Improved maternal-fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study.
Communication
Emergency
Intervention
Maternal–fetal outcomes
Obstetric referral
Phone call
Quasi-experimental
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
05 Sep 2022
05 Sep 2022
Historique:
received:
03
11
2021
accepted:
26
08
2022
entrez:
5
9
2022
pubmed:
6
9
2022
medline:
8
9
2022
Statut:
epublish
Résumé
Emergency obstetric referrals develop adverse maternal-fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may bridge such communication challenges. We investigated effect of a phone call communication prior to referral of mothers in labour as intervention to reduce preparation delays and improve maternal-fetal outcome at a referral hospital in a resource limited setting. This was a quasi-experimental study with non-equivalent control group conducted at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda from September 2020 to March 2021. Adverse maternal-fetal outcomes included: early neonatal death, fresh still birth, obstructed labour, ruptured uterus, maternal sepsis, low Apgar score, admission to neonatal ICU and hysterectomy. Exposure variable for intervention group was a phone call prior maternal referral from a lower health facility. We compared distribution of clinical characteristics and adverse maternal-fetal outcomes between intervention and control groups using Chi square or Fisher's exact test. We performed logistic regression to assess association between independent variables and adverse maternal-fetal outcomes. We enrolled 177 participants: 75 in intervention group and 102 in control group. Participants had similar demographic characteristics. Three quarters (75.0%) of participants in control group delayed on admission waiting bench of MRRH compared to (40.0%) in intervention group [p = < 0.001]. There were significantly more adverse maternal-fetal outcomes in control group than intervention group (obstructed labour [p = 0.026], low Apgar score [p = 0.013] and admission to neonatal high dependency unit [p = < 0.001]). The phone call intervention was protective against adverse maternal-fetal outcome [aOR = 0.22; 95%CI: 0.09-0.44, p = 0.001]. The phone call intervention resulted in reduced delay to patient admission at a tertiary referral hospital in a resource limited setting, and is protective against adverse maternal-fetal outcomes. Incorporating the phone call communication intervention in the routine practice of emergency obstetric referrals from lower health facilities to regional referral hospitals may reduce both maternal and fetal morbidities. Pan African Clinical Trial Registry PACTR20200686885039.
Sections du résumé
BACKGROUND
BACKGROUND
Emergency obstetric referrals develop adverse maternal-fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may bridge such communication challenges. We investigated effect of a phone call communication prior to referral of mothers in labour as intervention to reduce preparation delays and improve maternal-fetal outcome at a referral hospital in a resource limited setting.
METHODS
METHODS
This was a quasi-experimental study with non-equivalent control group conducted at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda from September 2020 to March 2021. Adverse maternal-fetal outcomes included: early neonatal death, fresh still birth, obstructed labour, ruptured uterus, maternal sepsis, low Apgar score, admission to neonatal ICU and hysterectomy. Exposure variable for intervention group was a phone call prior maternal referral from a lower health facility. We compared distribution of clinical characteristics and adverse maternal-fetal outcomes between intervention and control groups using Chi square or Fisher's exact test. We performed logistic regression to assess association between independent variables and adverse maternal-fetal outcomes.
RESULTS
RESULTS
We enrolled 177 participants: 75 in intervention group and 102 in control group. Participants had similar demographic characteristics. Three quarters (75.0%) of participants in control group delayed on admission waiting bench of MRRH compared to (40.0%) in intervention group [p = < 0.001]. There were significantly more adverse maternal-fetal outcomes in control group than intervention group (obstructed labour [p = 0.026], low Apgar score [p = 0.013] and admission to neonatal high dependency unit [p = < 0.001]). The phone call intervention was protective against adverse maternal-fetal outcome [aOR = 0.22; 95%CI: 0.09-0.44, p = 0.001].
CONCLUSION
CONCLUSIONS
The phone call intervention resulted in reduced delay to patient admission at a tertiary referral hospital in a resource limited setting, and is protective against adverse maternal-fetal outcomes. Incorporating the phone call communication intervention in the routine practice of emergency obstetric referrals from lower health facilities to regional referral hospitals may reduce both maternal and fetal morbidities.
TRIAL REGISTRATION
BACKGROUND
Pan African Clinical Trial Registry PACTR20200686885039.
Identifiants
pubmed: 36064375
doi: 10.1186/s12884-022-05007-0
pii: 10.1186/s12884-022-05007-0
pmc: PMC9442930
doi:
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
684Informations de copyright
© 2022. The Author(s).
Références
BMC Pregnancy Childbirth. 2014 Sep 04;14:304
pubmed: 25189169
Int J Environ Res Public Health. 2021 Aug 13;18(16):
pubmed: 34444330
PLoS One. 2020 Feb 10;15(2):e0228856
pubmed: 32040542
Glob Health Action. 2011;4:
pubmed: 22216018
BMC Health Serv Res. 2020 Jan 10;20(1):32
pubmed: 31924203
BMC Pregnancy Childbirth. 2014 May 05;14:159
pubmed: 24886330
BMC Pregnancy Childbirth. 2017 Jan 19;17(1):42
pubmed: 28103836
Health Serv Manage Res. 2006 Aug;19(3):174-85
pubmed: 16848958
BMC Pregnancy Childbirth. 2016 Nov 8;16(1):343
pubmed: 27825311
Qual Saf Health Care. 2006 Dec;15(6):433-6
pubmed: 17142594
BMC Med Inform Decis Mak. 2016 Jul 07;16:84
pubmed: 27387548
Trop Doct. 2018 Apr;48(2):132-135
pubmed: 29108472
Can J Public Health. 2019 Aug;110(4):520-522
pubmed: 31140141
BMC Pregnancy Childbirth. 2016 Aug 05;16(1):207
pubmed: 27495904
J Gen Intern Med. 2010 Oct;25(10):1123-8
pubmed: 20512531
BJOG. 2017 Mar;124(4):584-594
pubmed: 27704703
JAMA. 2014 Jul 16;312(3):229-30
pubmed: 24953141
Glob Health Action. 2020;13(1):1707403
pubmed: 31928163
Lancet. 2006 Oct 7;368(9543):1284-99
pubmed: 17027735
BMC Pregnancy Childbirth. 2018 Mar 22;18(1):71
pubmed: 29566655
JMIR Mhealth Uhealth. 2014 Mar 26;2(1):e15
pubmed: 25098184
Soc Sci Med. 1994 Apr;38(8):1091-110
pubmed: 8042057
Reprod Health. 2014 Jan 20;11(1):8
pubmed: 24438150
Ann Fam Med. 2004 May-Jun;2(3):204-8
pubmed: 15209195
J Pregnancy. 2020 Oct 28;2020:8878037
pubmed: 33194231
Matern Health Neonatol Perinatol. 2021 Jul 15;7(1):13
pubmed: 34266492
BMJ Open Qual. 2018 Sep 28;7(3):e000249
pubmed: 30306139
East Afr Med J. 2003 Mar;80(3):144-9
pubmed: 12762430
PLoS One. 2013 May 21;8(5):e63846
pubmed: 23704943