- Title
- Availability and quality of emergency obstetric care among health facilities in Ethiopia
- Creator
- Bali, Ayele Geleto
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Introduction: In sub-Saharan African countries, where two-thirds of global maternal deaths occur, obstetric complications remain the major health threat for women. Ethiopia is among the countries with the highest maternal deaths in the world. The high maternal mortality ratio is mainly attributed to poor access and quality of emergency obstetric care (EmOC). However, there is a scarcity of literature on the availability and quality of EmOC in Ethiopia. Therefore, this thesis aimed to assess the availability and quality of EmOC in health facilities in Ethiopia. Methods: This thesis employed a mixed methods approach where a combination of systematic reviews, meta-analysis, quantitative and qualitative studies were conducted. Initially, systematic reviews and meta-analysis were conducted to identify barriers to access to and utilisation of EmOC, and women’s knowledge about obstetric danger signs. Then, three quantitative studies were conducted using a representative dataset accessed from the Ethiopian Public Health Institute to determine the availability and quality of EmOC in hospitals. The data used in this thesis were collected in 2016 as part of a national assessment of emergency obstetric and newborn care in Ethiopia. Finally, a complementary qualitative study was conducted in hospitals to assess midwives’ perceptions about the quality of EmOC. Results: In SSA, several factors that were seen at all levels of care affected women’s access to and utilisation of EmOC. The pooled random effect meta-analysis revealed that only 48%, 43% and 32% of women know about obstetric danger signs that could happen during pregnancy, delivery and the immediate postpartum period, respectively. This study also demonstrated that, at the national level, maternal near miss incidence ratio and mortality index were 20.8% and 0.64%, respectively. The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 live births while the annual caesarean section rate and the DOCFR in hospitals were 20.3% (95% CI: 20.2–20.5) and 0.64% (95% CI: 0.58–0.70%) respectively. However, there were significant regional variations in the magnitudes of these indicators. The findings of the qualitative study also revealed that a shortage of health infrastructure, insufficiency in trained providers, a shortage of medical supplies and essential drugs and poor management of services delivery affected the quality of EmOC. Conclusions: In sub-Saharan Africa, several interdependent barriers that exist at multiple levels—either at home, on the way to health facilities or at the facilities—hampered access to and utilisation of EmOC for women in need. The observed regional disparities in the DOCFR, maternal near miss incidence ratio and mortality index indicate regional variation in the quality of EmOC. This necessitates the equitable distribution of health resources, strengthening maternal health interventions and quality improvement initiatives to tackle the observed regional variations. There is also a need for holistic strategies, including improvements to healthcare systems and the socio-economic status of women.
- Subject
- Ethiopia; emergency obstetric care; health facilities; women
- Identifier
- http://hdl.handle.net/1959.13/1469002
- Identifier
- uon:48139
- Rights
- Copyright 2021 Ayele Geleto Bali
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 21 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 386 KB | Adobe Acrobat PDF | View Details Download |