Health system and quality of care factors contributing to maternal deaths in East Java, Indonesia.

Autor: Mahmood MA; School of Public Health, University of Adelaide, Adelaide, SA, Australia.; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Hendarto H; Faculty of Medicine, Department of Obstetrics and Gynaecology, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Laksana MAC; Faculty of Medicine, Department of Obstetrics and Gynaecology, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Damayanti HE; Faculty of Medicine, Department of Obstetrics and Gynaecology, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Suhargono MH; Bangil General Hospital, Pasuruan District, Jawa Timur, Indonesia., Pranadyan R; Faculty of Medicine, Department of Obstetrics and Gynaecology, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Santoso KH; Department of Health, Jawa Timur, Surabaya, Indonesia., Redjeki KS; Department of Health, Surabaya, Indonesia., Winard B; Faculty of Medicine, Department of Obstetrics and Gynaecology, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Prasetyo B; Faculty of Medicine, Department of Obstetrics and Gynaecology, Universitas Airlangga, Soetomo Teaching Hospital, Surabaya, Indonesia.; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Vercruyssen J; Obstetrics Department, Antwerp University Hospital, Edegem, Belgium., Moss JR; School of Public Health, University of Adelaide, Adelaide, SA, Australia., Bi P; School of Public Health, University of Adelaide, Adelaide, SA, Australia., Masitah S; Wahab Syaharani Hospital, Samarinda, Indonesia., Warsiti; Soetomo Teaching Hospital, Surabaya, East Java, Indonesia., Pratama AW; Faculty of Medicine, School of Midwifery, Universitas Airlangga, Surabaya, Indonesia., Dewi ER; Faculty of Medicine, School of Midwifery, Universitas Airlangga, Surabaya, Indonesia., Listiyani CH; Faculty of Medicine, School of Midwifery, Universitas Airlangga, Surabaya, Indonesia., Mufidah I; Department of Health, Kutai Kartanegara, Kalimantan Timur, Indonesia.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Feb 26; Vol. 16 (2), pp. e0247911. Date of Electronic Publication: 2021 Feb 26 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0247911
Abstrakt: Despite most Indonesian women now receiving antenatal care on the nationally recommended four occasions and being delivered by skilled birth attendants, the nation's maternal mortality ratio (MMR) is estimated as 177 per 100,000 live births. Recent research in a rural district of Indonesia has indicated that poor service quality due to organizational and personnel factors is now a major determinant of this high MMR. The present research is an in-depth analysis of possible health service organizational and quality of care related causes of death among 30 women admitted to a peak referral hospital in a major Indonesian city. Despite their condition being complex or deteriorating, most of these women arrived at the hospital in a state where it was feasible to prevent death with good quality care. Poor application of protocols, poor information flow from frontline hospitals to the peak referral hospital, delays in emergency care, and delays in management of deteriorating patients were the main contributing factors to these deaths. Pyramidal referrals also contributed, as many women were initially referred to hospitals where their condition could not be effectively managed. While generic quality improvement measures, particularly training and monitoring for rigorous application of clinical protocols (including forward planning for deteriorating patients) will help improve the situation, the districts and hospitals need to develop capacity to assess their local situation. Unless local organisational factors, staff knowledge and skill, blood and blood product availability, and local reasons for delays in providing care are identified, it may not be possible to effectively reduce the adverse pregnancy outcomes.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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