DOI: 10.5061/dryad.x95x69pfh
title: Delays in emergency obstetrics referrals in Addis Ababa hospitals, Ethiopia: a facility-based, cross-sectional study

description: Objectives: To assess where the delays occur in the referral chain at most
 and maternal health outcomes based on the three delay model in Addis
 Ababa, Ethiopia. Design: The study was a facility-based cross-sectional
 study Setting:  Two public and tertiary hospitals in Addis Ababa
 Participants: All pregnant women who were referred for only labor and
 delivery services after 28 weeks of gestation between December 2018 and
 February 2019 in Zewditu and Gandhi Memorial hospitals. Primary and
 secondary outcome measures: The primary outcome was the type of delays
 from the three-delay model which met operationally defined time. Maternal
 health outcomes based on the three-delay model as a secondary outcome.
    Results: A total of 403 pregnant women referred for
 delivery to the study hospitals were included in the study. Three-fourth
 (301, 74.7%) of referred pregnant women had the third delay (delayed
 receiving appropriate care); (211, 52.4%) had a first delay (delay in
 making a decision to seek care). Overall 366(90.8%) pregnant women had
 experienced at least one of the three delays and 71(17.6%) had all the
 three delays. Twenty-nine (7.2%) referred women had severe maternal
 outcomes (SMO). The most leading causes/diagnosis of SMO were blood
 transfusion 17 (58.6%) followed by postpartum hemorrhage 15 (52%) then
 eclampsia 9 (31%). In addition, women who experienced severe maternal
 outcomes were 2.9 times more likely to have at least one of the three
 delays. Conclusion & recommendation:  This study
 highlights the persistence of delays at all levels and especially delay
 three and its contribution to severe maternal outcomes. Strengthening
 health referral systems and addressing specific health system bottlenecks
 during labor and birth in order to ensure no mother will be endangered. We
 also recommend a qualitative method of study (focus group discussion and
 in-depth interview) and observing the tertiary hospitals set-up and
 readiness to manage obstetrics emergencies.
description: Data collection
 After they gave birth,
 women were identified and interviewed from emergency OPD, labor ward, and
 in-patient wards every day before they discharged from the hospital by
 data collectors using pretested and structured questionnaires. 
 The referral papers
 reviewed and date, time and diagnosis of referral was recorded for each
 mother. The triage paper and patient chart are also reviewed including
 mode of transportation, date and time of arrival, sources of referrals,
 obstetrics performances, the time taken to admit/get the service after
 arrival, diagnosis at receiving hospital, gestational age, place and mode
 of delivery, newborn outcomes, and severe maternal complications types and
 managements. Women interviewed on socio-demographic characteristics, time
 interval to seek medical advice and reason for the delay to seek the care
 (if there was).  Data Process/analysis
 Data were entered in
 epi-info version 7.2.2.6 and transported to SPSS Version-21 statistics
 software for cleaning and analysis. Descriptive statistics were used to
 present women by their socio-demographic characteristics, referral
 diagnosis, diagnosis at receiving hospitals, obstetrics characteristics,
 mode of delivery, newborn outcomes, the three delays, and severe maternal
 outcomes. Severe maternal outcomes were analyzed for the three delays. The
 relationship between the three delays and SMO were examined using the
 multivariate logistic regression. The goodness of the model was tested by
 the Hosmer-Lemeshow test for goodness-of-fit. Selected variables were
 included in the model to account for maternal characteristics differences
 other than delays in seeking and receiving care  
description: File Information: 1. <strong>Conceptual
 frame work</strong>: how the study conducted on the three-delay
 models<br> <br> 2. <strong>Dx at receiving and
 referral</strong>: This excel sheet showed cases diagnosis<br>
 from referral centres and diagnosis in the two selected hospitals. It
 showed<br> also, the disparity of diagnosis based on the
 findings.<br> <br> 3. <strong>Latent stage of labor only
 SPSS sheet showed:</strong> Mother diagnosed below 4 cm<br>
 cervical dilation without any obstetrics/ and medical complications. On
 the<br> other hand,thus cases  don't need urgent
 admission.<br> <br> 4. <strong>Time interval for
 admission excel sheet showed</strong>: first part showed
 the<br> time it took to reach the hospitals after referrals. Second
 part showed:the<br> time duration the mother stayed in emergency
 OPD, after admission decided.<br>