Third Delays in the Management of Obstetric Emergencies: A Qualitative Study of Arua Regional Referral Hospital - Uganda (original) (raw)
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Texila International Journal of Public Health, 2020
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. A number of factors are attributable to this delay. Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV. Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers). Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%). Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV. Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).
Cognizance Journal of Multidisciplinary Studies, 2021
Signal functions are a representative shortlist of key interventions and activities that address major causes of morbidity or mortality and that are indicative of a certain type and level of care in a health facility. For example, signal functions indicative of "basic emergency obstetric care (EmOC)" could be provided by midwives at a lower level health centre, whereas "comprehensive EmOC" signal functions indicate a higher level of care, usually at a hospital or . Thus, signal function test is very vital in measuring Obstetric and Newborn Functionality of Health Facilities. On the other hand, third delays are the delays in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy.
Journal of Pregnancy
Background. Timing to get obstetric care is critical in preventing maternal death and disability. Maternal third delay, the delay in receiving care after reaching health facilities, involves factors related to organization, quality of care, patient referral, and availability of staff and equipment. However, data is limited on maternal third delay and its associated factors at higher health facilities in Ethiopia. Objective. This study is aimed at assessing the magnitude of maternal third delay and associated factors among women admitted for emergency obstetric care in public hospitals in Sidama Regional State, Ethiopia, 2021. Methods. An institution-based cross-sectional study was conducted from September to November 2021. Face-to-face interview with a structured questionnaire and data extraction from medical charts were carried out in selected 542 women (using systematic sampling method). The collected data were coded and entered using EpiData, and bivariable and multivariable logi...
Exploring the third delay: an audit evaluating obstetric triage at Mulago National Referral Hospital
BMC Pregnancy and Childbirth, 2016
Background: Mulago National Referral Hospital has the largest maternity unit in sub-Saharan Africa. It is situated in Uganda, where the maternal mortality ratio is 310 per 100,000 live births. In 2010 a 'Traffic Light System' was set up to rapidly triage the vast number of patients who present to the hospital every day. The aim of this study was to evaluate the effectiveness of the obstetric department's triage system at Mulago Hospital with regard to time spent in admissions and to identify urgent cases and factors adversely affecting the system. Methods: A prospective audit of the obstetric admissions department was carried out at the Mulago Hospital. Data were obtained from tagged patient journeys using two data collection tools and compiled using Microsoft Excel. StatsDirect was used to compose graphs to illustrate the results. Results: Informal triage was occurring 46 % of the time at the first checkpoint in a woman's journey, but the 'Traffic Light System' was not being used and many of the patient's vital signs were not being recorded. Conclusions: It is hypothesised that the 'Traffic Light System' is not being used due to its focus on examination finding and diagnosis, implying that it is not suitable for an early stage in the patient's journey. Replacing it with a simple algorithm to categorise women into the urgency with which they need to be seen could rectify this.
2017
Background: Perinatal audit and the three-delays model are increasingly being employed to analyse barriers to perinatal health, at both community and facility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals. Methods: Perinatal audits were carried out at two main urban hospitals, one at district level and the other at tertiary level, in Kigali, Rwanda, from July 2012 to May 2013. Stillbirths and early neonatal deaths occurring after 22 completed weeks of gestation or more, or weighing at least 500 g, were included in the study. Factors contributing to mortality and potentially avoidable deaths, considering the local resources and feasibility, were identified using a three-delays model. Results: Out of 8424 births, there were 269 perinatal deaths (106 macerated stillbirths, 63 fresh stillbirths, 100 early neonatal deaths) corresponding to a stillbirth rate of 20/1000 births and a perinatal mortality rate of 32/1000 births. In total, 250 perinatal deaths were available for audit. Factors contributing to mortality were ascertained for 79% of deaths. Delay in care-seeking was identified in 39% of deaths, delay in arriving at the health facility in 10%, and provision of suboptimal care at the health facility in 37%. Delay in seeking adequate care was commonly characterized by difficulties in recognising or reporting pregnancy-related danger signs. Lack of money was the major cause of delay in reaching a health facility. Delay in referrals, diagnosis and management of emergency obstetric cases were the most prominent contributors affecting the provision of appropriate and timely care by healthcare providers. Half of the perinatal deaths were judged to be potentially avoidable and 70% of these were fresh stillbirths and early neonatal deaths. Conclusions: Factors contributing to delays underlying perinatal mortality were identified in more than threequarters of deaths. Half of the perinatal deaths were considered likely to be preventable and mainly related to modifiable maternal inadequate health-seeking behaviours and intrapartum suboptimal care. Strengthening the current roadmap strategy for accelerating the reduction of maternal and neonatal morbidity and mortality is needed for improved perinatal survival.
Third delay of Maternal Mortality in a tertiary hospital
2007
Objective: To assess the magnitude, causes and substandard care factors responsible for the third delay of maternal mortality seen in our unit III, Department of Obstetrics and Gynecology, Civil Hospital, Karachi. Methods: This Cross-sectional, retrospective study was carried out on 152 mothers who died over a period of eight years from 1997 to 2004 at Civil Hospital Karachi. Death summaries of all maternal deaths were reviewed from death registers and were studied for substandard care factors which could have been responsible for the third delay of maternal mortality. Results: The frequency of maternal mortality was 1.3 per 100 deliveries. The mean age was 29±6.49 years and mean parity was 3.24±3.25.The main causes of death were hypertensive disorders in 52/152 (34.21%), hemorrhage in 40/152 (26.31%), unsafe abortion in 16/152 (10.52%), puerperal sepsis in 14/152 (9.21%) and obstructed labor in 11/152 (7.2%) cases. Substandard care factors were present in 76.7% of patients, which i...
Factors associated with maternal delays in utilising emergency obstetric care in Arsi Zone, Ethiopia
South African Journal of Obstetrics and Gynaecology, 2019
Background. Delay to timely healthcare contributes to high maternal mortality and morbidity in developing countries. The so-called 'Three delays' model has been used extensively to investigate factors relating to maternal mortality. Objective. To investigate factors associated with delayed emergency obstetric care in Arsi Zone, Ethiopia. Methods. A cross-sectional study was conducted across 10 public health facilities in Arsi Zone, Ethiopia. The required sample size was calculated as 847, with the number of participants required at each facility determined proportionally. Results. Data from 775 respondents were used in the analysis. Approximately a quarter of respondents (n=203; 26.2%) reported a delayed decision to seek emergency obstetric care. The mean time for delay was 90 minutes (range 30 minutes-18 hours). Maternal age, educational level, monthly household income and antenatal visits were significant predictors of this first maternal delay. Close to a third of the respondents (n=234; 30.2%) reported a transport-related delay in reaching a healthcare facility; some respondents walked at least 30 minutes to reach the facility. Approximately a quarter of respondents (n=198; 25.5%) reported that they did not receive timely care after arriving at the healthcare facility. The mean delay was 42.3 minutes. Conclusion. The most common delay was related to difficulty in reaching the healthcare facility. In approximately half of the cases, the woman's husband took the decision to access medical care. This suggests limited independent decision-making power of women in this context. Such factors should be considered in efforts to reduce maternal morbidity and mortality.