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

Abstract

BackgroundNearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women’s access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa.MethodsArticles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings.ResultThe search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff.ConclusionsA number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness.Systematic review registrationPROSPERO CRD42017074102Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0842-2) contains supplementary material, which is available to authorized users.

A Multilevel Modelling of Barriers to Healthcare Access and Healthcare Seeking for Childhood Illnesses Among Childbearing Women in Burundi

“…Rural areas unlike urban areas are usually deprived settings, with poor and under-resourced facilities. Therefore, the lack of basic infrastructures such as healthcare facilities, poor transportation systems and road networks might determine the frequency and timing of seeking healthcare services [36,37,38,39].Women in rural areas would have to spend longer time to access a health facility due to erratic transport systems that might even be too costly and may not be affordable to these rural women [40]. Other environmental barriers such as topographical access to health facilities that are often dotted at the outskirts of these local communities might restrict women from seeking healthcare [41,42,43].…”

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Access to and Quality of Primary Healthcare: a Multi-Country Qualitative Case Study in West and East Africa

“…11 However, frequent rectal application of these herbal medicines were reported to be associated with toxicity caused by harmful ingredients, mechanical injury and infections. 11 As reported in a systematic review, 12 cultural beliefs around the use of traditional medicines have been identi ed as key barriers in seeking emergency obstetric care. In some studies, pregnant women preferred the TBAs who administered traditional medicines.…”