The effect of improving maternity services in a secondary facility, Zaria, Nigeria

Sabitu, Kabir; Alti-Mu'azu, M; Musa, Abdullahi; Ifenne, D. I.; Essien, E.S.; Golji, N; Adidu, V; Mukaddas, M

doi:10.1016/s0020-7292(97)00153-7

Cited by 13 publications

(20 citation statements)

References 4 publications

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“…The use of audits to improve obstetric referrals in Angola [24] caused impressive reductions in case fatality, but most women continued to opt for risky home deliveries rather than incur substantial debts to pay for advanced hospital treatment. Similar patterns were seen in Malawi following the introduction of maternal death audits[22], and despite major upgrades to equipment, facility and staff the number of complicated deliveries in Nigerian PMM projects [49,51-53] declined in all sites.…”

Section: Resultsmentioning

confidence: 55%

“…Two major initiatives dominate the studies in this category ; the PMM (Preventing Maternal Mortality) projects [49-53] focused on individual referral hospitals in Africa during the 1990s while the AMDD (Averting Maternal Death and Disability) projects [54-60] took a district based approach in a diverse range of sites a decade later. Of the two other studies examining EMOC, one examined a similar hospital rejuvenation project in Ethiopia [61] while the other examined the impact of a national level program to improve EMOC facilities in Peru[62].…”

Section: Resultsmentioning

confidence: 99%

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Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

2013

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ObjectivesEfforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship.MethodsWe undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence.FindingsMethodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions.ConclusionExisting evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.

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Section: Resultsmentioning

confidence: 55%

Section: Resultsmentioning

confidence: 99%

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

2013

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“…Onwudiegwu et al point to poor management in primary‐level facilities as an important source of delays before referrals. Recorded time from requesting an ambulance to arrival at the referring facility ranged from 45 min to 48 h , emphasizing that the lack of ambulances stationed at lower‐level facilities are a significant component of referral delays. In South Africa, ambulance response time did not vary by priority of call , suggesting that patients in critical condition were not successfully prioritized for transport.…”

Section: Discussionmentioning

confidence: 99%

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

Cavallaro

Marchant

2013

Acta Obstet Gynecol Scand

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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.

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“…The Prevention of Maternal Mortality network (Kamara 1997), for example, reported findings on average treatment times for only two of the 11 health facilities for which routine information on obstetric admissions and complications was noted (Ifenne et al. 1997; McGynn 1997; Sabitu et al. 1997).…”

Section: Introductionmentioning

confidence: 99%

Responsiveness to life‐threatening obstetric emergencies in two hospitals in Abidjan, Côte d'Ivoire

Gohou

Ronsmans

Kacou

et al. 2004

Tropical Med Int Health

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Summaryobjectives To document the frequency of severe obstetric illness, and the intervals between admission or decision and life-saving surgery and the factors contributing to delays, which were reported during case reviews in two hospitals in Abidjan, Cô te d'Ivoire.methods The study was conducted in the teaching hospital in Cocody (CHUC) and the district hospital in Abobo (FSAS) in 2000-01. All severe obstetric cases were inventoried over a period of 1 year, and a subset of cases selected for in-depth review. For the 23 audited cases requiring emergency surgery, the interval between admission/decision and surgery was determined and reasons for the delays examined.findings The yearly incidence of severe obstetric morbidity was 224.5 and 11.8 per 1000 live births in the CHUC and FSAS respectively. In CHUC, the decision-to-delivery time was extremely long (median 4.8 h) and this was largely determined by the time needed to obtain a complete surgical kit (median 2.8 h), either because the family had to pay for it in advance or because the kit lacked some essential components, which had to be bought separately. In FSAS, the decision-to-delivery time was much shorter (median 1.0 h).conclusion The interval between decision and emergency obstetric surgery substantially exceeded the 30 min generally advocated in industrialized countries. The reasons for the long delays were multiple and complex, but the main factors governing them were the huge case load of severe cases and the absence of any clear policy towards ensuring prompt and adequate treatment for life-threatening emergencies. In-depth reviews of cases of severe obstetric morbidity focusing in particular on the timing of emergency treatment could increase the responsiveness of the health system and providers to the needs of women requiring emergency obstetric care.

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The effect of improving maternity services in a secondary facility, Zaria, Nigeria

Abstract: Improving the quality of maternity services can increase utilization by women with uncomplicated pregnancies. However, utilization of emergency services appears to be influenced by other factors, such as the ability to treat obstetric complications and prevailing economic conditions.

Cited by 13 publications

References 4 publications

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

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

Responsiveness to life‐threatening obstetric emergencies in two hospitals in Abidjan, Côte d'Ivoire

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