Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature
Abstract Background Nearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Systematic Reviews |
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| Online Access: | http://link.springer.com/article/10.1186/s13643-018-0842-2 |
| _version_ | 1819265379628744704 |
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| author | Ayele Geleto Catherine Chojenta Abdulbasit Musa Deborah Loxton |
| author_facet | Ayele Geleto Catherine Chojenta Abdulbasit Musa Deborah Loxton |
| author_sort | Ayele Geleto |
| collection | DOAJ |
| description | Abstract Background Nearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women’s access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa. Methods Articles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings. Result The search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff. Conclusions A number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness. Systematic review registration PROSPERO CRD42017074102 |
| first_indexed | 2024-12-23T20:44:27Z |
| format | Article |
| id | doaj.art-53870406728d4e4289a45920ac05fbaa |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-12-23T20:44:27Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-53870406728d4e4289a45920ac05fbaa2022-12-21T17:31:50ZengBMCSystematic Reviews2046-40532018-11-017111410.1186/s13643-018-0842-2Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literatureAyele Geleto0Catherine Chojenta1Abdulbasit Musa2Deborah Loxton3School of Public Health, College of Health and Medical Sciences, Haramaya UniversityResearch Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of NewcastleResearch Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of NewcastleResearch Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, The University of NewcastleAbstract Background Nearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women’s access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa. Methods Articles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings. Result The search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff. Conclusions A number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness. Systematic review registration PROSPERO CRD42017074102http://link.springer.com/article/10.1186/s13643-018-0842-2BarrierAccessUtilizationEmergency obstetric careSub-Saharan Africa |
| spellingShingle | Ayele Geleto Catherine Chojenta Abdulbasit Musa Deborah Loxton Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature Systematic Reviews Barrier Access Utilization Emergency obstetric care Sub-Saharan Africa |
| title | Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature |
| title_full | Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature |
| title_fullStr | Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature |
| title_full_unstemmed | Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature |
| title_short | Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature |
| title_sort | barriers to access and utilization of emergency obstetric care at health facilities in sub saharan africa a systematic review of literature |
| topic | Barrier Access Utilization Emergency obstetric care Sub-Saharan Africa |
| url | http://link.springer.com/article/10.1186/s13643-018-0842-2 |
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