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Komolafe, Abiola Olubusola, Adekemi Eunice Olowokere, and Omolola Oladunni Irinoye. "Assessment of integration of emergency obstetric and newborn care in maternal and newborn care in healthcare facilities in Osun State, Nigeria." PLOS ONE 16, no. 4 (April 15, 2021): e0249334. http://dx.doi.org/10.1371/journal.pone.0249334.
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The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83–71)). The EmONC integration median score were 76 (IQR = 84–70), 76 (IQR = 80–68) and 78 (IQR = 84–74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87–78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.
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Ebener, Steeve, Karin Stenberg, Michel Brun, Jean-Pierre Monet, Nicolas Ray, Howard Lawrence Sobel, Nathalie Roos, et al. "Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries." BMJ Global Health 4, Suppl 5 (June 2019): e000778. http://dx.doi.org/10.1136/bmjgh-2018-000778.
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Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.
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Curtis, Andrew, Jean-Pierre Monet, Michel Brun, Issa Abdou-Kérim Bindaoudou, Idrissou Daoudou, Marta Schaaf, Yawo Agbigbi, and Nicolas Ray. "National optimisation of accessibility to emergency obstetrical and neonatal care in Togo: a geospatial analysis." BMJ Open 11, no. 7 (July 2021): e045891. http://dx.doi.org/10.1136/bmjopen-2020-045891.
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ObjectivesImproving access to emergency obstetrical and neonatal care (EmONC) is a key strategy for reducing maternal and neonatal mortality. Access is shaped by several factors, including service availability and geographical accessibility. In 2013, the Ministry of Health (MoH) of Togo used service availability and other criteria to designate particular facilities as EmONC facilities, facilitating efficient allocation of limited resources. In 2018, the MoH further revised and rationalised this health facility network by applying an innovative methodology using health facility characteristics and geographical accessibility modelling to optimise timely access to EmONC services. This study compares the geographical accessibility of the network established in 2013 and the smaller network developed in 2018.DesignWe used data regarding travel modes and speeds, geographical barriers and topographical and urban constraints, to estimate travel times to the nearest EmONC facilities. We compared the EmONC network of 109 facilities established in 2013 with the one composed of 73 facilities established in 2018, using three travel scenarios (walking and motorised, motorcycle-taxi and walking-only).ResultsWhen walking and motorised travel is considered, the 2013 EmONC network covers 81% and 96.6% of the population at the 1-hour and 2-hour limit, respectively. These figures are slightly higher when motorcycle-taxis are considered (82.8% and 98%), and decreased to 34.7% and 52.3% for the walking-only scenario. The 2018 prioritised EmONC network covers 78.3% (1-hour) and 95.5% (2-hour) of the population for the walking and motorised scenario.ConclusionsBy factoring in geographical accessibility modelling to our iterative EmONC prioritisation process, the MoH was able to decrease the designated number of EmONC facilities in Togo by about 30%, while still ensuring that a high proportion of the population has timely access to these services. However, the physical access to EmONC for women unable to afford motorised transport remains inequitable.
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Edosa, Dejene. "Assessment of Availability and Quality of Emergency Obstetric and Newborn Care Service in Southwestern Oromia, Ethiopia, 2017." Advances in Public Health 2021 (December 30, 2021): 1–8. http://dx.doi.org/10.1155/2021/5566567.
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Background. Emergency obstetrics and newborn care (EmONC) is an important lifesaving function which can avert the death of women facing obstetrics-related complications. It is a cost-effective, significant intervention to decrease maternal and neonatal morbidity and mortality in poor resource settings, including Ethiopia. Objective. The aim of this study was to assess the availability and quality of the EmONC services in southwestern Oromia, Ethiopia, in 2017. Methods. An institutional-based cross-sectional study was implemented from April to May 2017. Data were collected using checklists and questionnaires developed from different studies. Data were analyzed using EPI-info and exported to SPSS version 20 for further analysis. Each descriptive statistic was summarized using frequency, percentage, and tables for categorical variables. Results. Despite the fact that the overall coverage of fully functioning basic emergency obstetric and newborn care (BEmONC) facilities was greater than 5 per 500,000 people, nearly one-fourth (25.64%) provided less than expected signal functions, indicating that these facilities were nonfunctional. There were only 0.24 comprehensive emergency obstetric and newborn care (CEmONC) facilities per 500,000 people. The result of this study also revealed that the quality of EmONC facilities in all health-care settings was poor. Conclusion and Recommendation. There were gaps in performance signal functions as well as the availability and quality of EmONC in the study area. Availability and quality of EmONC necessitate improvements through enhancing health-care providers’ skills by training and mentoring as well as enabling facilities accessible for utilization of EmONC. Further research is needed to identify factors that could be barriers to the performance quality and coverage of EmONC services.
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Gueye, Mamour, Philippe Marc Moreira, Moussa Diallo, Omar Gasama, Mohamed Diadhiou, Mame Diarra Ndiaye Gueye, Serigne Modou Kane Gueye, et al. "Improving fetal dystocia management using simulation in Senegal: midterm results." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 1 (December 25, 2017): 52. http://dx.doi.org/10.18203/2320-1770.ijrcog20175832.
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Background: Maternal mortality, which constitutes the extreme point of the existing inequality between women in poor and rich countries, remains very high in Africa south of the Sahara. The objective of this study was to introduce a new training approach in Emergency Obstetric and Neonatal Care (EmONC) entered in Senegal to strengthen the skills of healthcare providers.Methods: The approach was based on the skills training using the so-called "humanist" method and "lifesaving skills". Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner.Results: With this approach, 432 providers were trained in 10 months. The increase in technical achievements of each participant was documented through the database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills and reduced missed learning opportunities as observed in former EmONC trainings.Conclusions: The impact of training on EmONC indicators and the introduction of this learning modality in basic training are the two major challenges in terms of prospects.
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Habonimana, Desire, Attakrit Leckcivilize, Catia Nicodemo, and Mike English. "Addressing the need for an appropriate skilled delivery care workforce in Burundi to support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign): a sequential study protocol." Wellcome Open Research 7 (July 27, 2022): 196. http://dx.doi.org/10.12688/wellcomeopenres.17937.1.
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Background Despite Burundi having formed a network of 112 health facilities that provide emergency obstetric and neonatal care (EmONC), the country continues to struggle with high rates of maternal and newborn deaths. There is a dearth of empirical evidence on the capacity and performance of EmONC health facilities and on the real needs to inform proper planning and policy. Our study aims to generate evidence on the capacity and performance of EmONC health facilities in Burundi and examine how the country might develop an appropriate skilled delivery care workforce to improve maternal and newborn survival. Methods We will use a sequential design where each study phase serially inputs into the subsequent phase. Three main study phases will be carried out: i) an initial policy document review to explore global norms and local policy intentions for EmONC staffing and ii) a cross-sectional survey of all EmONC health facilities to determine what percent of facilities are functional including geographic and population coverage gaps, identify staffing gaps assessed against norms, and identify other needs for health facility strengthening. Finally, we will conduct surveys in schools and different ministries to examine training and staffing costs to inform staffing options that might best promote service delivery with adequate budget impacts to increase efficiency. Throughout the study, we will engage stakeholders to provide input into what is reasonable staffing norms as well as feasible staffing alternatives within Burundi’s budget capacity. Analytical models will be used to develop staffing proposals over a realistic policy timeline. Conclusion Evidence-based health planning improves cost-effectiveness and reduces wastage within scarce and resource-constrained contexts. This study will be the first large-scale research in Burundi that builds on stakeholder support to generate evidence on the capacity of designated EmONC health facilities including human resources diagnosis and develop staffing skill-mix tradeoffs for policy discussion.
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Habonimana, Desire, Attakrit Leckcivilize, Catia Nicodemo, and Mike English. "Addressing the need for an appropriate skilled delivery care workforce in Burundi to support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign): a sequential study protocol." Wellcome Open Research 7 (September 26, 2022): 196. http://dx.doi.org/10.12688/wellcomeopenres.17937.2.
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Background Despite Burundi having formed a network of 112 health facilities that provide emergency obstetric and neonatal care (EmONC), the country continues to struggle with high rates of maternal and newborn deaths. There is a dearth of empirical evidence on the capacity and performance of EmONC health facilities and on the real needs to inform proper planning and policy. Our study aims to generate evidence on the capacity and performance of EmONC health facilities in Burundi and examine how the country might develop an appropriate skilled delivery care workforce to improve maternal and newborn survival. Methods We will use a sequential design where each study phase serially inputs into the subsequent phase. Three main study phases will be carried out: i) an initial policy document review to explore global norms and local policy intentions for EmONC staffing and ii) a cross-sectional survey of all EmONC health facilities to determine what percent of facilities are functional including geographic and population coverage gaps, identify staffing gaps assessed against norms, and identify other needs for health facility strengthening. Finally, we will conduct surveys in selected schools and ministries to examine training and staffing costs to inform staffing options that might best promote service delivery with adequate budget impacts to increase efficiency. Throughout the study, we will engage stakeholders to provide input into what are reasonable staffing norms as well as feasible staffing alternatives within Burundi’s budget capacity. Analytical models will be used to develop staffing proposals over a realistic policy timeline. Conclusion Evidence-based health planning improves cost-effectiveness and reduces wastage within scarce and resource-constrained contexts. This study will be the first large-scale research in Burundi that builds on stakeholder support to generate evidence on the capacity of designated EmONC health facilities including human resources diagnosis and develop staffing skill-mix tradeoffs for policy discussion.
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Cavallaro, Francesca L., Lenka Benova, El Hadji Dioukhane, Kerry Wong, Paula Sheppard, Adama Faye, Emma Radovich, et al. "What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal." BMJ Global Health 5, no. 3 (March 2020): e001915. http://dx.doi.org/10.1136/bmjgh-2019-001915.
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IntroductionIncreases in facility deliveries in sub-Saharan Africa have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. The readiness of facilities at different health system levels to provide both emergency obstetric and newborn care (EmONC) as well as referral is unknown. We describe this combined readiness by facility level and region in Senegal.MethodsFor this cross-sectional study, we used data from nine Demographic and Health Surveys between 1992 and 2017 in Senegal to describe trends in location of births over time. We used data from the 2017 Service Provision Assessment to describe EmONC and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. A national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans.ResultsBirths in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. Caesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in EmONC access. Only 9% of health posts had full readiness for basic EmONC, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). Although public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for EmONC and referral.ConclusionsOur findings imply that many lower-level public facilities—the most common place of birth in Senegal—are unable to treat or refer women with obstetric complications, especially in rural areas. In light of rising lower-level facility births in Senegal and elsewhere, improvements in EmONC and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality.
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Alobo, Gasthony, Emmanuel Ochola, Pontius Bayo, Alex Muhereza, Violah Nahurira, and Josaphat Byamugisha. "Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda." BMJ Open 11, no. 3 (March 2021): e042909. http://dx.doi.org/10.1136/bmjopen-2020-042909.
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ObjectivesTo critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting.DesignThis was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants.SettingThirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda.ParticipantsForty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling.ResultsAfter reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional.ConclusionOur findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.
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Dao, B. "I083 GUIDELINES FOR IN-SERVICE EMONC TRAINING." International Journal of Gynecology & Obstetrics 119 (October 2012): S180—S181. http://dx.doi.org/10.1016/s0020-7292(12)60113-1.
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Afri Ningsih, Rena, Yusrawati, Aldina Ayunda Insani, and Joserizal Serudji. "Maternal characteristics in obstetric emergency cases at RSUP Dr. M. Djamil Padang." Science Midwifery 10, no. 5 (November 29, 2022): 3897–903. http://dx.doi.org/10.35335/midwifery.v10i5.898.
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The causes of maternal death in West Sumatra Province in 2020 are bleeding at 2.1%, hypertension in pregnancy at 1.5%, infection at 0.9%, metabolic disorders at 0.6% and other causes at 3.5%. Cases of maternal death can be caused by obstetric emergencies. This study aims to describe the characteristics of mothers in obstetric emergencies at comprehensive emergency obstetric and newborn care (EmONC) RSUP Dr. M. Djamil Padang. This study is a descriptive study with a population of obstetric emergency cases at EmONC. hospital. Dr. M. Djamil Padang period May-June 2022. The sample is 108 respondents. The results of this study showed that from 108 respondents there were 23.1% of respondents with a diagnosis of severe preeclampsia, 79.6% of respondents aged 20-35 years, 84.3% of respondents with parity ≤ 2, the last education of respondents was senior high school 43.5%, 26.9% of respondents did not work, 81.5% of respondents did not have a history of non-communicable diseases, and 73.1% of respondents had a sufficient number of antenatal care (ANC) visits. Most patients with obstetric emergency cases at EmONC RSUP Dr. Mdjamil Padang with a diagnosis of severe preeclampsia, age 20-35 years, and the number of ANC visits is sufficient.
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Carter, Rebecca, Xu Xiong, Paul-Samson Lusamba-Dikassa, Elvis C. Kuburhanwa, Francine Kimanuka, Freddy Salumu, Guy Clarysse, et al. "Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study." Gates Open Research 3 (February 5, 2019): 13. http://dx.doi.org/10.12688/gatesopenres.12905.1.
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Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type—general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.
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Carter, Rebecca, Xu Xiong, Paul-Samson Lusamba-Dikassa, Elvis C. Kuburhanwa, Francine Kimanuka, Freddy Salumu, Guy Clarysse, et al. "Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study." Gates Open Research 3 (July 23, 2019): 13. http://dx.doi.org/10.12688/gatesopenres.12905.2.
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Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type—general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.
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Ambounda, Nathalie Ledaga, Sylvain Honore Woromogo, Felicite-Emma Yagata-Moussa, Liela Agnes Okoyi Ossouka, Vicky Noel Simo Tekem, Eliane Okira Ango, and Alain Jepang Kouanang. "Primary postpartum haemorrhage at the Libreville University Hospital Centre: Epidemiological profile of women." PLOS ONE 16, no. 9 (September 20, 2021): e0257544. http://dx.doi.org/10.1371/journal.pone.0257544.
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In Gabon, the proportion of maternal deaths directly related to Primary PostPartum Haemorrhage (PPPH) is 15 to 25%, despite the different means that the World Health Organization has made available to the providers of Emergency Obstetrical and Neonatal Care (EmONC). The objective of this study was to determine the prevalence and epidemiological characteristics of Primary PostPartum Haemorrhage to improve its management and reduce the rate of maternal deaths. An analytical retrospective study involved 42,728 records, whose data were collected using a chart collection form on the basis of information contained in partograms and other patient records. Sociodemographic variables were expressed using percentage. The relationship between the etiologies of PPPH and certain characteristics of the women was established using the ORs with their 95% confidence intervals. The difference was significant if p < 0.05. The prevalence of PPPH was 1.6%. Delivery haemorrhages accounted for 65.5% of PPPH. The main factors associated with delivery haemorrhages were pauci parity and multiparity (p = 0.003 and 0.051), post-term (p = 0.042), and birth weight >4,000 g (p = 0.006). Those associated with genital tract injuries were young maternal age (p = 0.008) and multiparity (p = 0.028). The most common etiology was haemorrhage from delivery. Multiparity remains the most common risk factor and the young age of the patients. It is important to improve management through better assessment of blood loss in the primary postpartum period as well as capacity building of health providers on EmONC.
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Halim, Abdul, Animesh Biswas, Abu Sayeed Md Abdullah, and Fazlur Rahman. "Factors Associated with Maternal Deaths in District and Upazila Hospitals of Bangladesh." Bangladesh Journal of Obstetrics & Gynaecology 31, no. 1 (October 12, 2017): 16–22. http://dx.doi.org/10.3329/bjog.v31i1.34271.
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Objective(s): Aim of the study was to use death review to explore medical causes and three delay causal factors responsible for maternal deaths in district or below level health facilities of Bangladesh.Methods: Government health workers conducted facility based death review in 56 maternal deaths occurred during 2010-2012 in four district and five upazila (EmONC) health facilities of Bangladesh. The data was analyzed to assess the causal relationship between the medical causes and the three delays factors in maternal mortality.Results: Majority of the mothers died was young (89.3%; below age 30 years) and died during first pregnancy (78.6%) and postpartum period (71.4%). Postpartum hemorrhage and preeclampsia-eclampsia were the foremost causes of maternal deaths at district level facilities of Bangladesh. Seventy two percent of them arrived the hospitals in a travel time <2 hour from home or first care-centre when 88% of cases had an unstable general condition. 72% of them received treatment within one hour of admission in the hospital. The patients records reflected that only a few patients received life-saving interventions like blood transfusion, fundal message, and/or oxytocic in postpartum haemorrhage or magnesium sulphate in eclampsia. The study also observed a poor documentation in all the facilities, which was a challenge for death review.Conclusions: The study suggested improving quality of care and increasing availability of skills to manage the complicated cases in district and below level EmONC hospitals with focused interventions for postpartum haemorrhage and preeclampsia-eclampsia. The facility death review will be useful in identifying causal factors, the third delay factors and service gaps and to respond accordingly to avert similar deaths.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 16-22
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Kull, Kalevi. "Steps towards the natural meronomy and taxonomy of semiosis: Emotin between index and symbol?" Sign Systems Studies 47, no. 1/2 (August 8, 2019): 88–104. http://dx.doi.org/10.12697/sss.2019.47.1-2.03.
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The main aim of this brief and purposely radical essay is to investigate further possibilities for empirical research in natural classification of semiosis (signs as wholes). Before introducing emon – a missing term in the taxonomy of signs – we make a distinction between the natural and artificial, and between the taxonomic and meronomic classifications of signs. Natural classifications or typologies are empirically based, while artificial classifications do not require empirical test. Meronomy describes the relational or functional structure of the whole (for instance triadic, circular, etc. composition of sign), while taxonomy categorizes individuals (individual signs). We argue that a natural taxonomy of signs can be based on the existence of different complexity of operations during semiosis, which implies different mechanisms of learning. We add into the taxonomy a particular type of signs – emonic signs, which are at work in imitation and social learning, while being more complex than indexes and less complex than symbols. Icons are related to imprinting, indexes to conditioning, emons to imitating, and symbols to conventions or naming. We also argue that the semiotic typologies could undergo large changes after the discovery of the proper mechanisms or workings of semiosis.
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Lumaya, Joëlle Ambis, Roger Mwimba Mbungu, Andy Muela Mbangama, Patrick Muyayalo Kahindo, Berry Nsiangangu Kinkenda, Guillaume Bisinkam Malingisi, Anselme Mulaila Mbungu, et al. "Knowledge and Practice in Emergency Obstetric and Neonatal Care (EmONC) Providers in Kinshasa, Democratic Republic of Congo." Open Journal of Obstetrics and Gynecology 12, no. 09 (2022): 979–92. http://dx.doi.org/10.4236/ojog.2022.129081.
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Meazaw, Maereg Wagnew, Catherine Chojenta, Tefera Taddele, and Deborah Loxton. "Audit of Clinical Care for Women with Preeclampsia or Eclampsia and Perinatal Outcome in Ethiopia: Second National EmONC Survey." International Journal of Women's Health Volume 14 (February 2022): 297–310. http://dx.doi.org/10.2147/ijwh.s350656.
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Pem, Deki, Tashi Tshomo, Karma Jurmin, Karma Tshering, and Pema Lethro. "Review of documentation status of modified WHO Partograph in 47 Emergency Obstetric and Newborn Centers (EmONC) of Bhutan in 2018." International Journal of Nursing and Health Science 7, no. 1 (April 25, 2021): 20–23. http://dx.doi.org/10.14445/24547484/ijnhs-v7i1p105.
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Radomsky, A., F. Kaharuza, B. McCarthy, E. A. McCue, L. Ssenyonjo, and L. N. Ahern. "Improving Emergency Obstetric and Neonatal Care (EmONC) Practices through Retrospective Analysis of Intrapartum Stillbirth Data at the Fort Portal Regional Referral Hospital, Southwesten Uganda." Annals of Global Health 83, no. 1 (April 7, 2017): 198. http://dx.doi.org/10.1016/j.aogh.2017.03.493.
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Compaore, Rachidatou, Adja Mariam Ouedraogo, Adama Baguiya, Denise Olga Kpebo, Sidikiba Sidibe, and Seni Kouanda. "Availability and Utilization of Postabortion Care Services in Burkina Faso, Côte d’Ivoire, and Guinea: A Secondary Analysis of Emergency Obstetric and Neonatal Care Needs Assessments (EmONC)." Health Services Insights 15 (January 2022): 117863292210926. http://dx.doi.org/10.1177/11786329221092625.
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SYNOPSIS: Generally, there are disparities in the availability and utilization of postabortion care services within the different regions at the national level in Burkina Faso, Cote d’Ivoire, and Guinea and between the 3 countries. Access to postabortion care at the primary level must be improved and the adoption of family planning when providing postabortion care. Unsafe abortion remains one of the leading causes of maternal mortality in sub-Sahara Africa, with relatively poor access to quality postabortion care (PAC) services. This study evaluated the quantity and distribution as well as the utilization of PAC services in Burkina Faso, Cote d’Ivoire, and Guinea. We conducted a secondary data analysis using the most recent EmONC surveys in the 3 countries between 2016 and 2017. We used PAC signal functions approach to assess facilities’ capacity to provide basic PAC at both primary and referral level of care and comprehensive PAC at the referral level. We illustrated population coverage of PAC services based on the WHO benchmark, and then assessed the utilization of PAC services. Basic PAC capacity at primary level was low (36.6%), ranging from 16.2% in Burkina Faso to 36% in Cote d’Ivoire. About 82.0% of hospitals could provide comprehensive PAC. There were disparities in the geographical distribution of PAC services at both national and subnational levels. Abortion complications represented 16.2% of all obstetric emergencies, and uptake of PAC modern contraceptive was low (37.1%) in all countries. There is a need to focus on access to PAC at the primary level of care in the 3 countries.
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Bhattarai, Saraswoti Kumari Gautam, and M. Dahal. "Comprehensive Emergency Obstetrical and Neonatal Care (CEmONC) at Karnali Academy of Health Sciences, Teaching Hospital, Jumla." Journal of Karnali Academy of Health Sciences 1, no. 3 (December 31, 2018): 31–34. http://dx.doi.org/10.3126/jkahs.v1i3.24151.
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Introduction: Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries like Nepal with a high burden of maternal and newborn mortality. So this study aims to find out the status of comprehensive emergency obstetrical and neonatal care (CEmONC) service.
Method: A retrospective cross-sectional study was conducted using secondary data sources at maternity ward of KAHS teaching hospital, Jumla. Total 291 women admitted in maternity ward for childbirth were included in the study of six month period of 2075. Sampling technique was census for the study who were admitted for child birth purpose. Cases were selected from the record of the maternity ward. The data was collected by using structured tool. Ethical approval was taken from the ethical review committee of KAHS for ethical clearance. Data was analyzed by using descriptive statistics.
Result: There were 291 women admitted in the maternity ward for the purpose of childbirth during six-month period. Among them 224(76.97%) women delivered baby by spontaneous vaginal delivery; 61(20.96%) delivered with C/S and 6(2.06%) were delivered with instrumental delivery. Regarding the indication of 61 cesarean section (C/S) delivery; 22.95% with fetal distress, 16.39% with cephalopelvic disproportion and 11.47% with meconium stained liquor
Conclusions: About one third childbirth was done by cesarean section with indication of fetal distress, cephalo-pelvic disproportion and meconium stained liquor in higher proportion. Although CEONC service is effective, the rate of cesarean section can be reduced by providing good quality antenatal care.
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Dyer, J., S. Cohen, A. Christmas, P. Spencer, J. Taylor, H. Frank, J. Sterne, and D. Walker. "Designing and implementing an in-situ emergency obstetric and neonatal care (EmONC) simulation and team-training curriculum for midwife mentors to drive quality improvement in Bihar, India." Annals of Global Health 82, no. 3 (August 20, 2016): 353. http://dx.doi.org/10.1016/j.aogh.2016.04.063.
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Fredrick, Majiwa, Mukami Diana, Kiarie Jackline, Kiilu Colleta, Maithya Ruth, Gikunda George, Munyalo Bonnie, and Omogi Jarim. "Are Mentorship and Training the Key in Provision of Emergency Obstetric and New-Born Care (EmONC) Services? A Formative Evaluation of Pre and Post in Samburu County, Kenya." Open Journal of Clinical Diagnostics 11, no. 04 (2021): 100–111. http://dx.doi.org/10.4236/ojcd.2021.114008.
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Zemicheal, N. "P686 Creating enabling environment at clinical learning site to increase access and provision of EmONC by mass production of new cadres - the “Health Officers”, - the case of Ethiopia." International Journal of Gynecology & Obstetrics 107 (October 2009): S609—S610. http://dx.doi.org/10.1016/s0020-7292(09)62177-9.
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Wariri, Oghenebrume, Egwu Onuwabuchi, Jacob Albin Korem Alhassan, Eseoghene Dase, Iliya Jalo, Christopher Hassan Laima, Halima Usman Farouk, Aliyu U. El-Nafaty, Uduak Okomo, and Winfred Dotse-Gborgbortsi. "The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria." PLOS ONE 16, no. 1 (January 7, 2021): e0245297. http://dx.doi.org/10.1371/journal.pone.0245297.
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Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
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Grošelj, Nada. "Vonjave Emone." Keria: Studia Latina et Graeca 16, no. 1 (July 24, 2014): 159. http://dx.doi.org/10.4312/keria.16.1.159-160.
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V okviru dvatisočletnice »dograditve rimske Emone«, kot se diplomatsko izražajo mediji in ustanove (na kaj natanko se nanaša slovita omemba letnice 14/15 po Kr., najdena v Ljubljani na fragmentu rimske napisne plošče, je namreč nemogoče reči), že vse leto 2014 potekajo prireditve in razstave v spomin rimskih časov. Med izvirnejše gotovo sodi predstava Vonjave Emone, ki jo je uprizorilo gledališče Senzorium po konceptu in v režiji svoje direktorice in umetniške voditeljice Barbare Pie Jenič.
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Akhtar, Rowshan, Afroza Ferdous, Umme Kulsum, and Syeda Nurjahan Bhuiyan. "Averting Maternal Death and Disability : Role of Eoc in Chittagong District." Journal of Chittagong Medical College Teachers' Association 23, no. 1 (September 22, 2012): 7–10. http://dx.doi.org/10.3329/jcmcta.v23i1.51887.
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Objectives of this study are: 1. To find out the number of facitilities providing EmOC services in rural areas of Chittagong district. 2. To assess the proportion of women who deliver at Emoc facilities. 3. To find out the “METNEED” at EmOC facilities. 4. To find out the caesarean deliveries as a proportion of all births at EmOC. 5. To see the “Case fatality rate” which reflects the quality of care & facility performance. This is a retrospective study between January 2009 to December 2009 done in thirteen upazilla health complexes in Chittagong district of population size-52,39,000. Outcome measures are availability of EmOC, Proportion of births in EmOC facilities, Met need, Cesarean deliveries &case fatality rate. About 6.7 & of births take place in Comprensive EmOC facilities and 2.4% in Basic EmOC (i.e. About 9.1% births are institutional). Study shows that “Met Need” is about 18%. Only <0.8% of all births in the population is delivered by casesarean section. In this study case fatality rate is only .067%. This study describes the baseline indicates calculated in different upazillas. In Chittagong only 5 Comprehensive EmOC services are not sufficient to cover the largely populated area. If we expand the Basic EmOC and Comprehensive EmOC we can help the people even in grass root level.
JCMCTA 2012; 23(1): 7-10
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Nkhwalume, Ludo, and Yohana Mashalla. "Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana." African Health Sciences 21 (May 23, 2021): 51–58. http://dx.doi.org/10.4314/ahs.v21i.9s.
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Background: Maternal mortality rate remains a challenge in many developing countries.
Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality.
Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach.
Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised.
Conclusion: Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.
Keywords: Maternal mortality; health care workers; EMOC, in-service training.
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Nkhwalume, Ludo, and Yohana Mashalla. "Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana." African Health Sciences 21, no. 1 (May 23, 2021): 51–58. http://dx.doi.org/10.4314/ahs.v21i1.9s.
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Background: Maternal mortality rate remains a challenge in many developing countries.
Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality.
Methods: Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach.
Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised.
Conclusion: Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.
Keywords: Maternal mortality; health care workers; EMOC, in-service training.
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Kurniaty, Kurniaty, Djaswadi Dasuki, and Abdul Wahab. "Penanganan kasus abortus inkomplit pada puskesmas PONED di Kabupaten Sumbawa Barat." Berita Kedokteran Masyarakat 35, no. 1 (January 25, 2019): 17. http://dx.doi.org/10.22146/bkm.35562.
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Success rate in handling incomplete abortion in EmOC primary health care in West SumbawaPurposeThis study explored the success of incomplete abortion in EmOC PHC in West Sumbawa.MethodThis research used descriptive analytic design with mix method approach. Quantitative research with cross sectional design and qualitative research with multiple-case study approach. The quantitative research sample is mother with incomplete abortion and qualitative research sample that is midwife, doctor and head of Puskesmas. Quantitative data analysis used chi-square test and logistic regression. Qualitative data collection using indepth interview method.ResultsHandling of successful incomplete abortus was 63,3% and most of EmOC PHC was complete 67,3%. There is a significant correlation between the success of incomplete abortion handling with the completeness of EmOC PHC. The likelihood of successful completion of incomplete abortion cases in complete EmOC PHC was 4.1 times greater than that of incomplete EmOC PHC. There was a significant relationship between maternal gestational age at abortion with successful incomplete abortion treatment (OR = 7,1; CI95% 1.27-40,2). Qualitative results show that EmOC teamwork can influence the success of handling incomplete abortion cases.ConclusionCompleteness of EmOC PHC has relationship with handling of incomplete abortus case. Increased knowledge and competence of health workers in the handling of incomplete abortion, so that in case management is more prepared and competent.
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Rambu Ngana, Frederika, and A. A. I. N. Eka Karyawati. "Scenario modelling as planning evidence to improve access to emergency obstetric care in eastern Indonesia." PLOS ONE 16, no. 6 (June 9, 2021): e0251869. http://dx.doi.org/10.1371/journal.pone.0251869.
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The rate of maternal deaths in remote areas in eastern Indonesia–where geographic conditions are difficult and the standard of infrastructure is poor–is high. Long travel times needed to reach emergency obstetric care (EMOC) is one cause of maternal death. District governments in eastern Indonesia need effective planning to improve access to EMOC. The aim of this study was to develop a scenario modelling tool to be used in planning to improve access to EMOC in eastern Indonesia. The scenario model was developed using the geographic information system tool in NetLogo. This model has two inputs: the location of the EMOC facility (PONED) and the travel cost of moving across geographical features in the rainy and dry seasons. We added a cost-benefit analysis to the model: cost is the budget for building the infrastructure; benefit is the number of people who can travel to the EMOC in less than 1 hour if the planned infrastructure is built. We introduced the tool to representative midwives from all districts of Nusa Tenggara Timur province and to staff of Kupang district planning agency. We found that the tool can model accessibility to EMOC based on weather conditions; compare alternative infrastructure planning scenarios based on cost-benefit analysis; enable users to identify and mark poor infrastructure; and model travel across the ocean. Lay people can easily use the tool through interactive scenario modelling: midwives can use it for evidence to support planning proposals to improve access to EMOC in their district; district planning agencies can use it to choose the best plan to improve access to EMOC. Scenario modelling has potential for use in evidence-based planning to improve access to EMOC in low-income and lower-middle-income countries with poor infrastructure, difficult geography conditions, limited budgets and lack of trained personnel.
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Mukuru, Moses, Suzanne N. Kiwanuka, Linda Gibson, and Freddie Ssengooba. "Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviours of frontline health workers in Uganda." Health Policy and Planning 36, no. 3 (January 30, 2021): 260–72. http://dx.doi.org/10.1093/heapol/czab001.
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Abstract Uganda is among the sub-Saharan African Countries which continue to experience high preventable maternal mortality due to obstetric emergencies. Several Emergency Obstetric Care (EmOC) policies rolled out have never achieved their intended targets to date. To explore why upstream policy expectations were not achieved at the frontline during the MDG period, we examined the implementation of EmOC policies in Uganda by; exploring the barriers frontline implementers of EmOC policies faced, their coping behaviours and the consequences for maternal health. We conducted a retrospective exploratory qualitative study between March and June 2019 in Luwero, Iganga and Masindi districts selected based on differences in maternal mortality. Data were collected using 8 in-depth interviews with doctors and 17 midwives who provided EmOC services in Uganda’s public health facilities during the MDG period. We reviewed two national maternal health policy documents and interviewed two Ministry of Health Officials on referral by participants. Data analysis was guided by the theory of Street-Level Bureaucracy (SLB). Implementation of EmOC was affected by the incompatibility of policies with implementation systems. Street-level bureaucrats were expected to offer to their continuously increasing clients, sometimes presenting late, ideal EmOC services using an incomplete and unreliable package of inputs, supplies, inadequate workforce size and skills mix. To continue performing their duties and prevent services from total collapse, frontline implementers’ coping behaviours oftentimes involved improvization leading to delivery of incomplete and inconsistent EmOC service packages. This resulted in unresponsive EmOC services with mothers receiving inadequate interventions sometimes after major delays across different levels of care. We suggest that SLB theory can be enriched by reflecting on the consequences of the coping behaviours of street-level bureaucrats. Future reforms should align policies to implementation contexts and resources for optimal results.
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Ameh, Charles A., Mselenge Mdegela, Sarah White, and Nynke van den Broek. "The effectiveness of training in emergency obstetric care: a systematic literature review." Health Policy and Planning 34, no. 4 (May 1, 2019): 257–70. http://dx.doi.org/10.1093/heapol/czz028.
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Abstract Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before–after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
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Fodorean, Florin-Gheorghe. "Listing settlements and distances: The Emona-Singidunum road in Tabula Peutingeriana, Itinerarium Antonini and Itinerarium Burdigalense." Starinar, no. 67 (2017): 95–108. http://dx.doi.org/10.2298/sta1767095f.
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Our contribution is focused on the analysis and interpretation of several pieces of historical data regarding the Emona-Singidunum road along the Drava River, from three important ancient documents: Itinerarium Burdigalense sive Hierosolymitanum, Tabula Peutingeriana and Itinerarium Antonini. The key question of this study is: can the Bordeaux itinerary bring more light to the question of the sources of these ancient documents? If so, which method should be used to prove this? Therefore, we decided to compare data from the Peutinger map and the Antonine itinerary with those contained in the Bordeaux itinerary, by discussing a sector of the Aquileia-Viminacium road, more precisely, the route between Emona and Siscia. The objective was to see if there are resemblances or differences between these documents. After this comparative analysis of the three ancient sources, we reached some general conclusions and observations concerning these documents. The most important observation is that the structure of the Bordeaux itinerary along the Emona-Singidunum route reveals a careful planning of the main Roman road infrastructure during the 4th century A.D. (corresponding to the reorganisation of the official state transport, cursus publicus) and before this time. Why did the pilgrim choose the Emona-Poetovio-Sirmium-Singidunum road (along the Drava River), which measures 398 miles, instead of the Emona-Siscia-Sirmium-Singidunum road, along the Sava River, which is shorter (approximately 340 miles)? We suppose the answer is based on the full understanding of the infrastructure along the Drava River. This road could provide better travelling conditions for those officials who travelled using cursus publicus. However, we think the answer is based on another important issue. Using the official transportation system, the pilgrim chose the ?official? road.
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Zhang, Feng. "EMNC technological knowledge flow patterns: an overview of the US patents granted." Multinational Business Review 28, no. 1 (November 3, 2019): 129–55. http://dx.doi.org/10.1108/mbr-03-2019-0021.
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Purpose With considerable attention paid to the motives and process of idiosyncratic internationalization trajectory of multinationals from emerging economies (EMNCs), little is known on whether, and if so how, new competitive advantages of EMNCs are created and accumulated over time. MNC and EMNC literature agrees on the importance of external and internal knowledge linkages in technological competence creation. By building upon this framework, this paper aims to evaluate EMNCs’ external and internal knowledge flow patterns by benchmarking their counterparts from mature industrialized countries (MMNCs). Design/methodology/approach This study analyzes US patents granted between 2000 and 2014 to leading innovation-oriented EMNCs from China and India, and their matched MMNCs. Being the first to use the US patent and citation data in studying leading innovation-oriented EMNCs, the authors use a descriptive statistical method. Findings The findings offer empirical insights of the scale, scope and quality of EMNC technological competence creation. Moreover, in contrast to existing EMNC literature, it is found that EMNC parents have been the most important center of EMNC technological knowledge generation. The matched group comparisons of external and internal knowledge flows further reveal detailed similarities and differences of competence creation between EMNCs and MMNCs, and among EMNCs. Originality/value This study represents one of the first attempts to investigate the post-internationalization technological competence creation of EMNCs by using a novel data source. This study sets the foundation to deepen the understanding of EMNC technological competence creation. The findings suggest interesting propositions and offer important implications for future researches.
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Banke-Thomas, Aduragbemi, Judith Maua, Barbara Madaj, Charles Ameh, and Nynke van den Broek. "Perspectives of stakeholders on emergency obstetric care training in Kenya: a qualitative study." International Health 12, no. 1 (February 26, 2019): 11–18. http://dx.doi.org/10.1093/inthealth/ihz007.
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Abstract Background This study explores stakeholders’ perceptions of emergency obstetric care (EmOC) ‘skills-and-drills’-type training including the outcomes, strengths, weaknesses, opportunities and threats of the intervention in Kenya. Methods Stakeholders who either benefited from or contributed to EmOC training were purposively sampled. Semi-structured topic guides were used for key informant interviews and focus group discussions. Following verbatim transcriptions of recordings, the thematic approach was used for data analysis. Results Sixty-nine trained healthcare providers (HCPs), 114 women who received EmOC and their relatives, 30 master trainers and training organizers, and six EmOC facility/Ministry of Health staff were recruited. Following training, deemed valuable for its ‘hands-on’ approach and content by HCPs, women reported that they experienced improvements in the quality of care provided. HCPs reported that training led to improved knowledge, skills and attitudes, with improved care outcomes. However, they also reported an increased workload. Implementing stakeholders stressed the need to explore strategies that help to maximize and sustain training outcomes. Conclusions The value of EmOC training in improving the capacity of HCPs and outcomes for mothers and newborns is not just ascribed but felt by beneficiaries. However, unintended outcomes such as increased workload may occur and need to be systematically addressed to maximize training gains.
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Banke-Thomas, Aduragbemi, Barbara Madaj, and Nynke van den Broek. "Social return on investment of emergency obstetric care training in Kenya." BMJ Global Health 4, no. 1 (January 2019): e001167. http://dx.doi.org/10.1136/bmjgh-2018-001167.
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IntroductionEmergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology.MethodsMixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions.ResultsTrained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred.ConclusionEmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.
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Brückmann, Peter, Ashfa Hashmi, Marina Kuch, Jana Kuhnt, Ida Monfared, and Sebastian Vollmer. "Public provision of emergency obstetric care: a case study in two districts of Pakistan." BMJ Open 9, no. 5 (May 2019): e027187. http://dx.doi.org/10.1136/bmjopen-2018-027187.
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ObjectivesPakistan is one out of five countries where together half of the global neonatal deaths occur. As the provision of services and facilities is one of the key elements vital to reducing this rate as well as the maternal mortality rate, this study investigates the status of the delivery of essential obstetric care provided by the public health sector in two districts in Khyber Pakhtunkhwa in 2015 aiming to highlight areas where critical improvements are needed.SettingWe analysed data from a survey of 22 primary and secondary healthcare facilities as well as 85 community midwives (CMWs) in Haripur and Nowshera districts.ParticipantsUsing a structured questionnaire we evaluated the performance of emergency obstetric care (EmOC) signal functions and patient statistics in public health facilities. Also, 102 CMWs were interviewed about working hours, basic and specialised delivery service provision, referral system and patient statistics.Primary outcome measuresWe investigate the public provision of emergency obstetric care using seven key medical services identified by the United Nations (UN).ResultsDeliveries by public health cadres account for about 30% of the total number of births in these districts. According to the UN benchmark, only a small fraction of basic EmOC (2/18) and half of the comprehensive EmOC (2/4) facilities of the recommended minimum number were available to the population in both districts. Only a minority of health facilities and CMWs carry out several signal functions. Only 8% of the total births in one of the study districts are performed in public EmOC health facilities.ConclusionsBoth districts show a significant shortage of available public EmOC service provisions. Development priorities need to be realigned to improve the availability, accessibility and quality of EmOC service provisions by the public health sector alongside with existing activities to increase institutional births.
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Sarswat, Gauri Kumari, Sangeeta Kansal, Alok Kumar, and Immanuel Joshua. "Assessment of Accessibility and Quality of Emergency Obstetric Care services: A cross sectional study in rural Varanasi." Indian Journal of Community Health 33, no. 4 (December 31, 2021): 663–67. http://dx.doi.org/10.47203/ijch.2021.v33i04.021.
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Background: Emergency Obstetrics care is an integrated strategy developed by the WHO, UNFPA and UNICEF that aims to equip health facilities with the capacity to provide evidence based, cost effective interventions to attend the leading causes of maternal mortality. Methods: A community based cross sectional study was conducted between April 2019 - July 2020. A total of 201 women who delivered in the last 6 months and had complications during their pregnancy were interviewed to find out accessibility and quality emergency obstetric Care (EmOC) services. Facility assessment was also done at two health facilities of Chiraigaon block for the assessment EmOC. Results: Findings show that only 41.8% respondents were able to reach the government health facilities in less than half-an-hour. Out of the total respondents who utilized government health facilities for EmOC, only 19% were attended by the health providers within 1 hour. Conclusion: Low percentage of respondents with complications were reaching the health facility within 30 minutes. Therefore, there is a strong need for strengthening of basic EmOC services at health facilities .
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Helelo, A. Z., L. I. Zungu, and R. J. Chiegil. "What creates good experiences for EmOC clients in public health facilities in Ethiopia?" South African Family Practice 57, no. 3 (May 1, 2015): 5. http://dx.doi.org/10.4102/safp.v57i3.4152.
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Objective: To describe aspects that create positive experiences for emergency obstetric care (EmOC) clients in public health facilities in Ethiopia.Design: A qualitative contextual descriptive phenomenological design was used in this study.Subjects and setting: In-depth interviews were conducted with women who had complications during childbirth and received EmOC in three hospitals in Addis Ababa.Outcome measures: Content analysis was used to analyse data as it complies with the phenomenological data analysis. The data were analysed using the Atlas ti version 6.2 qualitative data analysis software.Results: Care that is life-saving, safe, timely, responsive and given in a clean environment, where the service carers show humility, respect, equal treatment and encouragement in an effort to meet the clients’ needs and expectations, creates a good experience.Conclusion: Clients’ experiences during the provision of EmOC influence their future decisions on whether to seek care or not. The findings of the study along with the developed guidelines will assist in the improvement of the provision and utilisation of EmOC at public health facilities in Ethiopia.
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Amadi-Mgbenka, Chioma T., Luisa N. Borrell, Heidi E. Jones, Andrew Maroko, and Francisco Bolumar. "Effect of emergency obstetric care and proximity to comprehensive facilities on facility-based delivery in Malawi and Haiti." PLOS Global Public Health 2, no. 2 (February 2, 2022): e0000184. http://dx.doi.org/10.1371/journal.pgph.0000184.
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Proximity of households to comprehensive obstetric care is a key determinant for preventing maternal mortality due to obstetric emergencies. The relationship between proximity to comprehensive care and facility delivery is further complicated by the use of varied methods in measuring facility obstetric capacity–which may misrepresent the real scenario of obstetric care availability in a service environment. We investigated the joint effects of proximity and two emergency obstetric care assessment (EmOC) methods on women’s place of delivery in Malawi and Haiti. Household level and health facility data were obtained from the 2013–2018 Demographic and Health Surveys and Service Provision Assessment surveys. Records of women aged 15 to 49 years who had a childbirth in the last 5 years were linked to obstetric facilities within 5km, 10km and 15km from their households using Kernel Density Estimation. Log-binomial models were fitted to estimate the joint effects of proximity to comprehensive facilities on place of delivery and two EmOC methods (1. the facility’s recent performance of signal functions only, and 2. a composite index of obstetric care), and whether this varied by urban/rural setting. Proximity to comprehensive facilities was significantly associated with facility delivery in Malawi among women living 5km of a comprehensive facility (using EmOC method 2), in addition, living further (15km) from facilities with high capacity of EmOC was associated with reduced likelihood for facility delivery in urban settings in stratified analyses. In contrast, positive associations were present in Haiti in both urban and rural settings, with the likelihood of facility delivery being higher with greater proximity of women to comprehensive facilities, regardless of methods to define EmOC. Women living within 5km of a comprehensive facility in Haiti were the most likely to deliver in facilities based on EmOC method 1 (APR: 1.81, 95% CI 1.56, 2.09). Findings from Malawi elucidates the relevance of context and suggests the need for research in diverse settings.
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Marinow, Kirił. "Twierdza Emona. Na nadmorskich stokach średniowiecznego Hemusu." Vox Patrum 52, no. 1 (June 15, 2008): 617–33. http://dx.doi.org/10.31743/vp.8939.
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La forteresse Emona constitua une des fortifications flanquant les versants maritimes de la montagne Hemus (Bałkan, Stara Pianina), qui etaient une bariere strategique la plus importante dans la Thrace Nord-Est au Moyen Age. Construite le plus probablement par les Byzantins au dćbute du XII siecle, apres la liberation de la Bułgarie de la suprematie byzantine a la fin de ce siecle, elle tomba dans les mains bulgares. Les Byzantins la rattraperent pour le periode entre 1279/1280-1304. Au XIV siecle elle resta dans les mains bulgares, brievement tombant sous suprematie latine en tant que le resultat de la campagne du comte Amadee de Savoy contre la Bułgarie en 1366-1367, pour succomber aux Ottomans a la fin de ce siecle. Une derniere fois elle fut sous le pouvoir des Byzantins dans les annees 1403-1453. La place de fortification au but du promontoire maritime, avancć dans la mer, fit qu’Emona constitua un des port fondamentaux et a la fois un des points d’orientation pour la navigation aux XII-XV siecles sur le trajet maritime entre les centres maritimes importants comme Anchiale, Messembrie et Varna. Avec ce centre deux embarcaderes furent lies - aux versants Sud du promontoire ainsi qu’au Nord de la forteresse, dans la baie de Saint Demetrius. Sa place, proche a Anchiale et Messembrie, exereants pour la Byzance le role des bases d’ataques pour les actions militaires contre la Bułgarie, determina son importance comme un avant-poste de la partie la plus d’est du systeme de la defense de Stara Pianina pour un Etat bulgare. Emona limita du Sud et veilla sur l’acces au massif de Stara Pianina du cóte de la mer, surveillant aussi les mouvements sur la route maritime de terre. Dans la domene ecclesiastique elle resta au principe constamment liee avec la metropole de Messembrie, alors soumise au patriarcat de Constantinople, meme dans le temps, ou elle fut place entre les frontieres de l’Etat bulgare.
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Quealy-Gainer, Kate. "Bright Lights, Dark Nights by Stephen Emond." Bulletin of the Center for Children's Books 69, no. 2 (2015): 86. http://dx.doi.org/10.1353/bcc.2015.0793.
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Mutuku, J., and Dr M. Githae. "Delays in Africa Accessing Emergency Obstetric Care in Sub-Saharan; Kenya Situation." International Journal of Contemporary Research and Review 9, no. 07 (July 11, 2018): 20484–96. http://dx.doi.org/10.15520/ijcrr/2018/9/07/549.
Full textAbstract:
Delay in accessing facility for delivery by a skilled person has huge impact on maternal health outcomes in developing countries. However, women’s deaths at birth in Sub-Saharan countries remain high due to challenges associated with accessing immediate Emergency Obstetric Care (EmOC) at birth.
While the deaths are preventable through availability of EmOC and skilled persons attending to delivery, access to these services remain poor and most women continue to give birth at home without the assistance of a skilled person.
The purpose of the study was to identify barriers to accessing EmOC in order to suggest ways of increasing skilled birth attendance in Kenya, a strategy that is known to reduce maternal mortality and morbidity. Relevant literature from abstracts of scholarly journals from major search engines were scanned and analyzed for results.
Significant factors that were identified to cause delay in accessing EmOC are maternal education, financial status, ignorance, delay in decision making by family, preference for Traditional Birth Attendants (TBA), travel cost, means of transport, distance, and impassable roads. Further barriers are poor quality of care due to supplies and equipment shortage, rude, unwelcoming staff, user fees paid on admission and long waiting hours in the facilities.
Based on the findings, various barriers that hinder women from accessing EmOC exist. To increase the number of births assisted by skilled professionals and reduce maternal deaths, these barriers need to be tackled from family, community, and facility levels.
The recommendations include community sensitization and health education on pregnancy related danger signs, strengthening of health care systems to ensure availability of supplies, equipment, and improving referral systems. Integration of TBAs role to health care system will ensure timely referral and increased facility deliveries.
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Djurić, Bojan, Luka Gale, Rok Brajkovič, Iris Bekljanov Zidanšek, Barbara Horn, Edisa Lozić, Branko Mušič, and Marko Vrabec. "Kamnolom apnenca v Podpeči pri Ljubljani in njegovi izdelki." Arheološki vestnik 73 (July 7, 2022): 155–98. http://dx.doi.org/10.3986/av.73.06.
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Kamnolom v naselju Podpeč pri Ljubljani velja za glavni kamnolom rimske kolonije Emone (Ljubljana). Obstoj antičnega kamnoloma v Podpeči je bil do sedaj utemeljen le na podlagi makroskopske podobnosti med Členom litiotidnega apnenca, ki izdanja v Podpeči, in z njim povezanimi rimskimi spomeniki, odkritimi v Ljubljani. V okviru pričujočega dela smo skušali poiskati oprijemljive arheološke in geoarheološke dokaze za njegov obstoj. V skrajno severnem delu kamnoloma smo izvedli arheološko sondiranje, hkrati pa natančno določili sestavo apnenca na tem območju in v 288 izdelkih iz antične Emone. Sondiranje severno od modernega kamnoloma je odkrilo dobro ohranjene sledove rimskodobne kamnoseške dejavnosti. Hkrati je litološka analiza spomenikov iz Emone razkrila, da je kar 182 (ali 64 odstotkov) analiziranih spomenikov izdelanih iz apnenca, litološko identičnega različkom, ki izdanjajo v Podpeči. Ti različki se prostorsko grupirajo severno od modernega kamnoloma. Pri tem sicer ostaja odprto vprašanje pripadnosti nekaterih različkov apnenca v izdelkih, ki so brez diagnostičnih komponent in bi lahko pripadali tudi nekoliko starejšemu Členu krkinega apnenca. Rekonstrukcijo obsega starega kamnoloma omogoča primerjava faciesov izvornih litostratigrafskih enot in izdelkov, pa tudi historična analiza zgodnjih kartografskih in katastrskih dokumentov. Analiza najzgodnejših izdelkov je omogočila hipotezo o prihodu kamnosekov iz kamnoloma v Nabrežini.
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Sanjaya, Muhamad Indri, Suryani Suryani, and Luluk Syahr Banu. "Respon Beberapa Varietas Pakcoy Terhadap Media Cocopeat Pada Sistem Wick." Jurnal Ilmiah Respati 13, no. 2 (December 31, 2022): 189–98. http://dx.doi.org/10.52643/jir.v13i2.2711.
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Kebutuhan pangan terutama sayuran yang sehat untuk di komsumsi semakin meningkat. Namun ketersediaannya masih belum mencukupi, karena keterbatasan lahan khususnya di wilayah perkotaan. Salah satu solusi untuk memenuhi kebutuhan pangan tersebut dengan meningkatkan produksi melalui budidaya tanaman menggunakan teknologi pertanian salah satunya sistem wick. Penelitian ini bertujuan untuk mengetahui respon pertumbuhan beberapa varietas tanaman sawi pakcoy (Brassica rapa L) terhadap media tanam cocopeat yang dibudidayakan dengan hidroponik system wick. Penelitian ini menggunakan Rancangan Acak Lengkap (RAL). Satu faktor yang terdiri dari 3 perlakuan dan 6 ulangan, sehingga di peroleh 18 satuan percobaan. Dengan taraf sebagai berikut: P1 : Cocopeat+ Fantana P2 : Cocopeat + Emone 26 P3 : Cocopeat+ Nauli F1 Teknik pengumpulan data menggunakan metode eksperimen dengan menggunakan parameter tinggi tanaman, jumlah daun, berat segar dan panjang akar. Hasil penelitian menunjukkan bahwa respon varietas pakcoy terhadap media tanam cocopeat, berpengaruh sangat nyata terhadap varietas Emone 26 pada tinggi tanaman, jumlah helai daun, berat segar tanaman, dan panjang akar tanaman. Respon varietas pakcoy Emone 26 memberikan hasil terbaik pada tinggi tanaman (29,817 cm) dan panjang akar tanaman (31,00 cm), dan respon varietas pakcoy Nauli F1 memberikan hasil terbaik pada jumlah daun tanaman (16,833 helai) dan berat segar tanaman (90,50 gram).Kata kunci: Varietas Pakcoy, Cocopeat, Hidroponik,Sistem Wick
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Kuhn, Daniel, Rezzo Schlauch, and Reinhold Weber. "Rezension von: Schlauch, Rezzo; Weber, Reinhold, Keine Angst vor der Macht." Zeitschrift für Württembergische Landesgeschichte 75 (March 7, 2022): 517–18. http://dx.doi.org/10.53458/zwlg.v75i.2060.
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Fülle, Reinhold, and Claus-Peter Hutter. "Rezension von: Hutter, Claus-Peter, Der Neckar." Schwäbische Heimat 67, no. 1 (February 18, 2022): 123–24. http://dx.doi.org/10.53458/sh.v67i1.1839.
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Kuhn, Daniel, Reinhold Weber, and Ines Mayer. "Rezension von: Mayer, Ines; Weber, Reinhold (Hrsg.), Menschen, die uns bewegten." Zeitschrift für Württembergische Landesgeschichte 74 (March 24, 2022): 474–75. http://dx.doi.org/10.53458/zwlg.v74i.2221.
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