Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital.
Adolescent
Adult
Apgar Score
Armed Conflicts
Birth Rate
Cesarean Section
/ statistics & numerical data
Confidence Intervals
Controlled Before-After Studies
Delivery, Obstetric
/ methods
Efficiency, Organizational
Female
Health Services Accessibility
/ organization & administration
Humans
Infant, Newborn
Labor, Induced
/ statistics & numerical data
Outcome and Process Assessment, Health Care
Perinatal Care
/ standards
Perinatal Death
Pregnancy
Pregnancy Outcome
Quality of Health Care
/ standards
Retrospective Studies
Stillbirth
/ epidemiology
Yemen
Young Adult
Adaptive response
Armed conflict
Caesarean section
Childbirth
Fragile and conflict-affected states
Humanitarian response
Quality of care
Yemen
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
07 Jan 2021
07 Jan 2021
Historique:
received:
05
10
2020
accepted:
16
12
2020
entrez:
8
1
2021
pubmed:
9
1
2021
medline:
18
5
2021
Statut:
epublish
Résumé
Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility's pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction's effects on the quality of intrapartum care and birth outcomes. A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.
Sections du résumé
BACKGROUND
BACKGROUND
Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility's pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction's effects on the quality of intrapartum care and birth outcomes.
METHODS
METHODS
A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month.
RESULTS
RESULTS
Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume.
CONCLUSIONS
CONCLUSIONS
Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.
Identifiants
pubmed: 33413161
doi: 10.1186/s12884-020-03507-5
pii: 10.1186/s12884-020-03507-5
pmc: PMC7791801
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
36Références
BMC Womens Health. 2017 Mar 15;17(1):20
pubmed: 28298198
Reprod Health Matters. 2013 Nov;21(42):103-12
pubmed: 24315067
BJOG. 2016 May;123(6):928-38
pubmed: 25974281
Med Anthropol. 2016 Nov-Dec;35(6):572-587
pubmed: 27050449
Int Health. 2016 Mar;8(2):89-95
pubmed: 26276813
Health Policy Plan. 2017 Jul 1;32(6):911-922
pubmed: 28402469
BMC Health Serv Res. 2013 May 10;13:174
pubmed: 23663299
BJOG. 2012 Apr;119(5):605-13
pubmed: 22329559
Reprod Health. 2018 Jan 10;15(1):8
pubmed: 29321051
BJOG. 2018 Jan;125(2):235-245
pubmed: 28892306
Br Med Bull. 2003;67:27-37
pubmed: 14711752
Hum Resour Health. 2014 Mar 19;12:17
pubmed: 24641840
Am J Obstet Gynecol. 2009 Jan;200(1):35.e1-6
pubmed: 18667171
Confl Health. 2018 Jan 22;12:2
pubmed: 29387145
BMC Pregnancy Childbirth. 2016 Aug 19;16:236
pubmed: 27543002
Z Geburtshilfe Neonatol. 2008 Dec;212(6):222-5
pubmed: 19085739
Lancet. 2014 Sep 20;384(9948):e42-4
pubmed: 24965825
Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:166-206
pubmed: 5338568
BMC Pregnancy Childbirth. 2016 Nov 10;16(1):351
pubmed: 27832753