Beyond the numbers of maternal near-miss in Rwanda – a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy

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Study Justification:
– Despite progress in reducing maternal deaths in Rwanda, women still face morbidities and mortalities during pregnancy.
– This study aimed to explore the care-seeking behaviors and experiences of maternity care among women who experienced a near-miss event during early or late pregnancy.
– The study aimed to identify potential health system limitations or barriers to maternal survival in Rwanda.
Highlights:
– The study used a qualitative approach to gather in-depth insights from 47 women who had experienced a near-miss event during pregnancy.
– The women faced various barriers to care-seeking, including factors such as wanted pregnancy, gestational age, insurance coverage, and marital status.
– Poor communication between women and healthcare providers resulted in inadequate or inappropriate treatment, leading some women to seek traditional medicine or repeatedly visit biomedical facilities.
– The study highlights the need for improved service provision routines, better information, and amendments to the insurance system to enhance prompt care-seeking.
– The study emphasizes the importance of a health system that considers the needs of all pregnant women, particularly those facing unintended pregnancies or complications in the early stages.
Recommendations:
– Improve service provision routines to ensure timely and appropriate care for pregnant women.
– Enhance communication between women and healthcare providers to avoid inadequate or inappropriate treatment.
– Amend the insurance system to address barriers to care-seeking and ensure access to necessary maternity care.
– Develop a health system that considers the needs of all pregnant women, including those facing unintended pregnancies or complications in the early stages.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Healthcare providers: Involved in delivering maternity care and implementing recommended changes.
– Insurance providers: Responsible for amending the insurance system to address barriers to care-seeking.
– Community leaders and organizations: Play a role in raising awareness and promoting access to maternity care.
Cost Items for Planning Recommendations:
– Training programs for healthcare providers to improve communication and service provision: budget for trainers, materials, and logistics.
– Information campaigns to raise awareness about available maternity care services: budget for materials, media, and outreach activities.
– Amendments to the insurance system: budget for policy development, administrative changes, and communication efforts.
– Monitoring and evaluation of the implemented changes: budget for data collection, analysis, and reporting.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design and analysis were guided by a framework of Naturalistic Inquiry, and the ‘three delays’ model was used for data sorting. The study included a relatively large sample size of 47 women, and interviews were conducted at three hospitals in Kigali. However, the abstract does not provide specific details about the methodology used or the criteria for selecting participants. To improve the strength of the evidence, the abstract could include more information about the study design, sampling strategy, and data collection methods.

Background: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. Methods: A framework of Naturalistic Inquiry guided the study design and analysis, and the ‘three delays’ model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. Results: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. Conclusion: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

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The study recommends several innovations to improve access to maternal health care for all pregnant women, particularly those facing unintended pregnancies or complications in the early stages of pregnancy. These innovations include:

1. Improving service provision routines: This involves ensuring that healthcare providers have the necessary skills and resources to provide appropriate and timely care to pregnant women. This may include training healthcare workers on best practices for maternal health care, ensuring an adequate number of skilled healthcare providers, and improving the overall quality of care provided.

2. Providing accurate and accessible information: Pregnant women need access to reliable and understandable information about pregnancy, childbirth, and available healthcare services. This can be achieved through various means, such as developing educational materials, conducting community outreach programs, and utilizing technology to disseminate information.

3. Making amendments to the insurance system: The study suggests that changes to the insurance system can help enhance prompt care-seeking among pregnant women. This may involve expanding insurance coverage to include prenatal care and childbirth services, reducing financial barriers to accessing care, and ensuring that insurance policies are designed to meet the specific needs of pregnant women.

By implementing these innovations, the study believes that the goal of improving access to maternal health care can be achieved, ultimately reducing maternal morbidities and mortalities in Rwanda.
AI Innovations Description
The recommendation from the study is to develop a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy. This can be achieved by improving service provision routines, providing accurate and accessible information, and making amendments to the insurance system to enhance prompt care-seeking. By addressing these barriers and ensuring that all pregnant women have access to appropriate and timely care, the goal of improving access to maternal health can be achieved.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach could be used. Here is a brief methodology that could be employed:

1. Study Design: Conduct a prospective cohort study to assess the impact of the recommended interventions on improving access to maternal health. This study design allows for the collection of both quantitative and qualitative data.

2. Study Population: Select a representative sample of pregnant women in Rwanda, including those facing unintended pregnancies or complications in the early stages of pregnancy. Ensure diversity in terms of gestational age, insurance coverage, and marital status.

3. Intervention: Implement the recommended interventions, including improving service provision routines, providing accurate and accessible information, and making amendments to the insurance system to enhance prompt care-seeking.

4. Data Collection:
a. Quantitative Data: Collect data on key indicators related to access to maternal health, such as the number of antenatal care visits, the timing of care-seeking, and the utilization of maternal health services. Use structured questionnaires and medical records to collect this data.
b. Qualitative Data: Conduct in-depth interviews and focus group discussions with pregnant women to explore their experiences and perceptions regarding access to maternal health. Use open-ended questions to gather rich qualitative data.

5. Data Analysis:
a. Quantitative Analysis: Analyze the quantitative data using appropriate statistical methods, such as descriptive statistics and regression analysis, to assess the impact of the interventions on access to maternal health.
b. Qualitative Analysis: Transcribe and code the qualitative data using thematic analysis to identify common themes and patterns related to access to maternal health.

6. Ethical Considerations: Obtain ethical approval from relevant research ethics committees and ensure informed consent from all study participants. Protect the privacy and confidentiality of the participants throughout the study.

7. Data Interpretation and Reporting: Interpret the findings from both the quantitative and qualitative analyses. Summarize the impact of the recommended interventions on improving access to maternal health. Prepare a comprehensive report that includes clear and concise recommendations for policymakers and healthcare providers.

By employing this methodology, researchers can assess the effectiveness of the recommended interventions in improving access to maternal health and provide evidence-based recommendations for the development of a health system that considers the needs of all pregnant women.

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