Department of Family and Community Health, Ministry of Health Anseba Province, Keren, Anseba, Eritrea.
Sci Rep. 2022 Aug 26;12(1):14614. doi: 10.1038/s41598-022-18685-9.
Despite the critical role quality comprehensive emergency obstetric care (CEmOC) plays in ensuring safe motherhood, only a few studies have attempted to measure the impact of substandard and delayed care on maternal outcome thus far. This study evaluates the association between various process and timeliness indicators of CEmOC and adverse maternal outcome in Keren Hospital. This study compared women with potentially life-threatening condition (PLTC) and women with severe maternal outcome (SMO) with respect to various process and timeliness indicators. Logistic regression analysis was employed to assess the association of timeliness and process indicators with SMO using SPSS version-22 computer software. In this study, we included 491 cases of PLTC and 210 cases of SMO (171 maternal near misses and 39 maternal deaths). The following process indicators showed significant association with SMO: failure to give uterotonics for the treatment of postpartum hemorrhage, failure to administer prophylactic antibiotics, and delayed laporatomy for uterine rupture. Moreover, delays in referral, triaging, seeing an obstetrician, and receiving definitive treatement were strongly associated with SMO. The following causes of delay were also found to be independently associated with SMO: erroneous diagnosis, inappropriate management, multiple referrals between health facilities, unavailability of a senior obstetrician, and poor communication during referral. Among the miscellaneous factors, nighttime admission and referral during the rainy season showed significant association with SMO. Findings of this study indicate that huge gap exists in providing quality and timely care in Keren Hospital. In general, most incidents of substandard and delayed care were due to poor referral system, insufficiency of medical staff, inadequacy of drugs and equipment, and unavailability of standard management protocol. Improving the referral system, upgrading the technical skills of health professionals, making sure life-saving drugs and equipment are available all the time, and posting standard treatment and management protocols in the maternity and emergency rooms will play a vital role in reducing the occurrence of SMO in Keren Hospital.
尽管高质量综合产科急诊护理（CEmOC）在确保母婴安全方面发挥着至关重要的作用，但迄今为止，只有少数研究试图衡量次优和延迟护理对产妇结局的影响。本研究评估了在克伦医院，CEmOC 的各种过程和及时性指标与不良产妇结局之间的关联。本研究比较了有潜在生命威胁的情况（PLTC）和严重产妇结局（SMO）的妇女在各种过程和及时性指标方面的差异。使用 SPSS 版本 22 计算机软件，采用逻辑回归分析评估了及时性和过程指标与 SMO 的关联。在这项研究中，我们纳入了 491 例 PLTC 和 210 例 SMO（171 例产妇接近死亡和 39 例产妇死亡）。以下过程指标与 SMO 显著相关：产后出血治疗时未给予宫缩剂、未预防性使用抗生素以及子宫破裂时延迟剖腹术。此外，转诊、分诊、看产科医生和接受确定性治疗的延迟与 SMO 密切相关。还发现以下延迟原因与 SMO 独立相关：误诊、处理不当、医疗机构之间多次转诊、缺乏高级产科医生以及转诊期间沟通不畅。在杂项因素中，夜间入院和雨季转诊与 SMO 显著相关。本研究的结果表明，在克伦医院提供优质及时的护理方面存在巨大差距。总的来说，大多数次优和延迟护理的情况是由于转诊系统不完善、医务人员不足、药物和设备不足以及缺乏标准管理方案造成的。改善转诊系统、提高卫生专业人员的技术技能、确保随时提供救生药物和设备，并在妇产科和急诊室张贴标准治疗和管理方案，将在减少克伦医院 SMO 的发生方面发挥重要作用。
