Introduction Increases 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.
Methods For 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.
Results Births 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.
Conclusions Our 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.
- maternal health
- emergency obstetric care
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Handling editor Seye Abimbola
Twitter @dioukhane, @kerrylmwong
Contributors FLC, LB, MM-A and PS conceptualised the study, and designed the analyses with additional input from EHD and CR. KW, ER, LB and FLC prepared the databases. FLC, AF, EHD and AD compiled the list of facilities performing caesareans, and EHD and AF vetted data sources. FLC and KW conducted the data analysis, all authors including ASM contributed to the interpretation of results. FLC drafted the full manuscript, all authors edited the manuscript. All authors approved the final version of the manuscript.
Funding Some authors of this study were supported by funding from MSD, through its MSD for Mothers programme (https://merckformothers.com). Funding was used for general financial support, including staff salaries, travel and overhead. MSD had no role in the design, collection, analysis and interpretation of data, in writing of the manuscript, or in the decision to submit the manuscript for publication. MSD for Mothers is an initiative of Merck & Co., Kenilworth, New Jersey, USA.
Disclaimer The content of this publication is solely the responsibility of the authors and does not represent the official views of MSD.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the Ethics Committee of the London School of Hygiene & Tropical Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Access to data from the Demographic and Health Surveys and Service Provision Assessments can be requested on the website https://dhsprogram.com/.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.