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...
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-020-02996-8 |
| _version_ | 1819103870248288256 |
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| author | Tina Lavender Carol Bedwell Kieran Blaikie Valentina Actis Danna Chris Sutton Chowa Tembo Kasengele Sabina Wakasiaka Bellington Vwalika Rose Laisser |
| author_facet | Tina Lavender Carol Bedwell Kieran Blaikie Valentina Actis Danna Chris Sutton Chowa Tembo Kasengele Sabina Wakasiaka Bellington Vwalika Rose Laisser |
| author_sort | Tina Lavender |
| collection | DOAJ |
| description | 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 < 4 times and living > 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. |
| first_indexed | 2024-12-22T01:57:19Z |
| format | Article |
| id | doaj.art-96a3fd9d2d7f466a8061e3776050b3c0 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-22T01:57:19Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-96a3fd9d2d7f466a8061e3776050b3c02022-12-21T18:42:44ZengBMCBMC Pregnancy and Childbirth1471-23932020-05-0120111410.1186/s12884-020-02996-8Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and ZambiaTina Lavender0Carol Bedwell1Kieran Blaikie2Valentina Actis Danna3Chris Sutton4Chowa Tembo Kasengele5Sabina Wakasiaka6Bellington Vwalika7Rose Laisser8Jean McFarlane Building, University of ManchesterJean McFarlane Building, University of ManchesterJean McFarlane Building, University of ManchesterJean McFarlane Building, University of ManchesterJean McFarlane Building, University of ManchesterMinistry of Health Headquarters, Department of Public Health and ResearchUniversity of NairobiUniversity of Zambia ,School of MedicineArchbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Health SciencesAbstract 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 < 4 times and living > 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.http://link.springer.com/article/10.1186/s12884-020-02996-8TransfersIntrapartumMixed-methodsQualitativeGrounded theoryObservation |
| spellingShingle | Tina Lavender Carol Bedwell Kieran Blaikie Valentina Actis Danna Chris Sutton Chowa Tembo Kasengele Sabina Wakasiaka Bellington Vwalika Rose Laisser Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia BMC Pregnancy and Childbirth Transfers Intrapartum Mixed-methods Qualitative Grounded theory Observation |
| title | Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia |
| title_full | Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia |
| title_fullStr | Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia |
| title_full_unstemmed | Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia |
| title_short | Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia |
| title_sort | journey of vulnerability a mixed methods study to understand intrapartum transfers in tanzania and zambia |
| topic | Transfers Intrapartum Mixed-methods Qualitative Grounded theory Observation |
| url | http://link.springer.com/article/10.1186/s12884-020-02996-8 |
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