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Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district
BACKGROUND: Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by othe...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875781/ https://www.ncbi.nlm.nih.gov/pubmed/29596431 http://dx.doi.org/10.1371/journal.pone.0194576 |
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author | Thwala, Siphiwe Bridget Pearl Blaauw, Duane Ssengooba, Freddie |
author_facet | Thwala, Siphiwe Bridget Pearl Blaauw, Duane Ssengooba, Freddie |
author_sort | Thwala, Siphiwe Bridget Pearl |
collection | PubMed |
description | BACKGROUND: Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. METHODS: Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. RESULTS: All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001). CONCLUSIONS: The analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions. |
format | Online Article Text |
id | pubmed-5875781 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-58757812018-04-13 Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district Thwala, Siphiwe Bridget Pearl Blaauw, Duane Ssengooba, Freddie PLoS One Research Article BACKGROUND: Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. METHODS: Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. RESULTS: All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001). CONCLUSIONS: The analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions. Public Library of Science 2018-03-29 /pmc/articles/PMC5875781/ /pubmed/29596431 http://dx.doi.org/10.1371/journal.pone.0194576 Text en © 2018 Thwala et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://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 Thwala, Siphiwe Bridget Pearl Blaauw, Duane Ssengooba, Freddie Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district |
title | Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district |
title_full | Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district |
title_fullStr | Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district |
title_full_unstemmed | Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district |
title_short | Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district |
title_sort | measuring the preparedness of health facilities to deliver emergency obstetric care in a south african district |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875781/ https://www.ncbi.nlm.nih.gov/pubmed/29596431 http://dx.doi.org/10.1371/journal.pone.0194576 |
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