Background:Providing high-quality maternity services is crucial to increase utilization of these services and reduce maternal mortality. The quality of the maternity services provided to pregnant women in rural areas of Iran is poorly understood. Objectives: This study aimed to investigate the quality gap in the maternity care services provided by Rural Delivery Facilities and Safe Delivery Posts in Sistan and Balouchestan Province, southeast of Iran, as expressed by the difference in women's perceptions and experiences of services. Patients and Methods:In this cross-sectional study a total of 438 pregnant women who gave birth in rural maternity unit were recruited between February and May 2013. The SERVQUAL questionnaire was used for data collection. The Wilcoxon Signed-Rank test was used to compare the quality gap as expressed in the mean of differences in the expectation and perception scores. The quality gap was compared between demographic groups using Kruskal-Wallis tests. Results: There was a negative gap in all dimensions of the quality of services provided. The highest quality gap was found for the reliability dimension followed by tangibles, empathy, assurance and responsiveness. The participants' age, levels of education and the type of maternity unit were found to be associated with the clients' perceived quality of services. Conclusions:The quality gap in the services provided by maternity units showed that these units are not able to meet pregnant women's expectations completely. The negative quality gaps can be used as a guideline to improve the maternal health care quality and reduce maternal mortality, particularly in high-risk women such as those living in rural areas.
Objective: It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women. Materials and methods: This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis. Results: From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth). Conclusion: The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.
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