Using clinical cascades to measure obstetric emergency preparedness of health facilities: testing the cascade model using cross-sectional facility data in East Africa

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BMJ open. 2022 Apr 4;12(4):e057954. doi: 10.1136/bmjopen-2021-057954.

ABSTRACT

OBJECTIVES: Globally, hundreds of women die every day from preventable causes related to pregnancy, with the heaviest burden in sub-Saharan Africa. Five key emergencies – bleeding, infections, high blood pressure, complications of childbirth and unsafe abortions – account for almost 75% of these obstetrical deaths. Skilled clinicians with strategic supplies could prevent most deaths. In this study, we (1) measured facility readiness to handle common obstetric emergencies using clinical cascades and signal function tracers; (2) compared these estimates of readiness by facility characteristics; and (3) measured cascading resource declines.

DESIGN: A cross-sectional analysis of facility resources for common obstetric emergencies.

SETTING: Data were collected in 2016 from 23 hospitals (10 designated comprehensive emergency obstetric care (CEmOC) centres) in Migori county, western Kenya, and Busoga region, Kenya. eastern Uganda, as part of the Preterm Birth Initiative study in East Africa. Baseline data was used to estimate a facility’s readiness to handle common obstetric emergencies using signal function tracers and the clinical cascade model. We compared emergency preparedness using the proportion of facilities with tracers (signal functions) and the proportion with resources to identify and deal with the emergency (cascade steps 1 and 2).

RESULTS: Signaling functions overestimated practical emergency preparedness by 23 percentage points for five emergencies. Only 42% of CEmOC-designated facilities could provide basic emergency obstetric care. During the three stages of care (identify, treat and monitor-modify) for five emergencies, there was a combined 28% average decline in preparedness. Across all EDs, the largest decline occurred in the treatment stage. Drop-out patterns remained broadly consistent across all facility characteristics.

CONCLUSIONS: Accurate measurement of obstetric emergency preparedness is a prerequisite for building facility capacity to manage common emergencies. Cascades provide step-by-step estimates of emergency preparedness designed to guide targeted maternal survival policies and programs.

TEST REGISTRATION NUMBER: NCT03112018.

PMID:35379635 | DOI:10.1136/bmjopen-2021-057954

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