Addressing the Third Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Ensuring Adequate and Appropriate Facility-Based Maternal and Perinatal Health Care.
Journal
Global health, science and practice
ISSN: 2169-575X
Titre abrégé: Glob Health Sci Pract
Pays: United States
ID NLM: 101624414
Informations de publication
Date de publication:
11 03 2019
11 03 2019
Historique:
received:
23
07
2018
accepted:
21
09
2018
entrez:
15
3
2019
pubmed:
15
3
2019
medline:
11
10
2019
Statut:
epublish
Résumé
Saving Mothers, Giving Life (SMGL) is a 5-year initiative implemented in participating districts in Uganda and Zambia that aimed to reduce deaths related to pregnancy and childbirth by targeting the 3 delays to receiving appropriate care: seeking, reaching, and receiving. Approaches to addressing the third delay included adequate health facility infrastructure, specifically sufficient equipment and medications; trained providers to provide quality evidence-based care; support for referrals to higher-level care; and effective maternal and perinatal death surveillance and response. SMGL used a mixed-methods approach to describe intervention strategies, outcomes, and health impacts. Programmatic and monitoring and evaluation data-health facility assessments, facility and community surveillance, and population-based mortality studies-were used to document the effectiveness of intervention components. During the SMGL initiative, the proportion of facilities providing emergency obstetric and newborn care (EmONC) increased from 10% to 25% in Uganda and from 6% to 12% in Zambia. Correspondingly, the delivery rate occurring in EmONC facilities increased from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia. Nearly all facilities had at least one trained provider on staff by the endline evaluation. Staffing increases allowed a higher proportion of health centers to provide care 24 hours a day/7 days a week by endline-from 74.6% to 82.9% in Uganda and from 64.8% to 95.5% in Zambia. During this period, referral communication improved from 93.3% to 99.0% in Uganda and from 44.6% to 100% in Zambia, and data systems to identify and analyze causes of maternal and perinatal deaths were established and strengthened. SMGL's approach was associated with improvements in facility infrastructure, equipment, medication, access to skilled staff, and referral mechanisms and led to declines in facility maternal and perinatal mortality rates. Further work is needed to sustain these gains and to eliminate preventable maternal and perinatal deaths.
Sections du résumé
BACKGROUND
Saving Mothers, Giving Life (SMGL) is a 5-year initiative implemented in participating districts in Uganda and Zambia that aimed to reduce deaths related to pregnancy and childbirth by targeting the 3 delays to receiving appropriate care: seeking, reaching, and receiving. Approaches to addressing the third delay included adequate health facility infrastructure, specifically sufficient equipment and medications; trained providers to provide quality evidence-based care; support for referrals to higher-level care; and effective maternal and perinatal death surveillance and response.
METHODS
SMGL used a mixed-methods approach to describe intervention strategies, outcomes, and health impacts. Programmatic and monitoring and evaluation data-health facility assessments, facility and community surveillance, and population-based mortality studies-were used to document the effectiveness of intervention components.
RESULTS
During the SMGL initiative, the proportion of facilities providing emergency obstetric and newborn care (EmONC) increased from 10% to 25% in Uganda and from 6% to 12% in Zambia. Correspondingly, the delivery rate occurring in EmONC facilities increased from 28.2% to 41.0% in Uganda and from 26.0% to 29.1% in Zambia. Nearly all facilities had at least one trained provider on staff by the endline evaluation. Staffing increases allowed a higher proportion of health centers to provide care 24 hours a day/7 days a week by endline-from 74.6% to 82.9% in Uganda and from 64.8% to 95.5% in Zambia. During this period, referral communication improved from 93.3% to 99.0% in Uganda and from 44.6% to 100% in Zambia, and data systems to identify and analyze causes of maternal and perinatal deaths were established and strengthened.
CONCLUSION
SMGL's approach was associated with improvements in facility infrastructure, equipment, medication, access to skilled staff, and referral mechanisms and led to declines in facility maternal and perinatal mortality rates. Further work is needed to sustain these gains and to eliminate preventable maternal and perinatal deaths.
Identifiants
pubmed: 30867211
pii: GHSP-D-18-00272
doi: 10.9745/GHSP-D-18-00272
pmc: PMC6519670
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S85-S103Informations de copyright
© Morof et al.
Références
JAMA. 1999 Sep 1;282(9):867-74
pubmed: 10478694
Int J Gynaecol Obstet. 2005 Feb;88(2):181-93
pubmed: 15694106
Reprod Health. 2005 May 04;2(1):3
pubmed: 15871743
Lancet. 2006 Oct 28;368(9546):1474-7
pubmed: 17071267
Lancet. 2007 Oct 13;370(9595):1358-69
pubmed: 17933651
Midwifery. 2012 Feb;28(1):67-72
pubmed: 21232836
Lancet. 2011 Apr 23;377(9775):1421-8
pubmed: 21515164
Int J Health Plann Manage. 2012 Apr-Jun;27(2):e104-20
pubmed: 22674816
Soc Sci Med. 2012 Dec;75(11):2028-36
pubmed: 22940012
PLoS One. 2012;7(12):e52090
pubmed: 23284882
PLoS One. 2013 May 21;8(5):e63846
pubmed: 23704943
Int J Epidemiol. 2013 Jun;42(3):769-80
pubmed: 23918850
BMC Pregnancy Childbirth. 2014 Apr 10;14:137
pubmed: 24716750
Lancet. 2014 Jul 12;384(9938):189-205
pubmed: 24853593
Lancet. 2014 Jul 26;384(9940):347-70
pubmed: 24853604
PLoS One. 2014 Aug 05;9(8):e103927
pubmed: 25093729
Lancet Glob Health. 2014 Jun;2(6):e323-33
pubmed: 25103301
Reprod Health. 2014 Sep 19;11(1):71
pubmed: 25238684
Reprod Health. 2015 Apr 08;12:30
pubmed: 25884616
J Obstet Gynaecol India. 2016 Oct;66(Suppl 1):60-6
pubmed: 27651579
Lancet. 2017 Dec 17;388(10063):3027-3035
pubmed: 27839855
Syst Rev. 2017 Jun 6;6(1):110
pubmed: 28587676
Glob Public Health. 2018 Oct;13(10):1481-1494
pubmed: 28994352
PLoS One. 2017 Oct 26;12(10):e0186182
pubmed: 29073229
BJOG. 2018 Jul;125(8):932-942
pubmed: 29117644
BMC Health Serv Res. 2017 Dec 21;17(Suppl 3):831
pubmed: 29297323
Glob Health Sci Pract. 2019 Mar 13;7(Suppl 1):S6-S26
pubmed: 30867207
Glob Health Sci Pract. 2019 Mar 13;7(Suppl 1):S27-S47
pubmed: 30867208
Soc Sci Med. 1994 Apr;38(8):1091-110
pubmed: 8042057
Soc Sci Med. 1998 Apr;46(8):981-93
pubmed: 9579750