Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study
Objective To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.Design The study was a facility-based, cross-sectional study.Setting Two public and tertiary hospitals in Addis Ababa.Participants All pregnant w...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/6/e033771.full |
| _version_ | 1818911845491146752 |
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| author | Yemane Berhane Endalkachew Mekonnen Assefa |
| author_facet | Yemane Berhane Endalkachew Mekonnen Assefa |
| author_sort | Yemane Berhane |
| collection | DOAJ |
| description | Objective To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.Design The study was a facility-based, cross-sectional study.Setting Two public and tertiary hospitals in Addis Ababa.Participants All pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals.Primary and secondary outcome measures The primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model.Results A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays.Conclusion and recommendation This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals’ set-up and readiness to manage obstetric emergencies. |
| first_indexed | 2024-12-19T23:05:10Z |
| format | Article |
| id | doaj.art-a1267a0ba93f48be8f4c3d028b55d367 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-12-19T23:05:10Z |
| publishDate | 2020-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-a1267a0ba93f48be8f4c3d028b55d3672022-12-21T20:02:23ZengBMJ Publishing GroupBMJ Open2044-60552020-06-0110610.1136/bmjopen-2019-033771Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional studyYemane Berhane0Endalkachew Mekonnen Assefa1Addis Continental Institute of Public Health, Addis Ababa, EthiopiaObstetrics and Gynecology, Addis Ababa University College of Health Sciences, Addis Ababa, EthiopiaObjective To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.Design The study was a facility-based, cross-sectional study.Setting Two public and tertiary hospitals in Addis Ababa.Participants All pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals.Primary and secondary outcome measures The primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model.Results A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays.Conclusion and recommendation This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals’ set-up and readiness to manage obstetric emergencies.https://bmjopen.bmj.com/content/10/6/e033771.full |
| spellingShingle | Yemane Berhane Endalkachew Mekonnen Assefa Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study BMJ Open |
| title | Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study |
| title_full | Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study |
| title_fullStr | Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study |
| title_full_unstemmed | Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study |
| title_short | Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study |
| title_sort | delays in emergency obstetric referrals in addis ababa hospitals in ethiopia a facility based cross sectional study |
| url | https://bmjopen.bmj.com/content/10/6/e033771.full |
| work_keys_str_mv | AT yemaneberhane delaysinemergencyobstetricreferralsinaddisababahospitalsinethiopiaafacilitybasedcrosssectionalstudy AT endalkachewmekonnenassefa delaysinemergencyobstetricreferralsinaddisababahospitalsinethiopiaafacilitybasedcrosssectionalstudy |