The evolution of a quality of care approach for improving emergency obstetric care in rural hospitals in Nepal

Clapham, S.; Basnet, I; Pathak, Laxmi; McCall, Maria

doi:10.1016/j.ijgo.2004.03.013

Cited by 17 publications

(17 citation statements)

References 4 publications

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“…For improving and maintaining the quality, highly motivated staff with team work, collaborative activities with community, improved overall functioning of the health facilities, community awareness and positive perception towards providers are the inevitable aspects of emergency obstetric care. [23][24][25] An inter-countries cross-sectional study on global patterns of utilization of emergency obstetric care revealed that the comprehensive emergency obstetric care facilities are usually available to meet the recommended minimum number for the size of the population. Basic emergency obstetric care facilities are consistently not available in sufficient numbers both in countries with high and moderate levels of maternal mortality.…”

Section: 22mentioning

confidence: 99%

Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries

Bhandari

Dangal

2014

Nepal j. obstet. gynaecol.

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Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year nearly three million women die due to pregnancy related causes. This tragedy is avoidable if women have timely access to required emergency obstetric care.Emergency obstetric care refers to life-saving services for maternal and neonatal complications provided by skilled health workers. Since the beginning of the 1980's, several efforts have been intensified to improve maternal and child health status and reducing the high morbidity and mortality. There was built on a worldwide consensus to provide improved maternal and child health care for addressing the high morbidity and mortality. All participant countries agreed to integrate emergency obstetric care services in their national health care system. Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, many women in developing countries do not have access to essential health care services including emergency obstetric care. Basic emergency obstetric care by skilled birth attendants or timely referral for further comprehensive emergency obstetric care can reduce maternal deaths and disabilities significantly. This paper is based on the results published in PubMed, Medline, Lancet, WHO and Google Scholar web pages from 1990 to 2013.

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Section: 22mentioning

confidence: 99%

Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries

Bhandari

Dangal

2014

Nepal j. obstet. gynaecol.

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“…Despite efforts in Nepal to increase rates of institutional birth, 35 % of births nation-wide take place in a medical facility and in the impoverished Far-Western Development Region where this study takes place, that percentage is only 29 %. In Nepal, only 5 % of the estimated need for emergency obstetric care is met, and only 0.7 % of births are by cesarean section compared to the United Nations target of 5–15 % [5]. …”

Section: Introductionmentioning

confidence: 99%

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study

Maru¹,

Rajeev

Pokhrel

et al. 2016

BMC Pregnancy Childbirth

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BackgroundEncouraging institutional birth is an important component of reducing maternal mortality in low-resource settings. This study aims to identify and understand the determinants of persistently low institutional birth in rural Nepal, with the goal of informing future interventions to reduce high rates of maternal mortality.MethodsPostpartum women giving birth in the catchment area population of a district-level hospital in the Far-Western Development Region of Nepal were invited to complete a cross-sectional survey in 2012 about their recent birth experience. Quantitative and qualitative methods were used to determine the institutional birth rate, social and demographic predictors of institutional birth, and barriers to institutional birth.ResultsThe institutional birth rate for the hospital’s catchment area population was calculated to be 0.30 (54 home births, 23 facility births). Institutional birth was more likely as age decreased (ORs in the range of 0.20–0.28) and as income increased (ORs in the range of 1.38–1.45). Institutional birth among women who owned land was less likely (OR = 0.82 [0.71, 0.92]). Ninety percent of participants in the institutional birth group identified safety and good care as the most important factors determining location of birth, whereas 60 % of participants in the home birth group reported distance from hospital as a key determinant of location of birth. Qualitative analysis elucidated the importance of social support, financial resources, birth planning, awareness of services, perception of safety, and referral capacity in achieving an institutional birth.ConclusionAge, income, and land ownership, but not patient preference, were key predictors of institutional birth. Most women believed that birth at the hospital was safer regardless of where they gave birth. Future interventions to increase rates of institutional birth should address structural barriers including differences in socioeconomic status, social support, transportation resources, and birth preparedness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1022-9) contains supplementary material, which is available to authorized users.

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“…The quality factors that are pertinent to public hospital clients include attitude, interpersonal and technical skills of service personnel [34]. Health facilities in Nepal are often understaffed with poor infrastructure, equipment and management [35,36]. An assessment of quality of care in midwifery and emergency obstetric care services in Nepal found major shortfalls [37].…”

Section: Introductionmentioning

confidence: 99%

Women’s perception of quality of maternity services: a longitudinal survey in Nepal

Karkee

Lee

Pokharel

2014

BMC Pregnancy Childbirth

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BackgroundIn the context of maternity service, the mother’s assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal.MethodsA cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression.ResultsWithin the health facility sub-scale, birth centre was rated lowest on items ‘adequacy of medical equipment’, ‘health staff suited to women’s health’ and ‘adequacy of health staff’, whereas public hospital was rated the lowest with respect to ‘adequacy of room’, ‘adequacy of water’, ‘environment clean’, ‘privacy’ and ‘adequacy of information’. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001).ConclusionsOverall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.

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The evolution of a quality of care approach for improving emergency obstetric care in rural hospitals in Nepal

Cited by 17 publications

References 4 publications

Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries

Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study

Women’s perception of quality of maternity services: a longitudinal survey in Nepal

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