OBJECTIVE:To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.
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 only for labour 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. The secondary outcome was maternal health outcomes based on the three-delay model.
RESULTS:A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the 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%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays.
CONCLUSION AND RECOMMENDATION:This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals' set-up and readiness to manage obstetric emergencies.
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【Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study.].
【埃塞俄比亚亚的斯亚贝巴医院急诊转诊的延误：一项基于设施的横断面研究。】
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DOI：10.1136/bmjopen-2019-033771文章类型：杂志文章
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目的：基于三延迟模型，评估埃塞俄比亚亚的斯亚贝巴大多数孕产妇健康结局转诊链中的延误发生位置。
设计：该研究是一项基于设施的横断面研究。
地点：亚的斯亚贝巴的两家公立和三级医院。
参加者：所有孕妇在2018年12月至2019年2月期间在Zewditu和Gandhi Memorial Hospital的妊娠28周后仅接受分娩和分娩服务。
主要和次要指标：主要成果是三延迟模型中的延误类型，该延迟满足了运营规定的时间。次要结果是基于三延迟模型的孕产妇健康结果。
结果：共有403名孕妇被分派到研究医院进行了研究。被转诊的孕妇中有四分之三（301，74.7％）经历了第三次延误（延迟获得适当的护理）； 211人（52.4％）经历了第一次延误（决定寻求护理的延迟）。总共366名（90.8％）孕妇经历了这三种延误中的至少一种，而71名（17.6％）的孕妇经历了这三种延误中的至少一种。有29名（7.2％）推荐的妇女有严重的孕产妇结局。严重孕妇预后的主要原因/诊断是输血（17，58.6％），其次是产后出血（15，52％）和子痫（9，31％）。此外，经历严重孕产妇结局的妇女发生三种延误中至少一种的可能性要高2.9倍。
结论和建议：本研究强调了各级延迟的持续存在，尤其是第三次延迟及其对严重孕产妇结局的影响。我们建议加强卫生转诊系统，并解决分娩和分娩期间特定的卫生系统瓶颈，以确保没有母亲受到威胁。我们还建议进行定性研究（焦点小组讨论和深入访谈），并观察三级医院的设置和准备处理产科急症的准备情况。
设计：该研究是一项基于设施的横断面研究。
地点：亚的斯亚贝巴的两家公立和三级医院。
参加者：所有孕妇在2018年12月至2019年2月期间在Zewditu和Gandhi Memorial Hospital的妊娠28周后仅接受分娩和分娩服务。
主要和次要指标：主要成果是三延迟模型中的延误类型，该延迟满足了运营规定的时间。次要结果是基于三延迟模型的孕产妇健康结果。
结果：共有403名孕妇被分派到研究医院进行了研究。被转诊的孕妇中有四分之三（301，74.7％）经历了第三次延误（延迟获得适当的护理）； 211人（52.4％）经历了第一次延误（决定寻求护理的延迟）。总共366名（90.8％）孕妇经历了这三种延误中的至少一种，而71名（17.6％）的孕妇经历了这三种延误中的至少一种。有29名（7.2％）推荐的妇女有严重的孕产妇结局。严重孕妇预后的主要原因/诊断是输血（17，58.6％），其次是产后出血（15，52％）和子痫（9，31％）。此外，经历严重孕产妇结局的妇女发生三种延误中至少一种的可能性要高2.9倍。
结论和建议：本研究强调了各级延迟的持续存在，尤其是第三次延迟及其对严重孕产妇结局的影响。我们建议加强卫生转诊系统，并解决分娩和分娩期间特定的卫生系统瓶颈，以确保没有母亲受到威胁。我们还建议进行定性研究（焦点小组讨论和深入访谈），并观察三级医院的设置和准备处理产科急症的准备情况。
