1
|
Ononge S, Magunda A, Balaba D, Waiswa P, Okello D, Kaula H, Zalwango S, Bua DA, Ayebare A, Kaharuza F, Bennett C, Sulzbach S, Keller B, Mugerwa Y. Strengthening Kampala's Urban Referral System for Maternal and Newborn Care Through Establishment of an Emergency Call and Dispatch Center. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200332. [PMID: 37348939 DOI: 10.9745/ghsp-d-22-00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/03/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Most pregnant women living in urban slum communities in Uganda deliver at public health centers that are not equipped to provide emergency obstetric and newborn care. When obstetric emergencies occur, pregnant women are referred to a higher-level facility and are responsible for arranging and paying for their own transport. The Kampala Slum Maternal Newborn (MaNe) project developed and tested an emergency call and ambulance dispatch center and a mobile application to request, deploy, and track ambulances. We describe the development of these 2 interventions and findings on the feasibility, acceptability, and sustainability of the interventions. METHODS MaNe conducted a mixed-method feasibility study that included an assessment of the acceptability and demand of the interventions. In-depth interviews (N=26) were conducted with facility proprietors, health providers, ambulance drivers, Kampala Capital City Authority officers, and community members to understand the successes and challenges of establishing the call center and developing the mobile application. Thematic content analysis was done. Quantitative data from the call center dispatch logs were analyzed descriptively to complement the qualitative findings. FINDINGS Between April 2020 and June 2021, 10,183 calls were made to the emergency call and dispatch center. Of these, 25% were related to maternal and newborn health emergencies and 14% were COVID-19 related. An ambulance was dispatched to transfer or evacuate a patient in 35% of the calls. Participants acknowledged that the call center and mobile application allowed for efficient communication, coordination, and information flow between health facilities. Supportive district leadership facilitated the establishment of the call center and has taken over the operating costs of the center. CONCLUSION The call center and referral application improved the coordination of drivers and ambulances and allowed facilities to prepare for and treat cases more efficiently.
Collapse
Affiliation(s)
- Sam Ononge
- Makerere University College of Health Sciences, Kampala, Uganda.
| | - Andrew Magunda
- Population Services International Uganda, Kampala, Uganda
| | - Dorothy Balaba
- Population Services International Uganda, Kampala, Uganda
| | - Peter Waiswa
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Henry Kaula
- Population Services International Uganda, Kampala, Uganda
| | | | | | - Amable Ayebare
- Population Services International Uganda, Kampala, Uganda
| | | | - Cudjoe Bennett
- Office of Maternal and Child Health and Nutrition, Bureau of Global Health, U.S. Agency for International Development, Washington, DC, USA
| | - Sara Sulzbach
- Office of Maternal and Child Health and Nutrition, Bureau of Global Health, U.S. Agency for International Development, Washington, DC, USA
| | - Brett Keller
- Population Services International Uganda, Kampala, Uganda
| | - Yvonne Mugerwa
- Population Services International Uganda, Kampala, Uganda
| |
Collapse
|
2
|
Yevoo LL, Amarteyfio KA, Ansah-Antwi JA, Wallace L, Menka E, Ofori-Ansah G, Nyampong I, Mayeden S, Agyepong IA. The "No bed syndrome" in Ghana - what, how and why? A literature, electronic and print media review. FRONTIERS IN HEALTH SERVICES 2023; 3:1012014. [PMID: 37234197 PMCID: PMC10207332 DOI: 10.3389/frhs.2023.1012014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/03/2023] [Indexed: 05/27/2023]
Abstract
Objectives "No bed syndrome" has become a familiar phrase in Ghana. Yet, there is very little in medical texts or the peer reviewed literature about it. This review aimed to document what the phrase means in the Ghanaian context, how and why it occurs, and potential solutions. Design A qualitative desk review using a thematic synthesis of grey and published literature, print and electronic media content covering the period January 2014 to February 2021. Text was coded line by line to identify themes and sub-themes related to the research questions. Analysis was manual and with Microsoft Excel to sort themes. Setting Ghana. Participants and Intervention Not applicable. Results "No bed syndrome" describes the turning away by hospitals and clinics of people seeking walk in or referral emergency care with the stated reasons "no bed available" or "all beds are full". There are reported cases of people dying while going round multiple hospitals seeking help and being repeatedly turned away because there is "no bed". The situation appears to be most acute in the highly urbanized and densely populated Greater Accra region. It is driven by a complex of factors related to context, health system functions, values, and priorities. The solutions that have been tried are fragmented rather than well-coordinated whole system reform. Discussions and recommendations The "no bed syndrome" describes the challenge of a poorly functioning emergency health care system rather than just the absence of a bed on which to place an emergency case. Many low and middle income countries have similar challenges with their emergency health care systems and this analysis from Ghana is potentially valuable in attracting global attention and thinking about emergency health systems capacity and reform in low and middle income countries. The solution to the "no bed syndrome" in Ghana requires reform of Ghana's emergency healthcare system that takes a whole system and integrated approach. All the components of the health system such as human resource, information systems, financing, equipment tools and supplies, management and leadership need to be examined and addressed together alongside health system values such as accountability, equity or fairness in the formulation, implementation, continuous monitoring and evaluation of policies and programs for system reform to expand and strengthen emergency healthcare system capacity and responsiveness. Despite the temptation to fall back on them as low hanging fruit, piecemeal and ad-hoc solutions cannot solve the problem.
Collapse
Affiliation(s)
- Linda Lucy Yevoo
- Research and Development Division, Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
| | | | | | - Lauren Wallace
- Research and Development Division, Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
| | | | - Gifty Ofori-Ansah
- Greater Accra Region, Ningo Prampram District, Ghana Health Service, Accra, Ghana
| | | | - Samuel Mayeden
- Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Irene Akua Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons (GCPS), Accra, Ghana
| |
Collapse
|
3
|
Cavallin F, Contin A, Alfeu N, Macmillian B, Seni AHA, Cebola BR, Calgaro S, Putoto G, Trevisanuto D. Prognostic role of TOPS in ambulance-transferred neonates in a low-resource setting: a retrospective observational study. BMC Pregnancy Childbirth 2022; 22:726. [PMID: 36151540 PMCID: PMC9503278 DOI: 10.1186/s12884-022-05060-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing the severity of transferred neonates at admission can improve resource allocation. This study evaluated the role of TOPS (illness severity score including temperature, oxygen saturation, skin perfusion and blood sugar) in predicting mortality in neonates transferred by ambulance in a low-resource setting. METHODS The study was conducted at Beira Central Hospital (Mozambique). Infants who were transferred by ambulance to the Neonatal Intensive Care Unit between 16th June and 16th October 2021 were included. The association between TOPS and mortality was investigated with a logistic regression model. Receiver-operating characteristics (ROC) curve was derived for TOPS; area under the ROC curve, sensitivity and specificity were calculated. RESULTS In-transport mortality was 2/198 (1.0%) and in-hospital mortality was 75/196 (38.3%). Median gestational age and birthweight were 38 weeks and 2600 g. Main causes of admission were asphyxia (29.3%), prematurity (25.3%) and sepsis (22.7%). Hypothermia and oxygen desaturation at admission were 75.8% and 32.3%. TOPS ≥ 1 was associated with increased mortality risk (odds ratio 7.06. 95% confidence interval 1.90 to 45.82), with 0.97 sensitivity and 0.26 specificity. CONCLUSIONS The high mortality rate calls for interventions and quality initiative studies to improve the transfer process and the conditions at admission. TOPS can be used to identify neonates at risk of mortality and concentrate efforts of health care providers. Interventions preventing hypothermia and oxygen desaturation should be implemented in pre-transport stabilization and care during transport.
Collapse
Affiliation(s)
| | - Annaelena Contin
- Doctors With Africa CUAMM Mozambique, Beira, Mozambique.,Department of Woman's and Child's Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy
| | - Natércia Alfeu
- Department of Pediatrics, Beira Central Hospital, Beira, Mozambique
| | | | | | | | - Serena Calgaro
- Doctors With Africa CUAMM Mozambique, Beira, Mozambique. .,Department of Woman's and Child's Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy.
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Via Giustiniani, 3, 35128, Padua, Italy
| |
Collapse
|
4
|
Wong KL, Banke-Thomas A, Sholkamy H, Dennis ML, Pembe AB, Birabwa C, Asefa A, Delamou A, Sidze EM, Dossou JP, Waiswa P, Beňová L. Tale of 22 cities: utilisation patterns and content of maternal care in large African cities. BMJ Glob Health 2022; 7:bmjgh-2021-007803. [PMID: 35232813 PMCID: PMC8889454 DOI: 10.1136/bmjgh-2021-007803] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Globally, the majority of births happen in urban areas. Ensuring that women and their newborns benefit from a complete package of high-quality care during pregnancy, childbirth and the postnatal period present specific challenges in large cities. We examine health service utilisation and content of care along the maternal continuum of care (CoC) in 22 large African cities. Methods We analysed data from the most recent Demographic and Health Survey (DHS) since 2013 in any African country with at least one city of ≥1 million inhabitants in 2015. Women with live births from survey clusters in the most populous city per country were identified. We analysed 17 indicators capturing utilisation, sector and level of health facilities and content of three maternal care services: antenatal care (ANC), childbirth care and postnatal care (PNC), and a composite indicator capturing completion of the maternal CoC. We developed a categorisation of cities according to performance on utilisation and content within maternal CoC. Results The study sample included 25 326 live births reported by 19 217 women. Heterogeneity in the performance in the three services was observed across cities and across the three services within cities. ANC utilisation was high (>85%); facility-based childbirth and PNC ranged widely, 77%–99% and 29%–94%, respectively. Most cities showed inconsistent levels of utilisation and content across the maternal CoC, Cotonou and Accra showed relatively best and Nairobi and Ndjamena worst performance. Conclusion This exploratory analysis showed that many DHS can be analysed on the level of large African cities to provide actionable information about the utilisation and content of the three maternal health services. Our comparative analysis of 22 cities and proposed typology of best and worst-performing cities can provide a starting point for extracting lessons learnt and addressing critical gaps in maternal health in rapidly urbanising contexts.
Collapse
Affiliation(s)
- Kerry Lm Wong
- Infectious Disease and Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | | | - Hania Sholkamy
- Social Research Center, American University in Cairo, Cairo, Egypt
| | | | - Andrea B Pembe
- Obstetric and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alexandre Delamou
- Department of Public Health, Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | | | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.,Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| |
Collapse
|