Factors that Led to Third Delays in the Management of Obstetric Emergencies in Midigo Health Centre IV - Yumbe District, Uganda

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DOI: 10.21522/TIJPH.2013.08.01.Art026

Authors : Storia Nyeta, Omona Kizito

Abstract:

Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. A number of factors are attributable to this delay.

Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV.

Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers).

Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%).

Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV.

Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).

References:

[1].   Bhandari, T. R. and Dangal, G. (2014). Emergency Obstetric Care: Strategy for Reducing Maternal Mortality in Developing Countries. NJOG, 9 (17): 8-16. Available from:

http://njog.org.np/njog/index.php/njog/article/download/71/43/.

[2].   Bjarke, L. S., Elsass, P., Brigitte, B. N., Massawe, S., Nyakina, J., Vibeke, R. (2010) Substandard emergency obstetric care - a confidential enquiry into maternal deaths at a regional hospital in Tanzania. Tropical Medicine and International Health, 15(8): 894-900. DOI: 10.1111/j.1365-3156.2010.02554. x.

[3].   Borgen project. (2016). The “Three Delays” at the Root of Maternal Mortality. Borgen project [Blog Post]. Available from https://borgenproject.org/the-three-delays-maternal-mortality/.

[4].   Cavallaro, F. L. and Marchant, T. J. (2013). Responsiveness of Emergency Obstetric Care Systems in Low- and Middle-Income Countries: A Critical Review of the “Third Delay”. London School of Tropical Medicine Research Online; 92 (5): 496-507. DOI: 10.1111/aogs.12071.

[5].   Hannah, E. K., Alice, S. and Stephen, H. K. (2013). Why Are Women Dying When They Reach Hospital on Time? A Systematic Review of the ‘Third Delay’. Plos one; 8 (5). DOI : https://doi.org/10.1371/journal.pone.0063846.

[6].   Helelo, A. Z., Zungu, L. I. and Chiegil, R. J. (2015). What Creates Good Experiences for EmOC Clients in Public Health Facilities in Ethiopia? South African Family Practice, 57 (3): 203-207. DOI: 10.1080/20786190.2015.1024014.

[7].   Israel, G. D. (1992). Determining Sample Size. [Pdf online] 1992. Available from:

https://www.tarleton.edu/academicassessment/documents/Samplesize.pdf.

[8].   Ministry of Health [MoH] Uganda. Annual Health Sector Performance Report: Financial Year 2014/2015. Kampala: Author; 2015.

[9].   Mismay G, Morrow RH. (n.d). Delay in Seeking and Receiving Emergency Obstetric Care in Eritrea. Journal of Eritrean Medical Association (JEMA). Available from

https://www.ajol.info/index.php/jema/article/viewFile/52700/41303.


[10].  Polonia, G. (2013). Analysis of sample size in consumer surveys [Pdf online] 2013. Available at

http://ec.europa.eu/economy_finance/db_indicators/surveys/documents/workshops/2013/pl-gfk_k._pusczak_-_sample_size_in_customer_surveys_v2_2.pdf.

[11].  Rodolfo, C. P, et al. (2014). Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy and Childbirth 2014; 14(159). DOI: 10.1186/1471-2393-14-159).

[12].  Thaddeus, S. and Maine, D. (1994). Too Far to Walk: Maternal Mortality in Context. Social Science and Medicine, 38 (8): 1091-1110. DOI: 10.1016/0277-9536(94)90226-7.

[13].  Uganda Bureau of Statistic [UBOS]. National Population and Housing Census 2014. Kampala: Author; 2015.

[14]. United Nations Development Programme [UNDP]. (2017). Sustainable Development Goal, Goal 3 targets. [Blog Post]. Available from

http://www.undp.org/content/undp/en/home/sustainable-development-goals/goal-3-good-health-and-well-being/targets/

[15].  United Nations Population Fund [UNFPA]. (2014). Setting Standards for Emergency Obstetric and Newborn Care. [Blog Post]. Available from http://www.unfpa.org/resources/setting-standards-emergency-obstetric-and-newborn-care.

[16].  World Health Organization [WHO]. (2009). Monitoring Emergency Obstetric Care: A Handbook. Geneva: Author.

[17].  World Health Organization [WHO]. (2015). Applying the Lessons of Maternal Mortality Reduction to Global Emergency Health. Bulletin of the World Health Organization; 93: 417-423. DOI: http://dx.doi.org/10.2471/BLT.14.146571.

[18].  World Health Organization [WHO]. (2016). World Health Statistics data visualizations Dashboard. [Blog Post]. Available from

http://apps.who.int/gho/data/node.sdg.3-1?lang=en.