Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

Alaofè, Halimatou; Lott, Breanne E.; Kimaru, Linda; Okusanya, Babasola O; Okechukwu, Abidemi; Chebet, Joy J.; Meremikwu, Martin; Ehiri, John E.

doi:10.5334/aogh.2934

Cited by 20 publications

(29 citation statements)

References 47 publications

(151 reference statements)

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“…Most of the women residing in rural areas would mostly prefer traditional birth attendants due to lack of birth preparedness plans [ 56 – 58 ]. On the other hand, women who died during transit were mostly affected by the unavailability of transportation on their referral from a peripheral health facility [ 59 , 60 ]. Considering the gap, Ethiopia has established maternity waiting rooms (MWRs), which serve as a waiting area until labor is initiated.…”

Section: Discussionmentioning

confidence: 99%

Area of focus to handle delays related to maternal death in Ethiopia

et al. 2022

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Background Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia. Methods The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay. Result Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death. Conclusion Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.

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Section: Discussionmentioning

confidence: 99%

Area of focus to handle delays related to maternal death in Ethiopia

et al. 2022

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“…Some countries like Ethiopia established maternal waiting areas (MWA) for mothers who came from hardto-reach areas [40]. Moreover, integrating emergency obstetrics transportation with complementary maternal health services avert adverse pregnancy outcomes and improves access to skilled obstetric services for women in LMICs [41]. Likewise, women experienced intimate partner physical violence (beating) associated with increased occurrence of adverse birth outcomes.…”

Section: Discussionmentioning

confidence: 99%

Determinants of adverse birth outcome in Sub-Saharan Africa: analysis of recent demographic and health surveys

et al. 2021

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Background More than 75% of neonatal deaths occurred in the first weeks of life as a result of adverse birth outcomes. Low birth weight, preterm births are associated with a variety of acute and long-term complications. In Sub-Saharan Africa, there is insufficient evidence of adverse birth outcomes. Hence, this study aimed to determine the pooled prevalence and determinants of adverse birth outcomes in Sub-Saharan Africa. Method Data of this study were obtained from a cross-sectional survey of the most recent Demographic and Health Surveys (DHS) of ten Sub-African (SSA) countries. A total of 76,853 children born five years preceding the survey were included in the final analysis. A Generalized Linear Mixed Models (GLMM) were fitted and an adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was computed to declare statistically significant determinants of adverse birth outcomes. Result The pooled prevalence of adverse birth outcomes were 29.7% (95% CI: 29.4 to 30.03). Female child (AOR = 0.94, 95%CI: 0.91 0.97), women attended secondary level of education (AOR = 0.87, 95%CI: 0.82 0.92), middle (AOR = 0.94,95%CI: 0.90 0.98) and rich socioeconomic status (AOR = 0.94, 95%CI: 0.90 0.99), intimate-partner physical violence (beating) (AOR = 1.18, 95%CI: 1.14 1.22), big problems of long-distance travel (AOR = 1.08, 95%CI: 1.04 1.11), antenatal care follow-ups (AOR = 0.86, 95%CI: 0.83 0.86), multiparty (AOR = 0.88, 95%CI: 0.84 0.91), twin births (AOR = 2.89, 95%CI: 2.67 3.14), and lack of women involvement in healthcare decision-making process (AOR = 1.10, 95%CI: 1.06 1.13) were determinants of adverse birth outcomes. Conclusion This study showed that the magnitude of adverse birth outcomes was high, abnormal baby size and preterm births were the most common adverse birth outcomes. This finding suggests that encouraging antenatal care follow-ups and socio-economic conditions of women are essential. Moreover, special attention should be given to multiple pregnancies, improving healthcare accessibilities to rural areas, and women’s involvement in healthcare decision-making.

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“…Although obstetric emergency referral is associated with decreased maternal mortality, poor liaison among health facilities in SSA results in unnecessary delays and affect EmOC service provision [6,11]. Reviews that explored the effectiveness of obstetric referral interventions have mainly focused on strategies to reduce delays in reaching a referral facility [12,13]. There is no review capturing interventions that minimise delays in referral when pregnant women arrive at health facilities.…”

Section: Introductionmentioning

confidence: 99%

Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub‐Saharan Africa: A systematic review

Avoka

McArthur

Banke-Thomas

2022

Tropical Med Int Health

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Objective The objective of the study was to review the evidence on interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub‐Saharan Africa (SSA). Methods A systematic search of PubMed, Embase, Cochrane Register and CINAHL Plus was conducted to identify studies on obstetric emergency referral in SSA. Studies were included based on pre‐defined eligibility criteria. Details of reported referral interventions were extracted and categorised. The Joanna Biggs Institute Critical Appraisal checklists were used for quality assessment of included studies. A formal narrative synthesis approach was used to summarise findings guided by the WHO's referral system flow. Results A total of 14 studies were included, with seven deemed high quality. Overall, 7 studies reported referral decision‐making interventions including training programmes for health facility and community health workers, use of a triage checklist and focused obstetric ultrasound, which resulted in improved knowledge and practice of recognising danger signs for referral. 9 studies reported on referral communication using mobile phones and referral letters/notes, resulting in increased communication between facilities despite telecommunication network failures. Referral decision making and communication interventions achieved a perceived reduction in maternal mortality. 2 studies focused on referral feedback, which improved collaboration between health facilities. Conclusion There is limited evidence on how well referral interventions work in sub‐Saharan Africa, and limited consensus regarding the framework underpinning the expected change. This review has led to the proposition of a logic model that can serve as the base for future evaluations which robustly expose the (in)efficiency of referral interventions.

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Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

Cited by 20 publications

References 47 publications

Area of focus to handle delays related to maternal death in Ethiopia

Area of focus to handle delays related to maternal death in Ethiopia

Determinants of adverse birth outcome in Sub-Saharan Africa: analysis of recent demographic and health surveys

Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub‐Saharan Africa: A systematic review

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