emoc –indian context

22

Upload: derora

Post on 06-Jan-2016

58 views

Category:

Documents


0 download

DESCRIPTION

EmOC –Indian context. EmOC provision a policy priority JSY to promote institutional births, thus provide access to EmOC Three tiered health system with referral services Free referral transport in some states-Janani Express in MP. - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: EmOC –Indian context
Page 2: EmOC –Indian context

EmOC –Indian context

• EmOC provision a policy priority

• JSY to promote institutional births, thus provide access to EmOC

• Three tiered health system with referral services

• Free referral transport in some states-Janani Express in MP

Page 3: EmOC –Indian context

Figure 1. Model of referral chain, adapted from Jahn A and De Brouwer V 2001.

Chaturvedi S, Randive B, Diwan V, De Costa A (2014) Quality of Obstetric Referral Services in India's JSY Cash Transfer Programme for Institutional Births: A Study from Madhya Pradesh Province. PLoS ONE 9(5): e96773. doi:10.1371/journal.pone.0096773http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096773

Page 4: EmOC –Indian context

Objectives

To study quality of referral services in JSY by examining

1. association between maternal referral and adverse birth outcomes

2. spatial access to Emergency obstetric care (EmOC) among mothers referred to and died at referral facility

Page 5: EmOC –Indian context

Objective 1: Methods

• Nested matched case control design

• Three heterogenous districts of Madhya Pradesh

• Cross sectional facility based study at facilities

reporting >10 deliveries/month (n=96), 5 days at each

facility

• Interviews with mothers delivered at the facility

(n= 1182)

Page 6: EmOC –Indian context

Table 2. Study facilities by level and distribution of mothers who accessed intra-partum care at these levels.

Chaturvedi S, Randive B, Diwan V, De Costa A (2014) Quality of Obstetric Referral Services in India's JSY Cash Transfer Programme for Institutional Births: A Study from Madhya Pradesh Province. PLoS ONE 9(5): e96773. doi:10.1371/journal.pone.0096773http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096773

Page 7: EmOC –Indian context

Figure 2. Mothers who reached study facilities for intra-partum care by referral status.

Chaturvedi S, Randive B, Diwan V, De Costa A (2014) Quality of Obstetric Referral Services in India's JSY Cash Transfer Programme for Institutional Births: A Study from Madhya Pradesh Province. PLoS ONE 9(5): e96773. doi:10.1371/journal.pone.0096773http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096773

Page 8: EmOC –Indian context

Design

Cases: mothers with adverse birth outcome at term delivery (n=34) Controls : mothers with live neonates at 48 hours postpartum (n=68) Controls matched individually to cases for type of complication

and place of delivery

Adverse birth outcome: Intra partum foetal death /early in facility neonatal death

Page 9: EmOC –Indian context

Sample characteristics

Cases (n==34) Controls (n=68)

Age in years, median (range) 22 (18-35) 23 (18-40)

Below poverty line * 65% 41%

Illiterate 32% 32%

Referred* 50% 25%

Primiparous 50% 44%

Caesarean section delivery 15% 28%

ANC visits < 2 38% 25%

Delivery care by doctor 21% 30%

* Significant at p<0.05

Page 10: EmOC –Indian context

Association bet maternal referral & adverse birth outcome

Variable Odds ratio (95% CI) P value

Maternal referral 2.61 (1.08; 6.6) 0.04

Age 1.83 (0.60, 5.51) 0.28

Education 1.2 (0.43- 3.43) 0.70

Below poverty line 2.06 (0.80-5.31) 0.13

Parity 0.63 (0.19-2.02) 0.43

ANC visit 1.19 (0.57, 2.48) 0.63

Provider 0.30 (0.07, 1.25) 0.10

Maternal referral associated with significantly higher odds of adverse birth outcomes

Page 11: EmOC –Indian context

Objective2 -Methods

• Application of Geographical Information System (GIS) tools

• Two hours travel time to CEmOC facility- UN standard for geographical access to EmOC

• Used two hours as desired time travel time to determine spatial access to EmOC services

Page 12: EmOC –Indian context

Objective 2 -Methods

1. Identification of CEmOC facilities by survey using UN signal functions

Digitization of district map with roads and maternity facilities

Page 13: EmOC –Indian context

Shahdol District:Delivery facilities and major roads

Delivery facilities- 63

CEmOC facility-1 (Dist Hospital)

Page 14: EmOC –Indian context

Objective 2 -Methods ctd…….

2. Review of maternal death records at CEmOC facility

(April2010-March 2012) : 124 deaths

3. Identification of deaths among mothers referred to

CEmOC facility : 55 referred in mothers

4.Referring facility locations plotted on GIS map

Page 15: EmOC –Indian context

Facilities that referred the 55 mothers who died

Page 16: EmOC –Indian context

Objective 2 -Methods ctd…

5.Buffer analysis of referring facility locations in Arc Info 10

Average speed for a van in the study area is 50 Km/hr

Buffers with a radius of 50 Km and 100 Km constructed around CEmOC facility

Page 17: EmOC –Indian context

100 km Buffer from CEmOC facility

Almost all were referred from within 2 hours travel time

Page 18: EmOC –Indian context

50 km Buffer from CEmOC facility

Most were referred from within 1 hour travel time

Page 19: EmOC –Indian context

Objective 2- Results

• Almost all mothers referred from within 2 hours distance

• Most (82%) referred from within one hour distance

• Median time between arrival and death- 6.75 hours (IQR- 2.1-32 hours)

Page 20: EmOC –Indian context

Summary results

• High odds of adverse birth outcome associated with maternal referral

• Maternal deaths despite spatial access to EmOC

Page 21: EmOC –Indian context

Conclusions

• Inefficiencies in referral services resulting in loss of life saving opportunities

• Failure to provide successful EmOC • Possible deficiencies at sender, transfer and

receiver levels of referral system• Poor quality of referral services in JSY in MP

Page 22: EmOC –Indian context

Acknowledgements

• EU FP 7 grant to project MATIND

• Government of Madhya Pradesh, India

Thank You!