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Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia

Measuring facility readiness to manage basic obstetric emergencies is a critical step toward reducing persistently elevated maternal mortality ratios (MMR). Currently, the Signal Functions (SF) is the gold standard for measuring facility readiness globally and endorsed by the World Health Organizati...

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Autores principales: Dougherty, Kylie, Gebremariam Gobezayehu, Abebe, Lijalem, Mulusew, Alamineh Endalamaw, Lamesgin, Biza, Heran, Cranmer, John N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399735/
https://www.ncbi.nlm.nih.gov/pubmed/37535678
http://dx.doi.org/10.1371/journal.pone.0289496
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author Dougherty, Kylie
Gebremariam Gobezayehu, Abebe
Lijalem, Mulusew
Alamineh Endalamaw, Lamesgin
Biza, Heran
Cranmer, John N.
author_facet Dougherty, Kylie
Gebremariam Gobezayehu, Abebe
Lijalem, Mulusew
Alamineh Endalamaw, Lamesgin
Biza, Heran
Cranmer, John N.
author_sort Dougherty, Kylie
collection PubMed
description Measuring facility readiness to manage basic obstetric emergencies is a critical step toward reducing persistently elevated maternal mortality ratios (MMR). Currently, the Signal Functions (SF) is the gold standard for measuring facility readiness globally and endorsed by the World Health Organization. The presence of tracer items classifies facilities’ readiness to manage basic emergencies. However, research suggests the SF may be an incomplete indicator. The Clinical Cascades (CC) have emerged as a clinically-oriented alternative to measuring readiness. The purpose of this study is to determine Amhara’s clinical readiness and quantify the relationship between SF and CC estimates of readiness. Data were collected in May 2021via Open Data Kit (ODK) and KoBo Toolbox. We surveyed 20 hospitals across three levels of the health system. Commodities were used to create measures of SF-readiness (e.g., % tracers) and CC-readiness. We calculated differences in SF and CC estimates and calculated readiness loss across six emergencies and 3 stages of care in the cascades. The overall SF estimate for all six obstetric emergencies was 29.6% greater than the estimates using the CC. Consistent with global patterns, hospitals were more prepared to provide medical management (70.0% ready) compared to manual procedures (56.7% ready). The SF overestimate was greater for manual procedures 33.8% overall for retained placenta and incomplete abortion) and less for medical treatments (25.3%). Hospitals were least prepared to manage retained placentas (30.0% of facilities were ready at treatment and 0.0% were ready at monitor and modify) and most prepared to manage hypertensive emergencies (85.0% of facilities were ready at the treatment stage). When including protocols in the analysis, no facilities were ready to monitor and modify the initial therapy when clinically indicated for 3 common emergencies—sepsis, post-partum hemorrhage and retained placentas. We identified a significant discrepancy between SF and CC readiness classifications. Those facilities that fall within this discrepancy are unprepared to manage common obstetric emergencies, and employees in supply management may have difficulty identify the need. Future research should explore the possibility of modifying the SF or replacing it with a new readiness measurement.
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spelling pubmed-103997352023-08-04 Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia Dougherty, Kylie Gebremariam Gobezayehu, Abebe Lijalem, Mulusew Alamineh Endalamaw, Lamesgin Biza, Heran Cranmer, John N. PLoS One Research Article Measuring facility readiness to manage basic obstetric emergencies is a critical step toward reducing persistently elevated maternal mortality ratios (MMR). Currently, the Signal Functions (SF) is the gold standard for measuring facility readiness globally and endorsed by the World Health Organization. The presence of tracer items classifies facilities’ readiness to manage basic emergencies. However, research suggests the SF may be an incomplete indicator. The Clinical Cascades (CC) have emerged as a clinically-oriented alternative to measuring readiness. The purpose of this study is to determine Amhara’s clinical readiness and quantify the relationship between SF and CC estimates of readiness. Data were collected in May 2021via Open Data Kit (ODK) and KoBo Toolbox. We surveyed 20 hospitals across three levels of the health system. Commodities were used to create measures of SF-readiness (e.g., % tracers) and CC-readiness. We calculated differences in SF and CC estimates and calculated readiness loss across six emergencies and 3 stages of care in the cascades. The overall SF estimate for all six obstetric emergencies was 29.6% greater than the estimates using the CC. Consistent with global patterns, hospitals were more prepared to provide medical management (70.0% ready) compared to manual procedures (56.7% ready). The SF overestimate was greater for manual procedures 33.8% overall for retained placenta and incomplete abortion) and less for medical treatments (25.3%). Hospitals were least prepared to manage retained placentas (30.0% of facilities were ready at treatment and 0.0% were ready at monitor and modify) and most prepared to manage hypertensive emergencies (85.0% of facilities were ready at the treatment stage). When including protocols in the analysis, no facilities were ready to monitor and modify the initial therapy when clinically indicated for 3 common emergencies—sepsis, post-partum hemorrhage and retained placentas. We identified a significant discrepancy between SF and CC readiness classifications. Those facilities that fall within this discrepancy are unprepared to manage common obstetric emergencies, and employees in supply management may have difficulty identify the need. Future research should explore the possibility of modifying the SF or replacing it with a new readiness measurement. Public Library of Science 2023-08-03 /pmc/articles/PMC10399735/ /pubmed/37535678 http://dx.doi.org/10.1371/journal.pone.0289496 Text en © 2023 Dougherty et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Dougherty, Kylie
Gebremariam Gobezayehu, Abebe
Lijalem, Mulusew
Alamineh Endalamaw, Lamesgin
Biza, Heran
Cranmer, John N.
Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia
title Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia
title_full Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia
title_fullStr Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia
title_full_unstemmed Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia
title_short Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia
title_sort comparison of obstetric emergency clinical readiness: a cross-sectional analysis of hospitals in amhara, ethiopia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399735/
https://www.ncbi.nlm.nih.gov/pubmed/37535678
http://dx.doi.org/10.1371/journal.pone.0289496
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