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Matthew C Strehlow, Jennifer A Newberry, Corey B Bills, Hyeyoun Elise Min, Ann E Evensen, Lawrence Leeman, Elizabeth A Pirrotta, G V Ramana Rao, S V Mahadevan
OBJECTIVES: Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS). DESIGN: Prospective observational study. SETTING: Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014. PARTICIPANTS: This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a 'pregnancy-related' problem for free-of-charge ambulance transport...
2016: BMJ Open
Bakar Fakih, Azzah A S Nofly, Ali O Ali, Abdallah Mkopi, Ali Hassan, Ali M Ali, Kate Ramsey, Theopista John Kabuteni, Godfrey Mbaruku, Mwifadhi Mrisho
BACKGROUND: It is estimated that 287,000 women worldwide die annually from pregnancy and childbirth-related conditions, and 6.9 million under-five children die each year, of which about 3 million are newborns. Most of these deaths occur in sub-Saharan Africa. The maternal health situation in Tanzania mainland and Zanzibar is similar to other sub-Saharan countries. This study assessed the availability, accessibility and quality of emergency obstetric care services and essential resources available for maternal and child health services in Zanzibar...
2016: BMC Pregnancy and Childbirth
Abel Mukengeshayi Ntambue, Françoise Kaj Malonga, Michele Dramaix-Wilmet, Roger Nlandu Ngatu, Philippe Donnen
BACKGROUND: The Democratic Republic of Congo (DRC) has a high rate of perinatal mortality (PMR), and health measures that could reduce this high rate of mortality are not accessible to all women. Where they are in place, their quality is not optimal. This study was initiated to assess the relationship between these suboptimal maternal, newborn and child health (MNCH) services and perinatal mortality (PM) in Lubumbashi, DRC's second-largest city. METHODS: We conducted a prospective cohort study, comparing women who had no, low, moderate, or high numbers of antenatal care (ANC) visits; three different levels of delivery care; and who did or did not attend postnatal care (PNC)...
2016: BMC Pregnancy and Childbirth
Ashis Das, Saji S Gopalan, Daniel Chandramohan
BACKGROUND: Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs. METHODS: A systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care...
2016: BMC Public Health
Angelo S Nyamtema, Nguke Mwakatundu, Sunday Dominico, Hamed Mohamed, Senga Pemba, Richard Rumanyika, Clementina Kairuki, Irene Kassiga, Allan Shayo, Omary Issa, Calist Nzabuhakwa, Chagi Lyimo, Jos van Roosmalen
BACKGROUND: In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. METHODS: Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems...
2016: PloS One
A M Kanté, A Exavery, J F Phillips, E F Jackson
OBJECTIVES: In the Tanzanian health system, women are expected to first visit their nearest front-line health facility (FLF) for delivery. However, women frequently bypass these FLF. Our study estimates the extent of bypassing for childbirth and assesses factors associated with this behaviour. METHODS: Data describing the experiences of 597 women who recently delivered at a facility and the EmONC service capability at 107 health facilities were collected in 2011...
April 2016: Tropical Medicine & International Health: TM & IH
Samuel Bosomprah, Andrew J Tatem, Winfred Dotse-Gborgbortsi, Patrick Aboagye, Zoe Matthews
OBJECTIVE: To provide clear policy directions for gaps in the provision of signal function services and sub-regions requiring priority attention using data from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey. METHODS: Using 2010 survey data, the fraction of facilities with only one or two signal functions missing was calculated for each facility type and EmONC designation. Thematic maps were used to provide insight into inequities in service provision...
January 2016: International Journal of Gynaecology and Obstetrics
Jennifer H Tang, Charlotte Kaliti, Angela Bengtson, Sumera Hayat, Eveles Chimala, Rachel MacLeod, Stephen Kaliti, Fanny Sisya, Mwawi Mwale, Jeffrey Wilkinson
OBJECTIVE: To evaluate whether a hospital-based mentoring program could significantly increase short- and longer-term emergency obstetrics and neonatal care (EmONC) knowledge and skills among health providers. METHODS: In a prospective before-and-after study, 20 mentors were trained using a specially-created EmONC mentoring and training program at Bwaila Hospital in Lilongwe, Malawi. The mentors then trained an additional 114 providers as mentees in the curriculum...
February 2016: International Journal of Gynaecology and Obstetrics
Primus Che Chi, Patience Bulage, Henrik Urdal, Johanne Sundby
OBJECTIVES: Maternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services...
2015: PloS One
Emmanuel Otolorin, Patricia Gomez, Sheena Currie, Kusum Thapa, Blami Dao
Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings...
June 2015: International Journal of Gynaecology and Obstetrics
Anne-Marie Bergh, Shisana Baloyi, Robert C Pattinson
This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed - five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries...
November 2015: Best Practice & Research. Clinical Obstetrics & Gynaecology
Anne-Marie Bergh, Emma Allanson, Robert C Pattinson
Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale-up and sustainability of such programmes. We reviewed the existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa...
November 2015: Best Practice & Research. Clinical Obstetrics & Gynaecology
Charles A Ameh, Nynke van den Broek
An estimated 289,000 maternal deaths, 2.6 million stillbirths and 2.4 million newborn deaths occur globally each year, with the majority occurring around the time of childbirth. The medical and surgical interventions to prevent this loss of life are known, and most maternal and newborn deaths are in principle preventable. There is a need to build the capacity of health-care providers to recognize and manage complications during pregnancy, childbirth and the post-partum period. Skills-and-drills competency-based training in skilled birth attendance, emergency obstetric care and early newborn care (EmONC) is an approach that is successful in improving knowledge and skills...
November 2015: Best Practice & Research. Clinical Obstetrics & Gynaecology
Marion Ravit, Aline Philibert, Caroline Tourigny, Mamadou Traore, Aliou Coulibaly, Alexandre Dumont, Pierre Fournier
The fee exemption policy for EmONC in Mali aims to lower the financial barrier to care. The objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in EmONC and the factors associated with these expenses. Data sampling followed the case control approach used in the large project (deceased and near-miss women). Our sample consisted of a total of 190 women who underwent caesarean interventions. Data were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman...
August 2015: Maternal and Child Health Journal
Sunil Saksena Raj, Suneedh Manthri, Pratap Kumar Sahoo
BACKGROUND: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). METHODS: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010...
February 2015: International Journal of Health Policy and Management
Lauren Owens, Katherine Semrau, Reuben Mbewe, Kebby Musokotwane, Caroline Grogan, Deborah Maine, Davidson H Hamer
OBJECTIVE: To evaluate the capacity of health facilities in Southern Province, Zambia, to perform routine obstetric care and emergency obstetric and neonatal care (EmONC). METHODS: Surveys were completed at 90 health centers and 10 hospitals between September 1, 2011, and February 28, 2012. An expanded set of signal functions for routine care and EmONC was used to assess the facilities' capacity to provide obstetric and neonatal care. RESULTS: Interviews were completed with 172 health workers...
January 2015: International Journal of Gynaecology and Obstetrics
Alemnesh H Mirkuzie, Mitike Molla Sisay, Alemnesh Tekelebirhan Reta, Mulu Muleta Bedane
BACKGROUND: Emergency obstetric and neonatal care (EmONC) is a high impact priority intervention highly recommended for improving maternal and neonatal health outcomes. In 2008, Ethiopia conducted a national EmONC survey that revealed implementation gaps, mainly due to resource constraints and poor competence among providers. As part of an ongoing project, this paper examined progress in the implementation of the basic EmONC (BEmONC) in Addis Ababa and compared with the 2008 survey. METHODS: A facility based intervention project was conducted in 10 randomly selected public health centers (HCs) in Addis Ababa and baseline data collected on BEmONC status from January to March 2013...
2014: BMC Pregnancy and Childbirth
Alemnesh H Mirkuzie, Mitike Molla Sisay, Mulu Muleta Bedane
BACKGROUND: In 2010, the Federal Ministry of Health of Ethiopia (FMOH) has developed standard Basic Emergency Obstetric and Neonatal Care (BEmONC) in-service training curricula to respond to the high demand for competency in EmONC. However, the effectiveness of the training curricula has not been well documented. A collaborative intervention project in Addis Ababa has trained providers using the standard BEmONC curricula where this paper presents Krikpartick level 1 and level 2 evaluation of the training...
2014: BMC Medical Education
David R Ellard, Wanangwa Chimwaza, David Davies, Joseph Paul O'Hare, Francis Kamwendo, Siobhan Quenby, Frances Griffiths
OBJECTIVES: The 'enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa' (ETATMBA) project is training emergency obstetric and new-born care (EmONC) non-physician clinicians (NPCs) as advanced clinical leaders. Our objectives were to evaluate the implementation and changes to practice. DESIGN: A mixed methods process evaluation with the predominate methodology being qualitative. SETTING: Rural and urban hospitals in 8 of the 14 districts of northern and central Malawi...
2014: BMJ Open
Mohamed Yilla, Sara L Nam, Austine Adeyemo, Samuel A Kargbo
The Government of Sierra Leone launched the Free Health Care Initiative in 2010, which contributed to increased use of facility based maternity services. However, emergency obstetric and neonatal care (EmONC) facilities were few and were inadequately equipped to meet the increased demand. To ensure provision of EmONC in some priority facilities, the Ministry of Health and Sanitation undertook regular facility assessments. With the use of assessment tools and scorecards it is possible to make improvements to the services provided in the period after assessment...
October 2014: International Journal of Gynaecology and Obstetrics
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