Can innovative ambulance transport avert pregnancy–related deaths? One–year operational assessment in Ethiopia

Godefay, Hagos; Kinsman, John; Admasu, Kesetebirhan; Byass, Peter

doi:10.7189/jogh.06.010410

Cited by 30 publications

(29 citation statements)

References 16 publications

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“…The assessment of maternal mortality decline (effect measure) occurred after the intervention had taken place, thereby showing temporality between intervention and the expected outcome of the study. In our results, as has been reported by others, we also assessed a type of dose response relationship with, for instance, the use of transportation, where pregnant women with the least access to transportation had the highest maternal mortality rates compared to the groups with the best access to transportation [33]. And over the years, there has been a consistent decline in MMR for all these transportation groups.…”

Section: Discussionsupporting

confidence: 53%

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

Lindtjørn

Mitiku²,

Zidda

et al. 2017

PLoS ONE

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BackgroundIn a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work.ResultsIn this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24–0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2–4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P<0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61–4.61)).ConclusionsOur results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is implemented.

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Section: Discussionsupporting

confidence: 53%

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

Lindtjørn

Mitiku²,

Zidda

et al. 2017

PLoS ONE

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“…These findings are consistent with the findings of studies conducted in Nepal,19 Zambia20 and Ethiopia,21 wherein physical distance to the maternity facility and lack of geographic access were reported as barriers for the place of delivery. On the other hand, freely available transport service for the pregnant mothers was reported to cause substantially reduced pregnancy-related mortality in Ethiopia 22. It is, however, important to note that the distance to a health facility in this study was assessed based on the mothers’ report, which is subjective; it may over- or underestimate the actual distance to the health facilities and may affect the associations.…”

Section: Discussionmentioning

confidence: 95%

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

Fisseha

Berhane

Worku

et al. 2017

IJWH

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BackgroundPoor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia.Subjects and methodsA community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI).ResultsA total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization.ConclusionImplementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

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“…The former rate the care as per their understanding of what is ‘good’ or appropriate, while providers would rate good care as clinically appropriate care as per standard international protocols [28] Both providers and women cited lack of reliable transport as a major barrier in accessing care during delivery, like other study settings in LMICs [29–31]. Not only provision of reliable transportation systems, but also provision of trained paramedics in case of emergency situations plays a crucial role where accessibility is an issue in several countries [32–34]. …”

Section: Discussionmentioning

confidence: 99%

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

Bhattacharyya

Srivastava

Saxena

et al. 2018

Global Health Action

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Background: Persistently high maternal mortality levels are a concern in developing countries. In India, monetary incentive schemes have increased institutional delivery rates appreciably, but have not been equally successful in reducing maternal mortality. Maternal outcomes are affected by quality of obstetric care and socio-cultural norms. In this light there is need to examine the quality of care provided to women delivering in institutions. Objective: This study aimed to examine pregnant women’s expectations of high-quality care in public health facilities in Uttar Pradesh, India, and to contrast this with provider’s perceptions of the same, as well as the barriers that limit their ability to provide high-quality care. Methods: A qualitative descriptive analysis was conducted on data from two studies – focus group discussions with rural women in their last trimester of pregnancy (conducted in 2014) to understand women’s experience and satisfaction with maternal care services, and in-depth interviews with care providers (conducted in 2016–17) to understand provision of person-centred care. Provider perspectives were matched with themes of women’s perspectives on quality of childbirth care in facilities. Results: Major themes of care prioritised by women included availability of doctors at the facility; availability of medicines; food; ambulance services; maintenance of cleanliness and hygiene; privacy; good and safe delivery with no complications; client-provider interaction; financial cost of care. Many women also voiced no expectation of care, indicating disillusionment from the existing system. Providers concurred with women on all themes of care except availability of doctors, as they felt that trained nurses were proficient in conducting deliveries. Conclusions: This study shows that women have clear expectations of quality care from facilities where they go to deliver. Understanding their expectations and matching them with providers’ perspectives of care is critical for efforts to improve the quality of care and thereby impact maternal outcomes.

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Can innovative ambulance transport avert pregnancy–related deaths? One–year operational assessment in Ethiopia

Cited by 30 publications

References 16 publications

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

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Can innovative ambulance transport avert pregnancy–related deaths? One–year operational assessment in Ethiopia

Cited by 30 publications

References 16 publications

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

Distance from health facility and mothers&rsquo; perception of quality related to skilled delivery service utilization in northern Ethiopia

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

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Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia