Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda
Objectives To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting.Design This was a qualitative study with two unit...
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| Format: | Article |
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/3/e042909.full |
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| author | Josaphat Byamugisha Alex Muhereza Emmanuel Ochola Pontius Bayo Gasthony Alobo Violah Nahurira |
| author_facet | Josaphat Byamugisha Alex Muhereza Emmanuel Ochola Pontius Bayo Gasthony Alobo Violah Nahurira |
| author_sort | Josaphat Byamugisha |
| collection | DOAJ |
| description | Objectives To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting.Design This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants.Setting Thirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda.Participants Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling.Results After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional.Conclusion Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes. |
| format | Article |
| id | doaj-art-6184cced5c734b84a89018f0f0ad4ba6 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6184cced5c734b84a89018f0f0ad4ba62024-11-20T07:35:08ZengBMJ Publishing GroupBMJ Open2044-60552021-03-0111310.1136/bmjopen-2020-042909Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern UgandaJosaphat Byamugisha0Alex Muhereza1Emmanuel Ochola2Pontius Bayo3Gasthony Alobo4Violah Nahurira5Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda6 Maternal and Newborn Care, RHITES - North Acholi, Gulu, Uganda4 St Mary`s Lacor Hospital, Gulu, Uganda4 St Mary`s Lacor Hospital, Gulu, Uganda1 Obstetrics and Gynecology, Lira University, Lira, Uganda7 Obstetrics and Gynecology, Lacor Hospital, Gulu, UgandaObjectives To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting.Design This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants.Setting Thirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda.Participants Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling.Results After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional.Conclusion Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.https://bmjopen.bmj.com/content/11/3/e042909.full |
| spellingShingle | Josaphat Byamugisha Alex Muhereza Emmanuel Ochola Pontius Bayo Gasthony Alobo Violah Nahurira Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda BMJ Open |
| title | Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda |
| title_full | Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda |
| title_fullStr | Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda |
| title_full_unstemmed | Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda |
| title_short | Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda |
| title_sort | why women die after reaching the hospital a qualitative critical incident analysis of the third delay in postconflict northern uganda |
| url | https://bmjopen.bmj.com/content/11/3/e042909.full |
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