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Patterns and determinants of pathways to reach comprehensive emergency obstetric and neonatal care (CEmONC) in South Sudan: qualitative diagrammatic pathway analysis

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dc.contributor.author Elmusharaf, Khalifa
dc.contributor.author Byrne, Elaine
dc.contributor.author AbuAgla, Ayat
dc.contributor.author AbdelRahim, Amal
dc.contributor.author Manandhar, Mary
dc.contributor.author Sondrop, Egbert
dc.contributor.author O'Donovan, Diarmuid
dc.date.accessioned 2017-09-11T09:08:03Z
dc.date.available 2017-09-11T09:08:03Z
dc.date.issued 2017
dc.identifier.uri http://hdl.handle.net/10344/6051
dc.description peer-reviewed en_US
dc.description.abstract Background: Maternity referral systems have been under-documented, under-researched, and under-theorised. Responsive emergency referral systems and appropriate transportation are cornerstones in the continuum of care and central to the complex health system. The pathways that women follow to reach Emergency Obstetric and Neonatal Care (EmONC) once a decision has been made to seek care have received relatively little attention. The aim of this research was to identify patterns and determinants of the pathways pregnant women follow from the onset of labour or complications until they reach an appropriate health facility. Methods: This study was conducted in Renk County in South Sudan between 2010 and 2012. Data was collected using Critical Incident Technique (CIT) and stakeholder interviews. CIT systematically identified pathways to healthcare during labour, and factors associated with an event of maternal mortality or near miss through a series of in-depth interviews with witnesses or those involved. Face-to-face stakeholder interviews were conducted with 28 purposively identified key informants. Diagrammatic pathway and thematic analysis were conducted using NVIVO 10 software. Results: Once the decision is made to seek emergency obstetric care, the pregnant woman may face a series of complex steps before she reaches an appropriate health facility. Four pathway patterns to CEmONC were identified of which three were associated with high rates of maternal death: late referral, zigzagging referral, and multiple referrals. Women who bypassed nonfunctional Basic EmONC facilities and went directly to CEmONC facilities (the fourth pathway pattern) were most likely to survive. Overall, the competencies of the providers and the functionality of the first point of service determine the pathway to further care. Conclusions: Our findings indicate that outcomes are better where there is no facility available than when the woman accesses a non-functioning facility, and the absence of a healthcare provider is better than the presence of a noncompetent provider. Visiting non-functioning or partially functioning healthcare facilities on the way to competent providers places the woman at greater risk of dying. Non-functioning facilities and non-competent providers are likely to contribute to the deaths of women. en_US
dc.language.iso eng en_US
dc.publisher BioMed Central en_US
dc.relation.ispartofseries BMC Pregnancy and Childbirth;17: 278
dc.subject EmONC en_US
dc.subject referral system en_US
dc.subject maternal mortality en_US
dc.subject conflict affected fragile states en_US
dc.subject South Sudan en_US
dc.subject quality of care en_US
dc.subject competency en_US
dc.subject access en_US
dc.title Patterns and determinants of pathways to reach comprehensive emergency obstetric and neonatal care (CEmONC) in South Sudan: qualitative diagrammatic pathway analysis en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1186/s12884-017-1463-9
dc.contributor.sponsor Irish Aid Higher Education and Research Institutes 2007-2011 en_US
dc.contributor.sponsor University of Medical Sciences and Technology (UMST) en_US
dc.rights.accessrights info:eu-repo/semantics/closedAccess en_US
dc.internal.rssid 2725780


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