The quality of free antenatal and delivery services in Northern Sierra Leone

Abstract

BackgroundThe number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone.MethodsA cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities.ResultsThe quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care.ConclusionThe health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

Constraints to Get Access in Maternal Healthcare: A Review from Lower-middle-Income Countries

“…In lower-middle-income countries, insufficient fund allocation in health sector drives the poor people away from the health services, which results in imbalanced health outcomes (Green, 2018;C. Zhang et al, 2019), where maternal health care especially during delivery and after the delivery period is most neglected (Koroma et al, 2017).…”

“…Income of the general people has a direct connection with healthcare service utilization (Devkota & Upadhyay, 2015). Linking with this point, financial drawbacks deprived women from antenatal, delivery, and postnatal services in many lower-middle-income countries (Koroma et al, 2017). Consequently, women from lower socioeconomic strata are generally exposed to various types of perinatal complexities including premature birth, low birth weight, restricted growth in intra-uterine, antenatal and neonatal mortality, etc.…”

A reassessment of global antenatal care coverage for improving maternal health using sub-Saharan Africa as a case study

“…In fact, while higher ANC coverage is critical, the quality of care (including information on the services and interventions that are actually provided) and the timing of each visit also determine the extent to which such services are effective [ 7 , 18 , 22 ]. In many developing countries the quality of services provided remains low [ 23 , 24 ], which often leads to poor maternal and child health outcomes. Thus, it is recommended that countries “identify gaps in coverage and quality of care” as a way to ensure that pregnant women receive appropriate needed care [ 22 , 25 ], which extends inter alia beyond the number of contacts.…”

Evaluation of Antenatal Care Screening According to the National Recommendations in Senegal

“…In Paskistan, only 82.4% participants were screened for blood group and haemoglobin, 79.1% for blood glucose and hepatitis, and 0% for HIV and syphilis [9]. In Sierra Leone, less than a third of women were screened for haemoglobin estimation, albumin in urine and syphilis (10-28%), compared to an HIV test (50%) (10-28%) [10]. In the United States, complete adherence to screening test was 54.5% [14].…”

“…The comprehensive review of the literature has presented a qualitative study [8], and quantitative researches for laboratory examination in Sierra Leone and Pakistan [9][10], related to guidelines tests requested. Others studies have focused on some individual tests in the context of Prevention of Mother-to-Child Transmission (PMTCT).…”