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Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project.

ABSTRACT: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur.This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization.Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system.

SUBMITTER: Turab A

PROVIDER: S-EPMC3718721 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project.

Turab Ali A Ariff Shabina S Habib Muhammad A MA Ahmed Imran I Hussain Masawar M Rashid Akhtar A Memon Zahid Z Khan Mohammad I MI Soofi Sajid S Bhutta Zulfiqar A ZA

BMC pregnancy and childbirth 20130624

<h4>Background</h4>Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality rem ...[more]

PMID: 23800194

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Project description:BackgroundMaternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes.Methods/designWe have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality.DiscussionIn this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.Trial registrationClinicalTrials.gov NCT01073488.

Project description:BackgroundMajority of causes of maternal and newborn mortalities are preventable. However, poor access to and low utilization of health services remain major barriers to optimum health of the mothers and newborns. The objectives of this study were to assess maternal and newborn health services utilization and factors affecting mothers' health service utilization.MethodsA community based cross-sectional survey was carried out on randomly selected mothers who gave birth within a year preceding the survey. The survey was supplemented with key informant interviews of experts/health professionals. Multivariable logistic model was used to identify factors associated with service utilization. Adjusted odds ratios (AORs) were used to assess the strength of the associations at p-value ≤0.05. The qualitative data were summarized thematically.ResultsA total of 789 (99.1% response rate) mothers participated in the study. The proportion of the mothers who got at least one antennal care (ANC) visit, institutional delivery and postnatal care (PNC) were 93.3, 77.4 and 92.0%, respectively. Three-forth (74.2%) of the mothers started ANC lately and only 47.5% of them completed ANC4+ visits. Medium (4-6) family size (AOR: 2.3; 95% CI: 1.1, 4.9), decision on ANC visits with husband (AOR: 30.9; 95% CI: 8.3, 115.4) or husband only (AOR: 15.3; 95%CI: 3.8, 62.3) and listening to radio (AOR: 2.5; 95%CI: 1.1, 5.6) were associated with ANC attendance. Mothers whose husbands read/write (AOR: 1.6; 95% CI: 1.1, 2.), attended formal education (AOR: 2.8; 95% CI: 1.1, 6.8), have positive attitudes (AOR: 10.2; 95% CI: 25.9), living in small (AOR: 3.0; 95% CI: 1.2, 7.6) and medium size family (AOR: 2.3; 95% CI: 1.2, 4.1) were more likely to give birth in-health facilities. The proportion of PNC checkups among mothers who delivered in health facilities and at home were 92.0 and 32.5%, respectively. The key informants mentioned that home delivery, delayed arrival of the mothers, unsafe delivery settings, shortage of skilled personnel and supplies were major obstacles to maternal health services utilization.ConclusionsHealth information communication targeting husbands may improve maternal and newborn health services utilization. In service training of personnel and equipping health facilities with essential supplies can improve the provider side barriers.

Project description:Objectiveto understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality.Designqualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change.Settingfour urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital.Participantsadolescent women (15-20 years of age), adult women (21-49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team.Measurements and findingsfollowing informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was 'no me hace caso', or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of 'cuña' emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services.Key conclusions and implicationsthis study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal-newborn health services.

Project description:BackgroundIn approximately 15% of all pregnancies, a potentially fatal complication that necessitates medical attention arises, requiring a significant obstetrical intervention for the pregnant women to survive. Between 70% and 80% of maternal life-threating complication have been treated through emergency obstetric and newborn services. This study investigates women's satisfaction with emergency obstetric and newborn care services in Ethiopia and factors associated with their satisfaction.MethodsIn this systematic review and meta-analysis, we searched electronic databases, such as PubMed, Google Scholar, HINARI, Scopus, and Web of Sciences for primary studies. A standardized data collection measurement tool was used to extract the data. STATA 11 statistical software was used to analyze the data, and I2 tests were used to evaluate heterogeneity. The pooled prevalence of maternal satisfaction was predicted using a random-effects model.ResultsEight studies were included. The pooled prevalence of maternal satisfaction with emergency obstetric and neonatal care services was 63.15% (95% confidence interval: 49.48-76.82). Age (odds ratio = 2.88, 95% confidence interval: 1.62-5.12), presence of birth companion (odds ratio = 2.66, 95% confidence interval: 1.34-5.29), satisfaction with health workers' attitudes (odds ratio = 4.02, 95% confidence interval: 2.91-5.55), educational status (odds ratio = 3.59, 95% confidence interval: 1.42-9.08), length of stay at health facility (odds ratio = 3.71, 95% confidence interval: 2.79-4.94), and antenatal care visits (odds ratio = 2.22, 95% confidence interval: 1.52-3.24) were associated with maternal satisfaction with emergency obstetric and neonatal care service.ConclusionThis study found a low level of overall maternal satisfaction with emergency obstetric and neonatal care services. To increase maternal satisfaction and utilization, the government should focus on improving the standards of emergency maternal, obstetric, and newborn care by identifying gaps in maternal satisfaction regarding the services provided by healthcare professionals.

Project description:Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization's indicator "Availability of EmONC facilities" was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate "Availability of EmONC" by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator's value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator's validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.

Project description:BackgroundEstimating accessibility gaps to essential health interventions helps to allocate and prioritize health resources. Access to blood transfusion represents an important emergency health requirement. Here, we develop geo-spatial models of accessibility and competition to blood transfusion services in Bungoma County, Western Kenya.MethodsHospitals providing blood transfusion services in Bungoma were identified from an up-dated geo-coded facility database. AccessMod was used to define care-seeker's travel times to the nearest blood transfusion service. A spatial accessibility index for each enumeration area (EA) was defined using modelled travel time, population demand, and supply available at the hospital, assuming a uniform risk of emergency occurrence in the county. To identify populations marginalized from transfusion services, the number of people outside 1-h travel time and those residing in EAs with low accessibility indexes were computed at the sub-county level. Competition between the transfusing hospitals was estimated using a spatial competition index which provided a measure of the level of attractiveness of each hospital. To understand whether highly competitive facilities had better capacity for blood transfusion services, a correlation test between the computed competition metric and the blood units received and transfused at the hospital was done.Results15 hospitals in Bungoma county provide transfusion services, however these are unevenly distributed across the sub-counties. Average travel time to a blood transfusion centre in the county was 33 min and 5% of the population resided outside 1-h travel time. Based on the accessibility index, 38% of the EAs were classified to have low accessibility, representing 34% of the population, with one sub-county having the highest marginalized population. The computed competition index showed that hospitals in the urban areas had a spatial competitive advantage over those in rural areas.ConclusionThe modelled spatial accessibility has provided an improved understanding of health care gaps essential for health planning. Hospital competition has been illustrated to have some degree of influence in provision of health services hence should be considered as a significant external factor impacting the delivery, and re-design of available services.

Project description:Aim and objectivesThis review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths.BackgroundMost neonatal deaths (99%) occur in low- and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015.MethodsThe review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist.ResultsThe results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health.ConclusionThe systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services.Relevant to the clinical practiceConceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

Dataset Information

Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project.

Publications

Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project.

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