The United Nations Process Indicators for emergency obstetric care: Reflections based on a decade of experience

Paxton, Anne; Bailey, Patricia; Lobis, Samantha

doi:10.1016/j.ijgo.2006.08.009

Cited by 93 publications

(122 citation statements)

References 34 publications

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“…Measurements of met need in the African countries without surgically qualified nonphysician clinicians have usually shown very low levels outside of the major cities for this UN process indicator. 10 The first phase of our investigation showed that met need in these two regions of Tanzania is 30 percent. Uganda and Kenya, two adjacent countries that have much larger numbers of qualified physicians, report met need levels of 5 percent and 3 percent, respectively.…”

Section: Discussion and Policy Implicationsmentioning

confidence: 85%

The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

et al. 2009

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Five countries in sub-Saharan Africa use nonphysicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers provide most of this surgery outside of major cities. Questions about the quality of surgery by nonphysicians have kept most African countries from following this example. We reviewed the records of all patients admitted for complicated deliveries to fourteen district hospitals during four months. Among 1,134 complicated deliveries and 1,072 major obstetrical operations, there were no significant differences between assistant medical officers and medical officers in outcomes, risk indicators, or quality. There were significant differences between mission and government hospitals. I n r e s p o n s e to a c r i t i c a l s h o rtage of health care personnel with clinical skills, twenty-five of forty-seven nations in sub-Saharan Africa have trained and officially authorized nonphysician clinicians to provide clinical services, including writing prescriptions and performing minor surgery. In nineteen countries these clinicians are authorized to provide obstetrical care, but in only five (Ethiopia, Ghana, Malawi, Mozambique, and Tanzania) are they allowed to do cesarean sections and other major emergency obstetrical surgery. A f r i c a n W o r k f o r c e

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Section: Discussion and Policy Implicationsmentioning

confidence: 85%

The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

et al. 2009

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“…A current estimate of caesarean section rate in the sub-Saharan regions is about 2%, and as low as 0.4% in the Far North of Cameroon [30]. This is lower than the national rate of 5% -15% of the estimated live births currently recommended by the United Nations [31]. Hence some of these children who sustained hypoxic ischemic lesions could have been saved if there was a prompt intervention to obstetrical and perinatal complications and an increase in caesarean section rates.…”

Section: Discussionmentioning

confidence: 90%

Causes of developmental delay in children of 5 to 72 months old at the child neurology unit of Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon)

Nguefack¹,

Kamga²,

Moifo³

et al. 2013

OJPed

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Background: According to the World Health Organization, about 5% of children world-wide of 14-year-old and under have a moderate to severe developmental disability, and up to 15% of children under 5-year-old are developmentally delayed. Purpose: To determine the prevalence, socio-demographic profile, aetiologies, and the clinical presentation of developmental delay in children less than 6-year-old at the child neurology unit in a university-affiliated hospital in Yaounde. Materials and methods: It was a crosssectional descriptive study carried out in Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from August to December 2012. Children aged between 5 -72 months with a developmental quotient less than 70 were enrolled. Developmental delay (DD) was diagnosed and classified using the Denver developmental screening test (DDST). Data concerning the child (age, gender, severity of DD), the mother (age, age at conception, educational level, marital status), history of pregnancy and delivery, perinatal and postnatal events, results of para-clinical explorations (EEG, CT-scan, genetic tests), the severity of DD and the probable or demonstrate cause of DD were recorded on a standardized questionnaire. The chisquare test was used to compare variables. Results: During the study period, 2171 children aged 5 -72 months consulted the paediatric department of the hospital, 296 were examined at the child neurology unit of which 153 had a developmental quotient less than 70, giving a hospital prevalence of 7.0% and a prevalence of 51.7% at the child neurology unit. The mean age was 26.6 ± 18.0 months and there were 56% males. The main reason for consulting was tonus disorder (43.8%) and the developmental area of parental concern was the motor domain (90.2%). Regarding the clinical presentation, 75.2% of our population were children with cerebral palsy. DD was severe, mild, moderate and profound respectively in 14.2%, 13.5%, 12.2%, and 11.1%. Gross DD represented 90.2% of all DD children. The causes of DD were hypoxic-ischemic encephalopathy (41.8%), epilepsy (13.7%), sequelae of meningitis (6.5%), sequelae of kernicterus (6.5%), and infectious embryofoetopathies (5.2%). Conclusion: Developmental delay is frequent in paediatric neurology, with perinatal disorders being the leading aetiologies in Cameroon. Prevention of perinatal hypoxic-ischemic encephalopathy risk factors needs to be reinforced.

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“…Previous studies have identified limitations of the UN process indicators, which categorize health facilities as providing basic EmOC if they have performed each of the six signal functions at least once within the previous 3 months [19][20][21][22][23]. First, the process indicators cannot assess quality of care, such as whether the obstetric complications are being appropriately managed [22].…”

Section: Discussionmentioning

confidence: 99%

“…Second, some facilities do not have enough complicated deliveries to perform all six signal functions within a 3-month time frame and are thus classified as "nonEmOC"; for example, health centres rarely perform assisted vaginal delivery [22,23]. The Averting Maternal Death and Disability Program advocates using a designation of "basic minus one" for these facilities, to accurately reflect their contribution [23]. However, this system is unable to assess the capacity of facilities where all complications occur on an infrequent basis.…”

Section: Discussionmentioning

confidence: 99%

19: Measuring Access to Emergency Obstetric Care in Rural Zambia

Levine

Marsh

Nelson

et al. 2008

Annals of Emergency Medicine

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The United Nations Process Indicators for emergency obstetric care: Reflections based on a decade of experience

Abstract: The EmOC process indicators have been used successfully in a wide variety of settings. They describe vital elements of the health system and how well that system is functioning for women at risk of dying from major obstetric complications.

Cited by 93 publications

References 34 publications

The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

Causes of developmental delay in children of 5 to 72 months old at the child neurology unit of Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon)

19: Measuring Access to Emergency Obstetric Care in Rural Zambia

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