Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania.

Autor:	Beňová L; Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium., Semaan A; Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium asemaan@itg.be., Afolabi BB; Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria., Amongin D; Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda.; Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Babah OA; Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria., Dioubate N; Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea., Harissatou N; Institut de Nutrition et de Santé pour Enfants, Conakry, Guinea., Kikula AI; Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania., Nakubulwa S; Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.; Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda., Ogein O; College of Medicine, University of Lagos, Lagos, Nigeria., Adroma M; Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Anzo Adiga W; Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda., Diallo A; Service de la maternité, Hôpital National Ignace Deen, Conakry, Guinea., Diallo IS; Institut de Nutrition et de Santé pour Enfants, Conakry, Guinea., Diallo L; Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea., Cellou Diallo M; Service de la maternité, Hôpital National Ignace Deen, Conakry, Guinea., Maomou C; Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea., Mtinangi N; Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania., Sy T; Service de la maternité, Hôpital National Ignace Deen, Conakry, Guinea., Delvaux T; Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium., Delamou A; Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea., Nakimuli A; Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Pembe AB; Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania., Banke-Thomas AO; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Sep 20; Vol. 13 (9), pp. e076364. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.1136/bmjopen-2023-076364
Abstrakt:	Objectives: The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes. Design: Prospective observational mixed-methods study, combining monthly routine data (March 2019-February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave. Setting: Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda. Participants: 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels. Results: Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%-40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures. Conclusions: Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women's and care providers' needs, this can contribute to ensuring continuation of essential care provision during emergency. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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