Dataset Information

Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia.

ABSTRACT:

Background

Timely intrapartum referral between facilities is pivotal in reducing maternal/neonatal mortality and morbidity but is distressing to women, resource-intensive and likely to cause delays in care provision. We explored the complexities around referrals to gain understanding of the characteristics, experiences and outcomes of those being transferred.

Methods

We used a mixed-method parallel convergent design, in Tanzania and Zambia. Quantitative data were collected from a consecutive, retrospective case-note review (target, n?=?2000); intrapartum transfers and stillbirths were the outcomes of interest. A grounded theory approach was adopted for the qualitative element; data were collected from semi-structured interviews (n?=?85) with women, partners and health providers. Observations (n?=?33) of transfer were also conducted. Quantitative data were analysed descriptively, followed by binary logistic regression models, with multiple imputation for missing data. Qualitative data were analysed using Strauss's constant comparative approach.

Results

Intrapartum transfer rates were 11% (111/998; 2 unknown) in Tanzania and 37% (373/996; 1 unknown) in Zambia. Main reasons for transfer were prolonged/obstructed labour and pre-eclampsia/eclampsia. Women most likely to be transferred were from Zambia (as opposed to Tanzania), HIV positive, attended antenatal clinic ?30?min away from the referral hospital. Differences were observed between countries. Of those transferred, delays in care were common and an increase in poor outcomes was observed. Qualitative findings identified three categories: social threats to successful transfer, barriers to timely intrapartum care and reparative interventions which were linked to a core category: journey of vulnerability.

Conclusion

Although intrapartum transfers are inevitable, modifiable factors exist with the potential to improve the experience and outcomes for women. Effective transfers rely on adequate resources, effective transport infrastructures, social support and appropriate decision-making. However, women's (and families) vulnerability can be reduced by empathic communication, timely assessment and a positive birth outcome; this can improve women's resilience and influence positive decision-making, for the index and future pregnancy.

SUBMITTER: Lavender T

PROVIDER: S-EPMC7222428 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Publications

Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia.

Lavender Tina T Bedwell Carol C Blaikie Kieran K Danna Valentina Actis VA Sutton Chris C Kasengele Chowa Tembo CT Wakasiaka Sabina S Vwalika Bellington B Laisser Rose R

BMC pregnancy and childbirth 20200514 1

<h4>Background</h4>Timely intrapartum referral between facilities is pivotal in reducing maternal/neonatal mortality and morbidity but is distressing to women, resource-intensive and likely to cause delays in care provision. We explored the complexities around referrals to gain understanding of the characteristics, experiences and outcomes of those being transferred.<h4>Methods</h4>We used a mixed-method parallel convergent design, in Tanzania and Zambia. Quantitative data were collected from a ...[more]

PMID: 32408871

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Dataset Information

Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia.

Background

Methods

Results

Conclusion

Publications

Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia.

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