Using clinical cascades to measure health facilities' obstetric emergency readiness: testing the cascade model using cross-sectional facility data in East Africa
- PMID: 35379635
- PMCID: PMC8981352
- DOI: 10.1136/bmjopen-2021-057954
Using clinical cascades to measure health facilities' obstetric emergency readiness: testing the cascade model using cross-sectional facility data in East Africa
Abstract
Objectives: Globally, hundreds of women die daily from preventable pregnancy-related causes, with the greatest burden in sub-Saharan Africa. Five key emergencies-bleeding, infections, high blood pressure, delivery complications and unsafe abortions-account for nearly 75% of these obstetric deaths. Skilled clinicians with strategic supplies could prevent most deaths. In this study, we (1) measured facility readiness to manage common obstetric emergencies using the clinical cascades and signal function tracers; (2) compared these readiness estimates by facility characteristics; and (3) measured cascading drop-offs in resources.
Design: A facility-based cross-sectional analysis of resources for common obstetric emergencies.
Setting: Data were collected in 2016 from 23 hospitals (10 designated comprehensive emergency obstetric care (CEmOC) facilities) in Migori County, western Kenya, and Busoga Region, eastern Uganda, in the Preterm Birth Initiative study in East Africa. Baseline data were used to estimate a facility's readiness to manage common obstetric emergencies using signal function tracers and the clinical cascade model. We compared emergency readiness using the proportion of facilities with tracers (signal functions) and the proportion with resources for identifying and treating the emergency (cascade stages 1 and 2).
Results: The signal functions overestimated practical emergency readiness by 23 percentage points across five emergencies. Only 42% of CEmOC-designated facilities could perform basic emergency obstetric care. Across the three stages of care (identify, treat and monitor-modify) for five emergencies, there was a 28% pooled mean drop-off in readiness. Across emergencies, the largest drop-off occurred in the treatment stage. Patterns of drop-off remained largely consistent across facility characteristics.
Conclusions: Accurate measurement of obstetric emergency readiness is a prerequisite for strengthening facilities' capacity to manage common emergencies. The cascades offer stepwise, emergency-specific readiness estimates designed to guide targeted maternal survival policies and programmes.
Trial registration number: NCT03112018.
Keywords: international health services; maternal medicine; obstetrics; quality in health care.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Conflict of interest statement
Competing interests: AW represents his university on the Sexual, Reproductive and Child Health Committee for the Bill & Melinda Gates Foundation. JNC has grants from UNICEF and is an advisory board member for Towards Unity in Health and chair for the Community-Based Primary Health Care working group with the American Public Health Association, International Health Section. DW is on the Board of Directors of PRONTO International, a not-for-profit agency.
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References
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- World Health Organization . Maternal mortality, 2019. Available: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality [Accessed 21 Mar 2021].
-
- World Health Organization . Trends in maternal mortality 2000 to 2017: estimates by who, UNICEF, UNFPA, world bank group, and the United nations population division. Geneva: Wrold Health Organization, 2019.
-
- World Health Organization . Mother-baby package: implementing safe motherhood in countries. Geneva, Switzerland: Maternal Health and Safe Motherhood Programme, Division of Family Health, 1996.
-
- World Health Organization . Monitoring emergency obstetric care: a Handbook. Geneva, Switzerland: Department of Reproductive Health and Research, 2009.
