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

Abstract

BackgroundNearly 15% of all pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labor, and complications of abortion. Between 1990 and 2015, an estimated 10.7 million women died due to obstetric complications. Almost all of these deaths (99%) happened in developing countries, and 66% of maternal deaths were attributed to sub-Saharan Africa. The majority of cases of maternal mortalities can be prevented through provision of evidence-based potentially life-saving signal functions of emergency obstetric care. However, different factors can hinder women’s ability to access and use emergency obstetric services in sub-Saharan Africa. Therefore, the aim of this review is to synthesize current evidence on barriers to accessing and utilizing emergency obstetric care in sub-Saharan African. Decision-makers and policy formulators will use evidence generated from this review in improving maternal healthcare particularly the emergency obstetric care.MethodsElectronic databases including MEDLINE, CINAHL, Embase, and Maternity and Infant Care will be searched for studies using predefined search terms. Articles published in English language between 2010 and 2017 with quantitative and qualitative design will be included. The identified papers will be assessed for meeting eligibility criteria. First, the articles will be screened by examining their titles and abstracts. Then, two reviewers will review the full text of the selected articles independently. Two reviewers using a standard data extraction format will undertake data extraction from the retained studies. The quality of the included papers will be assessed using the mixed methods appraisal tool. Results from the eligible studies will be qualitatively synthesized using the narrative synthesis approach and reported using the three delays model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be employed to present the findings.DiscussionThis systematic review will present a detailed synthesis of the evidence for barriers to access and utilization of emergency obstetric care in sub-Saharan Africa over the last 7 years. This systematic review is expected to provide clear information that can help in designing maternal health policy and interventions particularly in emergency obstetric care in sub-Saharan Africa where maternal mortality remains high.Systematic review registrationPROSPERO CRD42017074102.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0720-y) contains supplementary material, which is available to authorized users.

Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria

“…Several reports indicate that a large number of women tend not to attend basic antenatal care or delivery services in health facilities, but rather attempt to deliver at home or with traditional or faith-based birth attendants. As such, when women experience severe complications of pregnancy, they are brought to referral secondary or tertiary health care facilities for CEOC, sometimes in very dire conditions [4, 7, 8]. To date, the poor organization of CEOC in Nigeria has been well documented [8].…”

Effect of a labor triage checklist and ultrasound on obstetric referral at three primary health centers in Eastern Uganda

“…Improved quality of care, particularly during the intrapartum period, can reduce preventable maternal and perinatal mortality. In many low‐ and middle‐income countries, failure to receive adequate care when a facility is reached, the third delay, 3 is exacerbated by lack of supplies, personnel shortages, long waiting times, and weak referral protocols 4 …”

“…In many low-and middle-income countries, failure to receive adequate care when a facility is reached, the third delay, 3 is exacerbated by lack of supplies, personnel shortages, long waiting times, and weak referral protocols. 4 Effective referral from primary health centers (PHCs) to hospitals offering comprehensive emergency obstetric and neonatal care is a critical component of quality maternity care. 5 Inter-facility referral relies on a confluence of factors, such as timely arrival of a woman in labor, appropriate identification of high-risk conditions by providers, emergency transportation, and communication between the referring and receiving facilities.…”

Psychosocial Determinants of Expectant Mothers’ uptake of Sexual and Reproductive Health Services in the City of Parakou in 2017

“…Sub-Saharan Africa alone accounts for 66% of deaths (201,000), followed by South Asia (66,000). In a meta-analysis published in 2018, Geleto et al [2], reported that between 1990 and 2015, about 10.7 million women died from obstetric complications. Yet, it is recognized that maternity associated risks can be reduced for all these women through the implementation of the 5th Millennium Development Goal (MDG).…”