Responsiveness of emergency obstetric care systems in low‐ and middle‐income countries: a critical review of the “third delay”

Abstract

We reviewed the evidence on the duration, causes and effects of delays in providing emergency obstetric care to women attending health facilities (the third delay) in low-and middle-income countries. We performed a critical literature review using terms related to obstetric care, birth outcome, delays and developing countries. A manual search of key articles' reference lists was also performed. 69 studies met the inclusion criteria. Most studies reported long delays to providing care, and the mean waiting time for women admitted with complications was as much as 24 hours before treatment. The three most cited barriers to providing timely care were shortage of treatment materials, surgery facilities and qualified staff. Existing evidence is insufficient to estimate the effect of delays on birth outcomes. Delays to providing emergency obstetric care seem common in resource-constrained settings, but further research is necessary to determine the effect of the third delay on birth outcomes. KEYWORDS AND ABBREVIATIONSKeywords: third delay; emergency obstetric care; low-and middle-income countries; responsiveness; health services research Abbreviations: EmOCEmergency obstetric care LMIC Low-and middle-income countries WHO World Health Organisation KEY MESSAGEBetter understanding of the magnitude of effect of delays in providing emergency obstetric care in low-and middle-income countries has the potential to improve maternal and perinatal survival. Standardised approaches to measure their frequency, duration and effects should be developed.

Uterine Rupture in Resource-Poor Countries

“…A recent extensive review of phase III delays in resourcepoor countries found that the barriers to timely care most often cited were shortages of needed materials (such as drugs, blood, and medical supplies), poorquality surgical facilities, required payment of user fees, and lack of adequately trained, qualified staff. 94 It does not have to be this way. Communities should demand reliable health care institutions and should apply political pressure to hold government officials, hospital administrators, physicians, and nurses accountable for their performance.…”

Socioeconomic Inequalities in the Use of Maternal Health Care Services in Nigeria

“…Direct causes such as hemorrhage, hypertensive disorders, sepsis, embolism, and abortion account for about 75% of total maternal deaths in sub-Saharan Africa with hemorrhage as the leading cause, accounting for about 25% of maternal deaths (Say et al, 2014;WHO, 2008). Many of the maternal deaths are preventable with responsive obstetric care and medical assistance during delivery (Cavallaro & Marchant, 2013;Ray, Madzimbamuto, & Fonn, 2012). Access and responsive health care utilization remain relevant to maternal health promotion in many countries across the region.…”

The magnitude and factors related to facility-based maternal mortality in Mozambique

“…This suggest the need of continuous investment to improve the availability and deployment of highly qualified MCH nurses that can secure the provision of EmOC services. A recent multicountry survey on maternal and newborn health conducted by the WHO (Souza et al 2013), emphasize the need of universal coverage of lifesaving interventions and an overall improvement in the quality of maternal care (Cavallaro & Marchant 2013). A systematic review of the factors implicated in the institutional maternal death by Knight et al indicated that lack of human resources were the most reported barrier: forty-one of 43 studies referred to this barrier and particularly, the lack of training (Knight et al 2013).…”

“…On the basis of the data obtained from the 2007 general population census, it was estimated that 46% of all maternal deaths in Mozambique occur within a health facility (Saúde 2009). Factors related to health system organisation and the provision of health services have been identified elsewhere to play an important role in maternal deaths within the health facilities (( Kongnyuy et al 2009), (Knight et al 2013), (Cavallaro & Marchant 2013)).…”