What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal
Introduction Increases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newbo...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/3/e001915.full |
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| author | Lenka Benova Emma Radovich Francesca L Cavallaro Kerry Wong Alexandre Dumont Adama Faye Melisa Martinez-Alvarez El Hadji Dioukhane Paula Sheppard Abdou Salam Mbengue Carine Ronsmans |
| author_facet | Lenka Benova Emma Radovich Francesca L Cavallaro Kerry Wong Alexandre Dumont Adama Faye Melisa Martinez-Alvarez El Hadji Dioukhane Paula Sheppard Abdou Salam Mbengue Carine Ronsmans |
| author_sort | Lenka Benova |
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| description | Introduction Increases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal.Methods For this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans.Results Births in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral.Conclusions Our findings imply that many lower-level public facilities—the most common place of birth in Senegal—are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality. |
| format | Article |
| id | doaj-art-d6d5918eec0a4b219583ad21cc636cec |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-d6d5918eec0a4b219583ad21cc636cec2025-08-20T01:59:03ZengBMJ Publishing GroupBMJ Global Health2059-79082020-03-015310.1136/bmjgh-2019-001915What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in SenegalLenka Benova0Emma Radovich1Francesca L Cavallaro2Kerry Wong3Alexandre Dumont4Adama Faye5Melisa Martinez-Alvarez6El Hadji Dioukhane7Paula Sheppard8Abdou Salam Mbengue9Carine Ronsmans10Department of Public Health, Institute of Tropical Medicine, Antwerpen, BelgiumFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UKInstitute of Child Health, University College London, London, UKFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK13 CEPED, Université Paris Cité, IRD, INSERM, Paris, FranceCheikh Anta Diop University of Dakar, Dakar, SenegalDepartment of Global Health and Development, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Dakar, SenegalPlan International Canada, Ottawa, Ontario, CanadaInstitute of Social and Cultural Anthropology, Oxford University, Oxford, UKIRESSEF: Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Dakar, SenegalDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKIntroduction Increases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal.Methods For this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans.Results Births in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral.Conclusions Our findings imply that many lower-level public facilities—the most common place of birth in Senegal—are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality.https://gh.bmj.com/content/5/3/e001915.full |
| spellingShingle | Lenka Benova Emma Radovich Francesca L Cavallaro Kerry Wong Alexandre Dumont Adama Faye Melisa Martinez-Alvarez El Hadji Dioukhane Paula Sheppard Abdou Salam Mbengue Carine Ronsmans What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal BMJ Global Health |
| title | What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal |
| title_full | What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal |
| title_fullStr | What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal |
| title_full_unstemmed | What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal |
| title_short | What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal |
| title_sort | what the percentage of births in facilities does not measure readiness for emergency obstetric care and referral in senegal |
| url | https://gh.bmj.com/content/5/3/e001915.full |
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