Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania
Objectives The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.Design Prospective observational...
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BMJ Publishing Group
2023-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/9/e076364.full |
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| author | Lenka Benova Thérèse Delvaux Alexandre Delamou Nafissatou Dioubate Annettee Nakimuli Aline Semaan Dinah Amongin Bosede Bukola Afolabi Ochuwa Adiketu Babah Andrea Barnabas Pembe Sarah Nakubulwa Olubunmi Ogein Moses Adroma William Anzo Adiga Abdourahmane Diallo Lamine Diallo Mamadou Cellou Diallo Cécé Maomou Nathanael Mtinangi Telly Sy Niane Harissatou Amani Idris Kikula Ibrahima Sory Diallo Aduragbemi Oluwabusayo Banke-Thomas |
| author_facet | Lenka Benova Thérèse Delvaux Alexandre Delamou Nafissatou Dioubate Annettee Nakimuli Aline Semaan Dinah Amongin Bosede Bukola Afolabi Ochuwa Adiketu Babah Andrea Barnabas Pembe Sarah Nakubulwa Olubunmi Ogein Moses Adroma William Anzo Adiga Abdourahmane Diallo Lamine Diallo Mamadou Cellou Diallo Cécé Maomou Nathanael Mtinangi Telly Sy Niane Harissatou Amani Idris Kikula Ibrahima Sory Diallo Aduragbemi Oluwabusayo Banke-Thomas |
| author_sort | Lenka Benova |
| collection | DOAJ |
| description | Objectives The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.Design Prospective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.Setting Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.Results Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.Conclusions Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency. |
| first_indexed | 2024-03-11T20:43:48Z |
| format | Article |
| id | doaj.art-c5ba0d82b2224e009c0b4bbddd93c857 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T20:43:48Z |
| publishDate | 2023-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-c5ba0d82b2224e009c0b4bbddd93c8572023-10-01T20:45:08ZengBMJ Publishing GroupBMJ Open2044-60552023-09-0113910.1136/bmjopen-2023-076364Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and TanzaniaLenka Benova0Thérèse Delvaux1Alexandre Delamou2Nafissatou Dioubate3Annettee Nakimuli4Aline Semaan5Dinah Amongin6Bosede Bukola Afolabi7Ochuwa Adiketu Babah8Andrea Barnabas Pembe9Sarah Nakubulwa10Olubunmi Ogein11Moses Adroma12William Anzo Adiga13Abdourahmane Diallo14Lamine Diallo15Mamadou Cellou Diallo16Cécé Maomou17Nathanael Mtinangi18Telly Sy19Niane Harissatou20Amani Idris Kikula21Ibrahima Sory Diallo22Aduragbemi Oluwabusayo Banke-Thomas23Department of Public Health, Institute of Tropical Medicine, Antwerpen, BelgiumDepartment of Public Health, Institute of Tropical Medicine, Antwerpen, BelgiumDépartement de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, GuineaDépartement de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, GuineaDepartment of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, UgandaDepartment of Public Health, Institute of Tropical Medicine, Antwerpen, BelgiumDepartment of Health Policy Planning and Management, Makerere University, Kampala, UgandaDepartment of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, NigeriaDepartment of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, NigeriaDepartment of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of TanzaniaDepartment of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, UgandaCollege of Medicine, University of Lagos, Lagos, NigeriaDepartment of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, UgandaDepartment of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, UgandaService de la maternité, Hôpital National Ignace Deen, Conakry, GuineaService de la maternité, Hôpital Régional de Mamou, Mamou, GuineaService de la maternité, Hôpital National Ignace Deen, Conakry, GuineaService de la maternité, Hôpital Régional de Mamou, Mamou, GuineaDepartment of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, United Republic of TanzaniaService de la maternité, Hôpital National Ignace Deen, Conakry, GuineaInstitut de Nutrition et de Santé pour Enfants, Conakry, GuineaDepartment of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of TanzaniaInstitut de Nutrition et de Santé pour Enfants, Conakry, GuineaFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UKObjectives The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.Design Prospective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.Setting Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.Results Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.Conclusions Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency.https://bmjopen.bmj.com/content/13/9/e076364.full |
| spellingShingle | Lenka Benova Thérèse Delvaux Alexandre Delamou Nafissatou Dioubate Annettee Nakimuli Aline Semaan Dinah Amongin Bosede Bukola Afolabi Ochuwa Adiketu Babah Andrea Barnabas Pembe Sarah Nakubulwa Olubunmi Ogein Moses Adroma William Anzo Adiga Abdourahmane Diallo Lamine Diallo Mamadou Cellou Diallo Cécé Maomou Nathanael Mtinangi Telly Sy Niane Harissatou Amani Idris Kikula Ibrahima Sory Diallo Aduragbemi Oluwabusayo Banke-Thomas Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania BMJ Open |
| title | Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania |
| title_full | Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania |
| title_fullStr | Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania |
| title_full_unstemmed | Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania |
| title_short | Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania |
| title_sort | obstetric referrals complications and health outcomes in maternity wards of large hospitals during the covid 19 pandemic a mixed methods study of six hospitals in guinea nigeria uganda and tanzania |
| url | https://bmjopen.bmj.com/content/13/9/e076364.full |
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