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P E Bailey, J van Roosmalen, G Mola, C Evans, L de Bernis, B Dao
OBJECTIVE: To assess the use of assisted vaginal delivery (AVD) in low- and middle-income countries (LMICs), highlighting what level of care procedures were performed and identifying systemic barriers to its use. DESIGN: Cross-sectional health facility assessments. SETTING: Up to 40 countries in Latin America, sub-Saharan Africa and Asia. POPULATION: Assessments tended to be national in scope and included all hospitals and samples of midlevel facilities in public and private sectors...
January 31, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Florina Serbanescu, Howard I Goldberg, Isabella Danel, Tadesse Wuhib, Lawrence Marum, Walter Obiero, James McAuley, Jane Aceng, Ewlyn Chomba, Paul W Stupp, Claudia Morrissey Conlon
BACKGROUND: Achieving maternal mortality reduction as a development goal remains a major challenge in most low-resource countries. Saving Mothers, Giving Life (SMGL) is a multi-partner initiative designed to reduce maternal mortality rapidly in high mortality settings through community and facility evidence-based interventions and district-wide health systems strengthening that could reduce delays to appropriate obstetric care. METHODS: An evaluation employing multiple studies and data collection methods was used to compare baseline maternal outcomes to those during Year 1 in SMGL pilot districts in Uganda and Zambia...
January 19, 2017: BMC Pregnancy and Childbirth
Abel Mukengeshayi Ntambue, Françoise Kaj Malonga, Karen D Cowgill, Michèle Dramaix-Wilmet, Philippe Donnen
BACKGROUND: While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi. METHODS: This cross-sectional survey was conducted in April and May 2011...
January 19, 2017: BMC Pregnancy and Childbirth
Adja Mariam Ouédraogo, Laeticia Ouédraogo/Nikiema, Ivlabèhiré Bertrand Meda, Kassouta N'Tapi, Seni Kouanda
OBJECTIVE: To assess the availability, utilization, and quality of emergency obstetric and neonatal care (EmONC) in Togo. METHODS: A cross-sectional study of EmONC services in all public and private health facilities in the territory of Togo conducted from July to December, 2012. The generic tools developed by the Averting Maternal Death and Disability program were used as the basic tools for this evaluation. RESULTS: The survey involved 1019 health facilities including 864 potential EmONC facilities that constituted the final sample...
November 2016: International Journal of Gynaecology and Obstetrics
Adama Baguiya, Ivlabèhiré Bertrand Meda, Tieba Millogo, Mamadou Kourouma, Halima Mouniri, Seni Kouanda
OBJECTIVE: To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) in Guinea given the high maternal and neonatal mortality rates. METHODS: We used the Guinea 2012 needs assessment data collected via a national cross-sectional census of health facilities conducted from September to October 2012. All public, private, and faith-based health facilities that performed at least one delivery during the period of the study were included...
November 2016: International Journal of Gynaecology and Obstetrics
Seni Kouanda, Adja M Ouédraogo, Gautier H Ouédraogo, Djeneba Sanon, Seydou Belemviré, Leopold Ouédraogo
OBJECTIVE: To analyze and compare the availability, utilization, and quality of services for maternal and neonatal health in 2010 and 2014 in Burkina Faso. METHODS: A cross-sectional study of emergency obstetric and neonatal care services (EmONC) in all public and private health facilities in Burkina Faso in 2010 and a sample of 812 health facilities in 2014. The generic tools developed by the Averting Maternal Death and Disability (AMDD) program were used as the basic tools for evaluation...
November 2016: International Journal of Gynaecology and Obstetrics
Carolyn Blake, Nii Ankonu Annorbah-Sarpei, Claire Bailey, Yakubu Ismaila, Sylvia Deganus, Samuel Bosomprah, Francesco Galli, Sarah Clark
BACKGROUND: With the limited availability of quality emergency obstetric and newborn care (EmONC) in Ghana, and a lack of dialogue on the issue at district level, the Evidence for Action (E4A) program (2011-2015) initiated a pilot intervention using a social accountability approach in two regions of Ghana. OBJECTIVE: Using scorecards to assess and improve maternal and newborn health services, the intervention study evaluated the effectiveness of engaging multiple, health and non-health sector stakeholders at district level to improve the enabling environment for quality EmONC...
December 2016: International Journal of Gynaecology and Obstetrics
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)...
April 26, 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...
April 14, 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
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