Personal accounts of ‘near-miss’ maternal mortalities in Kampala, Uganda

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Study Justification:
The objective of this study was to explore the socio-economic determinants of maternal mortality in Uganda by interviewing women who had experienced ‘near-miss’ maternal deaths. This study is important because it provides insights into the factors that contribute to maternal mortality and can help inform policies and interventions to reduce maternal deaths in Uganda.
Highlights:
– The study conducted interviews with thirty women who narrowly avoided maternal deaths due to various complications.
– The predominant theme that emerged from the interviews was powerlessness, both within and outside the hospital.
– Financial barriers and problems with transport were found to be major factors influencing health-seeking behavior.
– Medical mistakes and delays in referral were evident, particularly in rural health centers.
– Women appreciated the care they received from the central government hospital, but there were reports of overcrowding, long delays, shortages, and inhumane care.
– No reports of bribery were found.
Recommendations:
Based on the findings of this study, the following recommendations can be made:
1. Improve access to affordable healthcare services by addressing financial barriers and transportation issues.
2. Enhance the quality of care in rural health centers by addressing medical mistakes and delays in referral.
3. Address issues of overcrowding, long delays, shortages, and inhumane care in central government hospitals.
4. Strengthen the empowerment of women by addressing the powerlessness they experience both within and outside the hospital.
Key Role Players:
1. Ministry of Health: Responsible for implementing policies and interventions to address the identified issues.
2. Healthcare providers: Involved in delivering quality care and ensuring timely referrals.
3. Community leaders and organizations: Engaged in raising awareness and providing support to women in need.
4. Non-governmental organizations (NGOs): Collaborate with the government to implement programs and initiatives aimed at reducing maternal mortality.
Cost Items for Planning Recommendations:
1. Training and capacity building for healthcare providers.
2. Infrastructure improvements in rural health centers and central government hospitals.
3. Transportation services to improve access to healthcare facilities.
4. Awareness campaigns and community outreach programs.
5. Monitoring and evaluation of interventions to ensure effectiveness.
Please note that the cost items provided are general categories and not actual cost estimates. Actual budget planning would require a detailed analysis of specific needs and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on an observational study using qualitative research methods. The sample size is relatively small (30 women), which may limit the generalizability of the findings. However, the study provides valuable insights into the socio-economic determinants of maternal mortality in Uganda. To improve the strength of the evidence, future research could consider increasing the sample size and using a mixed-methods approach to complement the qualitative findings with quantitative data. Additionally, conducting the interviews in multiple languages and involving participants from diverse socio-economic backgrounds could enhance the representativeness of the study.

Objective: To explore the socio-economic determinants of maternal mortality in Uganda through interviews with women who had ‘near-misses’. Design: Observational study using qualitative research methods. Setting: The postnatal and gynaecology wards of a large government hospital in Kampala, Uganda. Sample: Thirty women who had narrowly avoided maternal deaths with diagnoses of obstructed labour (7), severe pre-eclampsia/eclampsia (3), post caesarean infection (6), haemorrhage (5), ectopic pregnancy (5) and septic abortion (4). Methods: The semi-structured interviews were conducted in the local language by a woman unconnected to the hospital, and were recorded before being translated and transcribed. Analysis was conducted in duplicate using commercial software. Results: The predominant theme was powerlessness, which occurred both within and outside the hospital. It was evident in the women’s attempts to get both practical and financial help from those around them as well as in their failure to gain rapid access to care. Financial barriers and problems with transport primarily governed health-seeking behaviour. Medical mistakes and delays in referral were evident in many interviews, especially in rural health centres. Women were appreciative of the care they received from the central government hospital, although there were reports of overcrowding, long delays, shortages and inhumane care. There were no reports of bribery. Conclusions: Women with near-miss maternal mortalities experience institutional and social powerlessness: these factors may be a major contributor to maternal mortality. © RCOG 2005.

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Based on the provided description, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that can reach remote areas and provide essential maternal health services, including prenatal care, skilled birth attendance, and postnatal care.

2. Telemedicine: Utilizing telemedicine technologies to connect healthcare providers in rural health centers with specialists in larger hospitals. This can help in timely diagnosis and appropriate management of maternal complications.

3. Community-based health workers: Training and deploying community-based health workers who can provide education, support, and basic maternal health services to women in their communities. These workers can also act as a bridge between the community and healthcare facilities.

4. Improving transportation infrastructure: Addressing the transportation challenges faced by pregnant women by improving road networks, providing ambulances, or establishing emergency transportation systems to ensure timely access to healthcare facilities.

5. Financial assistance programs: Implementing programs that provide financial support to pregnant women, especially those from low-income backgrounds, to cover the costs associated with maternal health services, including transportation, hospital fees, and medications.

6. Strengthening referral systems: Establishing efficient referral systems between rural health centers and larger hospitals to ensure timely transfer of high-risk cases and reduce delays in accessing appropriate care.

7. Quality improvement initiatives: Implementing quality improvement initiatives in healthcare facilities to address overcrowding, long delays, shortages, and inhumane care. This can involve training healthcare providers, improving infrastructure, and ensuring adequate availability of essential supplies and medications.

These innovations aim to address the socio-economic determinants of maternal mortality and improve access to timely and quality maternal health services in Uganda.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health based on the study conducted in Kampala, Uganda is as follows:

1. Strengthening healthcare infrastructure: Address the issues of overcrowding, long delays, shortages, and inhumane care reported in the central government hospital. This can be achieved by increasing the capacity of healthcare facilities, ensuring adequate staffing and resources, and improving the overall quality of care.

2. Enhancing financial support: Address the financial barriers that govern health-seeking behavior by implementing policies that provide financial assistance to pregnant women, especially those from low-income backgrounds. This can include subsidies for healthcare services, transportation, and medications.

3. Improving transportation services: Address the problems with transport reported by the women in the study. This can be achieved by improving the availability and accessibility of transportation options, particularly in rural areas, to ensure that pregnant women can reach healthcare facilities in a timely manner.

4. Enhancing referral systems: Address the issues of medical mistakes and delays in referral reported, especially in rural health centers. Implement mechanisms to improve communication and coordination between healthcare facilities, ensuring that women with complications are promptly referred to higher-level facilities for appropriate care.

5. Empowering women: Address the theme of powerlessness experienced by women both within and outside the hospital. This can be achieved through community education programs that empower women with knowledge about their rights, available healthcare services, and the importance of seeking timely care during pregnancy and childbirth.

By implementing these recommendations, it is expected that access to maternal health services in Kampala, Uganda can be improved, leading to a reduction in maternal mortality rates.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Strengthening healthcare infrastructure: Invest in improving the facilities, equipment, and resources in healthcare centers, particularly in rural areas, to ensure timely and quality maternal healthcare services.

2. Enhancing transportation services: Develop and implement transportation systems that can efficiently and safely transport pregnant women to healthcare facilities, especially in remote areas where access is limited.

3. Increasing awareness and education: Conduct community-based education programs to raise awareness about the importance of prenatal and antenatal care, family planning, and the availability of maternal healthcare services. This can help overcome cultural and social barriers that prevent women from seeking timely care.

4. Improving financial support: Establish mechanisms to provide financial assistance or health insurance coverage for pregnant women, particularly those from low-income backgrounds, to reduce financial barriers to accessing maternal healthcare.

5. Strengthening referral systems: Develop and implement effective referral systems between primary healthcare centers and higher-level facilities to ensure timely and appropriate care for women with complications.

To simulate the impact of these recommendations on improving access to maternal health, a possible methodology could include the following steps:

1. Define indicators: Identify key indicators that reflect access to maternal health, such as the number of women receiving prenatal care, the percentage of deliveries attended by skilled birth attendants, or the time taken to reach a healthcare facility in case of emergencies.

2. Data collection: Gather baseline data on the identified indicators before implementing the recommendations. This can be done through surveys, interviews, or existing data sources.

3. Implement recommendations: Introduce the recommended interventions and monitor their implementation to ensure they are being effectively carried out.

4. Data analysis: Collect data on the indicators after the implementation of the recommendations. Compare the post-intervention data with the baseline data to assess the impact of the recommendations on improving access to maternal health.

5. Evaluation: Analyze the data to determine the extent to which the recommendations have improved access to maternal health. This can involve statistical analysis, qualitative assessments, and comparison with pre-defined targets or benchmarks.

6. Feedback and adjustment: Based on the evaluation results, provide feedback to stakeholders and policymakers. If necessary, make adjustments to the recommendations or implementation strategies to further enhance their impact.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for future interventions.

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