Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2013

Open Access 01-12-2013 | Research article

Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia

Authors: Jonathan M Spector, Jonathan Reisman, Stuart Lipsitz, Priya Desai, Atul A Gawande

Published in: BMC Pregnancy and Childbirth | Issue 1/2013

Login to get access

Abstract

Background

The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. The majority of global maternal and newborn deaths take place in Africa and Asia, yet few data exist that describe the availability of childbirth-related health technologies in these regions. We conducted a cross-sectional survey of health workers in Africa and Asia in order to profile the availability of health technologies considered to be essential to providing safe childbirth care.

Methods

Health workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics.

Results

Health workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability of 13 of 23 technologies (55%; 95% CI, 39%, 71%).

Conclusions

Substantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority.
Appendix
Available only for authorised users
Literature
1.
Oestergaard MZ, Inoue M, Yoshida S, et al: Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Medicine. 2011, 8 (8): e1001080-10.1371/journal.pmed.1001080.CrossRefPubMedPubMedCentral
2.
Lawn JE, Blencowe H, Pattinson R, et al: Stillbirths: Where? When? Why? How to make the data count?. Lancet. 2011, 377 (9775): 1448-1463. 10.1016/S0140-6736(10)62187-3.CrossRefPubMed
3.
Hogan MC, Foreman KJ, Naghavi M, et al: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010, 375 (9726): 1609-1623. 10.1016/S0140-6736(10)60518-1.CrossRefPubMed
4.
Ronsmans C, Graham WJ, Lancet Maternal Survival Series steering group: Maternal mortality: who, when, where, and why. Lancet. 2006, 368 (9542): 1189-1200. 10.1016/S0140-6736(06)69380-X.CrossRefPubMed
5.
Lawn JE, Cousens S, Zupan J, et al: 4 million neonatal deaths: When? Where? Why?. Lancet. 2005, 365: 891-900. 10.1016/S0140-6736(05)71048-5.CrossRefPubMed
6.
Darmstadt GL, Bhutta ZA, Cousens SN, et al: Evidence-based, cost-effective interventions: how many newborn babies can we save?. Lancet. 2005, 365 (9463): 977-988. 10.1016/S0140-6736(05)71088-6.CrossRefPubMed
7.
Lee AC, Cousens S, Wall SN, et al: Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health. 2011, 11 (Suppl 3): S12-10.1186/1471-2458-11-S3-S12.CrossRefPubMedPubMedCentral
8.
Black RE, Cousens S, Johnson HL, et al: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010, 375 (9730): 1969-1987. 10.1016/S0140-6736(10)60549-1.CrossRefPubMed
9.
World Health Organization, D.o.R.H.a.R.R: Managing newborn problems: A guide for doctors, nurses, and midwives. 2003, Geneva: World Health Organization
10.
World Health Organization, D.o.R.H.a.R.R: Managing complications of pregnancy and childbirth: a guide for midwives and doctors. 2005, India: Thomson Press
11.
World Health Organization, D.o.M.P.S: Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice. 2006, Geneva: World Health Organization
12.
World Health Organization, D.o.M.P.S: Managing prolonged and obstructed labour. 2006, Geneva: WHO Press
13.
World Health Organization, D.o.M.P.S: Managing eclampsia: education materials for teachers of midwifery. 2006, Geneva: WHO Press, 2
14.
World Health Organization, D.o.M.P.S: WHO Recommendations for the prevention of postpartum haemorrhage (WHO/MPS/07.06). 2007, Geneva: World Health Organization
15.
Lim SS, Dandona L, Hoisington JA, et al: India's Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010, 375 (9730): 2009-2023. 10.1016/S0140-6736(10)60744-1.CrossRefPubMed
16.
Ekirapa-Kiracho E, Waiswa P, Rahman MH, et al: Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study. BMC International Health and Human Rights. 2011, 11 (Suppl 1): S11-10.1186/1472-698X-11-S1-S11.CrossRefPubMedPubMedCentral
17.
Maine D: The strategic model for the PMM Network. International Journal of Gynaecology and Obstetrics. 1997, 59 (Suppl 2): S23-5.CrossRefPubMed
18.
Beck D, Ganges F, Goldman S, et al: Saving Newborn Lives: Care of the Newborn, Reference Manual. 2004, Washington D.C: Save the Children
19.
Tsu VD: New and underused technologies to reduce maternal mortality. Lancet. 2004, 363 (9402): 75-76. 10.1016/S0140-6736(03)15180-X.CrossRefPubMed
20.
Wagstaff A, Bustreo F, Bryce J, et al: Child health: reaching the poor. American Journal of Public Health. 2004, 94 (5): 726-736. 10.2105/AJPH.94.5.726.CrossRefPubMedPubMedCentral
21.
Zupan J: Perinatal mortality in developing countries. New England Journal of Medicine. 2005, 352 (20): 2047-2048. 10.1056/NEJMp058032.CrossRefPubMed
22.
Kerber KJ, de Graft-Johnson JE, Bhutta ZA, et al: Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007, 370 (9595): 1358-1369. 10.1016/S0140-6736(07)61578-5.CrossRefPubMed
23.
Allman J, Blumhagen J, Brown NL: Barriers to treatment of obstetric emergencies in rural communities of West Africa. The Prevention of Maternal Mortality Network. Studies in Family Planning. 1992, 23 (5): 279-291.CrossRef
24.
World Bank: Size of the Economy. 2011 World Development Indicators. 2011, Washington, D.C: World Bank, 10-11.
25.
Lipsitz SR, Fitzmaurice GM, Orav EJ, et al: Performance of generalized estimating equations in practical situations. Biometrics. 1994, 50: 270-278. 10.2307/2533218.CrossRefPubMed
26.
Rao JNK, Scott AJ: On Simple Adjustments to Chi-Square Tests with Survey Data. The Annals of Statistics. 1987, 15: 385-397. 10.1214/aos/1176350273.CrossRef
27.
Lawn JE, Yakoob MY, Haws RA, et al: 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth. 2009, 9 (Suppl 1): S2-10.1186/1471-2393-9-S1-S2.CrossRefPubMedPubMedCentral
28.
Murray CJ, Laakso T, Shibuya K, et al: Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015. Lancet. 2007, 370 (9592): 1040-1054. 10.1016/S0140-6736(07)61478-0.CrossRefPubMed
29.
Bryce J, Daelmans B, Dwivedi A, et al: Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Lancet. 2008, 371 (9620): 1247-1258.CrossRefPubMed
Metadata
Title
Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia
Authors
Jonathan M Spector
Jonathan Reisman
Stuart Lipsitz
Priya Desai
Atul A Gawande
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2013
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-13-43

Other articles of this Issue 1/2013

BMC Pregnancy and Childbirth 1/2013 Go to the issue

Research article

Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000 –2008: a population based data linkage study

Research article

Prognostic factors for low birthweight repetition in successive pregnancies: a cohort study

Research article

Developing a tool for obtaining maternal skinfold thickness measurements and assessing inter-observer variability among pregnant women who are overweight and obese

Research article

Autoantibodies and gastrointestinal symptoms in infertile women in relation to in vitro fertilization

Study protocol

A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol

Research article

Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case control study