Verbal Autopsies and Assessment of Emergency Obstetric Care
The PRHP researchers conducted 22 verbal autopsies that included interviews with family, friends, and knowledgeable people to investigate causes of death and to identify intervention priorities. They then developed a timeline that explored the direct causes of death and the social factors contributing to death using the three delays framework.
Delays in receiving appropriate care at the health facility were found to be the most significant factors underlying the women’s deaths. These facility-based delays included:
- a lack of competent motivated personnel
- shortages of supplies
- basic equipment
- lack of blood
- lack of adequate supervision and management
- cumbersome administrative processes, and financial requirements for services
Furthermore, many of the delays in seeking medical care were caused by families’ previous negative experiences with such deficiencies at health facilities.
Assessment of Emergency Obstetric Care
The verbal autopsies underlined the importance of understanding the factors impeding prompt, appropriate and reliable emergency obstetric care at the health facilities serving the PRHP collaborating communities.
The PRHP postdoctoral fellows under the supervision of an OBGYN with 15 years clinical experience carried out a qualitative assessment of emergency obstetric care in primary and secondary facilities serving the three collaborating communities. The purpose of this activity is to engage the hospital staff in the analysis obstetric practices occurring in their facility and begin discussion of ways to improve the quality of service.
Preliminary analyses revealed that:
- patient acuity was high; most women arrived with obstetric complications after failing to deliver at home
- hospital staff attempted to provide emergency obstetric care despite severe staffing shortages, deficient hospital resources, and inadequate medical supplies
- sporadic supply of electricity and unreliable telephone networks also compromised their ability to provide care