Abstract

Background: Prompt attention is one of the eight non-medical domains used to evaluate healthcare and is considered the most important domain for maternal healthcare. Prompt attention includes short travel and waiting times (within 1 hour) to support good health outcomes. This study aimed to determine the impact of prompt attention (as measured by travel and waiting times) on labour and childbirth services in two Tanzanian referral hospitals between October and November 2014.

Methods: Simple random sampling was used to recruit 163 mothers within 48 hours post-partum; 81 from Haydom Lutheran Referral Hospital and 82 from Mwananyamala Referral Hospital. Data were collected using a structured interviewer-administered questionnaire. Frequency distribution tables and figures were generated and Pearson’s chi-square tests were used to examine the relationships between travel and waiting times and maternal complications. P-values < 0.05 were considered statistically significant.

Results: The majority (n = 102, 62.6%) of participants travelled to the healthcare facility within 1 hour. However, 61 (37.4%) travelled for more than 1 hour. At both facilities, most participants (n = 161, 98.8%) waited less than 1 hour to be attended. Although 64.5% (n = 104) of the women who were attended within 1 hour did not develop maternal complications after childbirth, although 35.4% (n = 59) developed maternal complications. In addition, 71 (69.6%) of the 102 women who travelled to the health facility within 1 hour did not develop maternal complications.

Conclusion: There were insufficient data to detect a real difference in the association between waiting times and complications between the two hospitals. However, greater travelling time was statistically significantly associated with maternal complications in both hospitals. The reported complications might have been attributable to delays in deciding to access healthcare before labour. Further studies on this topic are needed, including qualitative research that explores mothers’ perspectives.

Keywords: Health System Responsiveness; Prompt Attention; Maternal Complications; Labour and Childbirth

References

1. Yakob and Ncama. “Measuring health system responsiveness at facility level in Ethiopia: performance, correlates and implications”. BMC Health Services Research(2017): 17.
2. , et al. “Health System Responsiveness: Concepts, Domains and Operationalization (2014).
3. , et al. “Health system responsiveness for delivery care in Southern Thailand”. International Journal of Quality in Health Care (2012a): 24.
4. Ngoma-Hazemba., et al. “Community Perspectives of a 3-Delays Model Intervention: A Qualitative Evaluation of Saving Mothers, Giving Life in Zambia”. Gshp (2019): 7.
5. Gerein Green and Pearson. “The implications of shortages of health professionals for maternal health in sub-Saharan Africa”. Reproductive Health Matters 14 (2006): 40-50.
6. Knight Selfand Kennedy. “Why are women dying when they reach hospital on time? A systematic review of the ‘third delay”. PloS one 8 (2013): e63846.
7. Mselle Moland., et al. “Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania”. BMC Health Services Research 13 (2013): 174.
8. Say L., et al. “Global Causes of Maternal Death: A WHO Systematic Analysis”. Lancet (2014).
9. World Health Organization. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: World Health Organization (2007).
10. Chao Lu., et al. “Healthcare system responsiveness in Jiangsu Province, China”. BMC Health Services Research 17 (2017): 31.
11. Bangladesh maternal health services and maternal mortality survey (2001).
12. “Utilisation of primary health care services in rural Bangladesh: the population and provider perspectives”. London School of Hygiene and Tropical Medicine (2001).
13. Pattinson R., et al. “Improving survival rates of newborn infants in South Africa”. Reprod Health1 (2005): 4.
14. Pembe B., et al. “Maternal referrals in rural Tanzania: Decision making and acceptance of referral advice”. African Journal of Reproductive Health2 (2008).
15. Liabsuetrakul Petmanee Sanguanchua and Oumudee. “Health system responsiveness for delivery care in Southern Thailand”. International Journal for Quality in Health Care 24 (2012b): 169-175.
16. Mgaya Massawe Kidanto and Mgaya. “Grand multiparity: is it still a risk in pregnancy?” BMC Pregnancy and Childbirth 13 (2013): 241.
17. Malhotra Puri., et al. “Donald School Manual of Practical Problems in Obstetrics”. JP Medical Ltd (2012).
18. Adam T., et al. “Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries 331 (2005): 1107.
19. Ban K. “The Global Strategy for Women’s and Children’s Health”. New York, NY, USA, United Nations (2010).
20. Bangladesh Maternal Health Services and Maternal Mortality Survey (2001).
21. Donald I. “The grand multipara in: Donald I, practical obstetric problems”. B.I publication. New Delhi, India (1998).
22. Gage AJ. “Barrier to the utilization of maternal health care in rural Mali 65 (2007): 1666-1682.
23. Khan KS., et al. “WHO analysis of causes of maternal death: a systematic review”. Lancet 9516 (2006): 1066-1074.
24. Making Pregnancy Safer. The critical roles of the skilled attendant: a joint statement by WHO, ICM and FIGO. 2004. Geneva, Switzerland: World Health Organization (WHO) (2004).
25. Riordan O., et al. “Education, Training and Female Informal Enterprises”. A Report for REPOA (1997).
26. Roman H., et al. “Obstetrics and Neonatal outcome in grandmultiparas”. American Journal of Obstetrics andGynecology 103 (2004): 1294-1298.
27. Ross CK., et al. “A comparative study of seven measures of patient satisfaction”. Medical Care4 (1995): 392-406.
28. Thaddeus S and Maine D. “Too far to walk: maternal mortality in context”. Social Science and Medicine8 (1994): 1091-1110.
29. Elaine Yellen., et al. “The measurement of patient satisfaction”. Journal of Public Health Medicine3 (2002): 236-249.
30. UNICEF, WHO, the World Bank, United Nations Population Division. The Inter-agency Group for Child Mortality Estimation (UN IGME). Levels and Trends in Child Mortality”. Report. New York, USA, UNICEF (2013).
31. World Health Organization. Policy brief one: integrating maternal, newborn and child health programmes. World Health Report 2005: make every mother and child count. 2005. Geneva, Switzerland: World Health Organization World Health Organization. World Health Report 2000.Geneva: World Health Organization (2000).