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Title: Quality of birthing care in low income settings : the case of Ethiopia
Author: Bayou, Negalign Berhanu
ISNI:       0000 0004 7969 1173
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2019
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Background: Maternal mortality is a common event for women in the poorer parts of the world. The maternal mortality ratio in Ethiopia is 412 per 100,000 live births. Most high burden countries including Ethiopia have strategies to provide skilled maternity care yet very few are making progress, due at least in part to not ensuring quality facility childbirth care. In Ethiopia, there are no studies on woreda (district) level factors associated with skilled birth attendance (SBA) rates, and evidence on quality of Labour and Delivery (L&D) care is generally scarce. Therefore, this project aimed at closing this gap. Methods: Two quantitative studies were conducted. The first study described variation in woreda SBA rates (N=839) and determinants of higher rates using a cross-sectional ecologic study design. The second study examined quality of birthing care in government hospitals (n=20) of Southern Nations and Nationalities Region (SNNPR) by collecting primary data, using a cross-sectional study design. Key findings: The first study showed that the mean woreda-level SBA rate in Ethiopia was low at an ecologic level, but with substantial variations. Women's families, the wider community, availability of health resources, and proportion of four or more antenatal care significantly increased the SBA rate. The second study revealed gaps in the structural, process and outcome aspects of quality of L&D care in the hospitals. About two thirds of the required inputs were fulfilled, and only two hospitals fulfilled almost all the standards. Laboratory services and safe blood, essential drugs, supplies and equipment were the areas with the largest gaps. In terms of process quality, about two thirds of the standards were met overall for each woman for which she was eligible. The highest scores were achieved with immediate and essential newborn care practices, and care during the second and third stages of labour. History of a danger sign in the current pregnancy had a positive effect on the process quality at the level of each woman. At hospital level, teaching status and structural quality index score had significant positive effects, whilst annual L&D service volume had a significant negative effect on the process quality index score. Perceived quality of L&D care provided was also suboptimal. Being illiterate, absence of a complication after birth, perceived high quality of interpersonal communication and emotional support, responsiveness, health education and physical environment; all positively influenced women's overall experience. Furthermore, teaching status and primary or general level of hospitals, staff training, and high quality of L&D care process index also positively affected the experience. Recommendations: It is essential to increase the coverage of four or more ANC visits and strengthen the current community-based approaches to meaningfully increase the SBA rate. There is a need to ensure that all hospitals meet the required structure to enable the provision of quality routine L&D care, with particular emphasis on laboratory services and safe blood for emergency transfusion, and availability of essential drugs, supplies and equipment. It is also important to focus efforts on the factors that showed a significant effect on the process quality of routine L&D care process and the women's experience with the care received.
Supervisor: Grant, Liz ; Riley, Simon Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: maternal death ; Ethiopia ; labour and delivery provision