Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia

• Type of Material: Article
• Authors: Kylie Dougherty, Columbia University; Abebe Gebremariam Gobezayehu, Emory University; Mulusew Lijalem, Emory University; Lamesgin Alamineh Endalamaw, Emory University; Heran Biza, Emory University; John N Cranmer, Emory University
• Language: English
• Date: 2023-08-03
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Dougherty et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0289496
• Title of Journal or Parent Work: PLOS ONE
• Volume: 18
• Issue: 8
• Start Page: e0289496
• End Page: e0289496
• Grant/Funding Information: Author KD was funded under a training grant from the National Institute of Nursing Research (T32 NRoo7969) and is currently funded under an F31 predoctoral trainee grant (F31NR020569). These two grants support KD’s tuition and education costs, and the National Institute of Nursing Research had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript. Data collection was supported by the Global Financing Facility; UNICEF-Ethiopia, but the Global Financing Facility did not play a role in study design, data analysis, decision to publish, or preparation of the manuscript.
• Keywords: INDICATORS; Multidisciplinary Sciences; Science & Technology; CARE; Science & Technology - Other Topics
• Research Categories: Health Sciences, Public Health; Health Sciences, Nursing

Abstract

Measuring facility readiness to manage basic obstetric emergencies is a critical step toward reducing persistently elevated maternal mortality ratios (MMR). Currently, the Signal Functions (SF) is the gold standard for measuring facility readiness globally and endorsed by the World Health Organization. The presence of tracer items classifies facilities’ readiness to manage basic emergencies. However, research suggests the SF may be an incomplete indicator. The Clinical Cascades (CC) have emerged as a clinically-oriented alternative to measuring readiness. The purpose of this study is to determine Amhara’s clinical readiness and quantify the relationship between SF and CC estimates of readiness. Data were collected in May 2021via Open Data Kit (ODK) and KoBo Toolbox. We surveyed 20 hospitals across three levels of the health system. Commodities were used to create measures of SF-readiness (e.g., % tracers) and CC-readiness. We calculated differences in SF and CC estimates and calculated readiness loss across six emergencies and 3 stages of care in the cascades. The overall SF estimate for all six obstetric emergencies was 29.6% greater than the estimates using the CC. Consistent with global patterns, hospitals were more prepared to provide medical management (70.0% ready) compared to manual procedures (56.7% ready). The SF overestimate was greater for manual procedures 33.8% overall for retained placenta and incomplete abortion) and less for medical treatments (25.3%). Hospitals were least prepared to manage retained placentas (30.0% of facilities were ready at treatment and 0.0% were ready at monitor and modify) and most prepared to manage hypertensive emergencies (85.0% of facilities were ready at the treatment stage). When including protocols in the analysis, no facilities were ready to monitor and modify the initial therapy when clinically indicated for 3 common emergencies—sepsis, post-partum hemorrhage and retained placentas. We identified a significant discrepancy between SF and CC readiness classifications. Those facilities that fall within this discrepancy are unprepared to manage common obstetric emergencies, and employees in supply management may have difficulty identify the need. Future research should explore the possibility of modifying the SF or replacing it with a new readiness measurement.