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Synthesis of recent articles on Emergency Obstetric Care, Quality, Utilization of care and Human resources

January 24, 2015

Emergency Obstetric care

David et al.; Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. The article aims to determine the prevalence of Near miss cases and maternal deaths in Mozambique (province) and to assess the probable causes of near miss cases and maternal death based on the three delays model.  The study states that the prevalence of near miss is important. Out of 27916 live births, 564 near misses, 71 maternal deaths were reported. The profile of near miss among adolescents (14-19 years old) were reported about 23.6%.  Few of them attend antenatal care (33.7%) The first (63.8%) and third delays (69.7%) could explain the causes of near misses and maternal deaths. First delay: empowerment; health attitudes; beliefs, knowledge. Third delay: transfer and treatment (lack of blood, operating room). Poor Perception of Quality of Care.

Echoka and coll.Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya quantified how many women had an unmet obstetrics needs  and identified where these women are located in a district in Kenya. 566 women in 2008, 724 in 2009 got a major obstetric intervention (MOI) and 90% got a caesarean section due to cephalopelvic disproportion-narrow pelvis , 11 % in 2008 and 6% in 2009 needed a lifesaving intervention and did not get it. Unmet need located in rural areas.

Groppi et al. A hospital-centered approach to improve emergency obstetric care in South Sudan evaluate the availability of EMOC in South Sudan (remote rural area) after the implementation of a hospital centered intervention with an ambulance referral system. The rate of Institutional deliveries increased after the intervention 13,3% corresponding to the 8213 expected deliveries in the catchment area. The rate of C/S increased: 4,9% corresponding to 0,6% of the expected number of deliveries in the catchment area.

Islam and coll. Rate of cesarean delivery at hospitals providing emergency obstetric care in Bangladesh evaluate the rate of cesarean and its reasons in 6 EMOC facilities in Bangladesh.  Among 3329 deliveries, 32% women had c/s. Main reason for c/s: previous caesarean delivery (24,1%) and fetal distress (21,9%) or prolonged or obstructed labor (20,5%). Despite the fact that the rate of caesarean section (hospital based study) is difficult to interpret, the frequency of cesarean is high in Bangladesh (comparing with the DHS, national surveys the last 10 years). Recommendations: Using guidelines, protocols and partograms to avoid unnecessary caesarean.

Owens et al. The state of routine and emergency obstetric and neonatal care in Southern Province, Zambia, assessed the capacity of health facilities to provide EMOC in Zambia. None of health facilities do not performed EMOC (the basic set) (n=90 in a province). 6 out of 10 performed CEMOC. Underuse of EMOC services. Lack of training and supplies explained the lack of provision of EMOC.

Social inequalities on the utilization of maternal health services

Hajizadeh et al. Social inequalities in the utilization of maternal care in Bangladesh: Have they widened or narrowed in recent years? assessed the evolution of social inequalities in utilization of antenatal care, facility based deliveries and skilled birth attendants in Bangladesh. Using DHS from 1995 to 2010. Gap increased between socioeconomic groups on utilization of maternal health care. Wealthier, educated and living in urban areas use more maternal health compared to women who are poor, less educated and living in rural areas.

Quality of care

WHO The prevention and elimination of disrespect and abuse during facility-based childbirth. Qualitative researches had reported abuses on women during childbirth in health centers in several settings. WHO calls for researches: to better define the concept of abuse during pregnancy and childbirth and measure its prevalence and its impact on women’s health and well-being. Recommendations: Introducing this dimension in health programs to improve the quality of care, must be part of a broader framework of human rights, training health workers and make them accountable on this issue and involving women (participatory approach) on action research.

Human resources

Murphy et al. A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa. Thirty seven articles included in the review. Lack of information and evidence on policies on training and deployment of human resources in maternal, newborn and child health. Policies on training and deployment are limited. Most of the human resources strategies are integrated in a broader management plan. Important gap between politics and research agenda, publications do not deal with national policies, did not target rural areas, and lack of evidence on human resources policies in terms of design, implementation and impact.