Experiences of referral with an obstetric emergency: voices of women admitted at Mbarara Regional Referral Hospital, South Western Uganda

Nabulo, Harriet; Gottfreðsdóttir, Helga; Ngonzi, Joseph; Kaye, Dan K.

doi:10.1186/s12884-023-05795-z

Cited by 4 publications

(1 citation statement)

References 46 publications

(51 reference statements)

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“…Initiatives to improve the quality of maternal healthcare services, enhance access to education, and alleviate poverty may have played a key role [ 88 , 89 , 90 , 91 ]. However, the MMR remains relatively high, suggesting that challenges such as health system weaknesses, the low socioeconomic status of women, and limited access to healthcare services are still prevalent [ 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ].…”

Section: Discussionmentioning

confidence: 99%

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990–2030): An ARIMA Forecasting Approach

Onambele,

Guillen-Aguinaga,

Guillen-Aguinaga

et al. 2023

Epidemiologia

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With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

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Section: Discussionmentioning

confidence: 99%

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990–2030): An ARIMA Forecasting Approach

Onambele,

Guillen-Aguinaga,

Guillen-Aguinaga

et al. 2023

Epidemiologia

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Experiences of referral with an obstetric emergency: voices of women admitted at Mbarara Regional Referral Hospital, South Western Uganda

Nabulo

Gottfreðsdóttir

Ngonzi

et al. 2023

BMC Pregnancy Childbirth

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Background Life-threatening obstetric complications usually lead to the need for referral and constitute the commonest direct causes of maternal deaths. Urgent management of referrals can potentially lower the maternal mortality rate. We explored the experiences of women referred with obstetric emergencies to Mbarara Regional Referral Hospital (MRRH) in Uganda, in order to identify barriers and facilitating factors. Methods This was an exploratory qualitative study. In-depth interviews (IDIs) were conducted with 10 postnatal women and 2 attendants as key informants. We explored health system and client related factors to understand how these could have facilitated or hindered the referral process. Data was analyzed deductively employing the constructs of the Andersen Healthcare Utilization model. Results Women experienced transport, care delays and inhumane treatment from health care providers (HCPs). The obstetric indications for referral were severe obstructed labor, ruptured uterus, and transverse lie in advanced labor, eclampsia and retained second twin with intrapartum hemorrhage. The secondary reasons for referral included; non-functional operating theatres due to power outages, unsterilized caesarian section instruments, no blood transfusion services, stock outs of emergency drugs, and absenteeism of HCPs to perform surgery. Four (4) themes emerged; enablers, barriers to referral, poor quality of care and poor health facility organization. Most referring health facilities were within a 30–50 km radius from MRRH. Delays to receive emergency obstetric care (EMOC) led to acquisition of in-hospital complications and eventual prolonged hospitalization. Enablers to referral were social support, financial preparation for birth and birth companion’s knowledge of danger signs. Conclusion The experience of obstetric referral for women was largely unpleasant due to delays and poor quality of care which contributed to perinatal mortality and maternal morbidities. Training HCPs in respectful maternity care (RMC) may improve quality of care and foster positive postnatal client experiences. Refresher sessions on obstetric referral procedures for HCPs are suggested. Interventions to improve the functionality of the obstetric referral pathway for rural south-western Uganda should be explored.

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“I was scared of the operation:” Qualitative study exploring the perceptions and experiences of women referred following obstetric complications in a Regional Referral Hospital in Eastern Uganda

Keem,

Nabirye,

Mukunya

et al. 2024

Preprint

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Introduction Women who are referred following emergency obstetric complications tend to experience several challenges while accessing obstetric care. This study was conducted to explore the perceptions and experiences of women who were referred following emergency obstetric complications in Eastern Uganda. Methods and materials We conducted 17 in-depth interviews with postpartum mothers who were referred to Mbale Regional Referral Hospital (MRRH). We explored the experiences and perceptions of women regarding the referral system, including their response to being referred, what they liked and disliked about being referred, and the challenges that they faced during referral. The study received ethical clearance and used thematic data analysis. Results We derived five themes from the data: 1) the facilitators of referral, 2) the challenges of reaching the referral site, 3) the quality of care in the referring facilities, 4) good quality of care in the referral facility, and 5) response to referral and appraisal of the referral system. An early decision to refer, informing the receiving facilities of the incoming referrals, and accompanying the woman to the referral site facilitated the referral of women. Women faced difficulty reaching the referral site because of financial constraints, poor roads, long distances, multiple referrals, and the use of inappropriate means of transport. Women experienced poor quality of care in the form of abuse and disrespectful maternity care, shortage of medicines and supplies, and unavailability of essential services in the referring facilities. Care in the receiving facility was perceived to be of good quality related to warm reception, immediate care on arrival, availability of services, and respectful and responsive healthcare providers. Response to being referred varied from being fearful, and anxious to reluctance and willingness to comply with referral advice. Overall, women positively appraised the referral system. Conclusions Women experienced challenges with referral systems related to inadequate staffing, poor quality of care, shortage of medicines and services, and difficulty reaching the referral site. Experiences and perceptions shaped how women responded to and appraised the referral system. Strengthening the quality of care in the referring facilities is critical in reducing unnecessary referrals and promoting positive birth outcomes.

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Experiences of referral with an obstetric emergency: voices of women admitted at Mbarara Regional Referral Hospital, South Western Uganda

Cited by 4 publications

References 46 publications

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990–2030): An ARIMA Forecasting Approach

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990–2030): An ARIMA Forecasting Approach

Experiences of referral with an obstetric emergency: voices of women admitted at Mbarara Regional Referral Hospital, South Western Uganda

“I was scared of the operation:” Qualitative study exploring the perceptions and experiences of women referred following obstetric complications in a Regional Referral Hospital in Eastern Uganda

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