. Interpretation Emergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.

Óbitos De Mulheres Em Idade Fértil Relacionadas a Gravidez, Parto E/Ou Puerpério No Estado Do Paraná Entre 2016 E 2020

“…Em países de baixa e média renda (PBMR), as mulheres geralmente apresentam resultados de saúde ruins durante a gravidez, o parto e o período pós-parto. Esses resultados incluem sangramento grave, infecções, hipertensão, complicações no parto, aborto inseguro e agravamento de condições de saúde pré-existentes (JOINER et al, 2021). Uma revisão sistemática recente descobriu que, de todas as causas de mortes maternas, a hemorragia é responsável por 27,1% das mortes, enquanto a hipertensão e a sepse são responsáveis por 14 e 10,7% das mortes, respectivamente (ABEBE et al, 2023).…”

Effectiveness of Community Engagement Using M-Mama Champions in Improving Literacy of Obstetric Danger Signs, Birth Preparedness and Complication Readiness Among Pregnant Women in Bahi, Dodoma. A Community-Based, Cluster Randomized Controlled Trial

“…M-MAMA Champions, are designed to provide health education in the form of women groups coupled with their experience from M-MAMA referral and emergency services to potentiate the positive gains from the program in all the regions in Tanzania. This will ensure that knowledge on obstetric danger signs among pregnant women is enhanced and contribute towards birth preparedness and complication readiness that ultimately contributes to maternal mortality reduction (15,19). determined to be cost-effective in shortening the second delay compared to routine ambulance use (9), whereby maternal mortality declined by 70% within two years.…”

Practice of Pre-Hospital Emergency Care and Associated Factors in Addis Ababa, Ethiopia: Facility-Based Cross-Sectional Study Design

“…10 A previous study conducted in Mexico and Japan reported that poor selection of medications and late referral to the hospital were important contributors to more than half of the deaths, and the willingness to perform CPR among health students before BLS training was 13% respectively. [11][12][13] A study in England showed that the most common assessments recorded by paramedics were respiratory (20.1%), pain (15.8%), and deceased (7.9%); 74.4% were transported to the hospital (99.5%). Among those with pain as the primary impression, (53.9%) received analgesic.…”