Access to care solutions in healthcare for obstetric care in Africa: A systematic review

• Published in: PloS one Vol. 16; no. 6; p. e0252583
• Main Authors: Joiner, Anjni, Lee, Austin, Chowa, Phindile, Kharel, Ramu, Kumar, Lekshmi, Caruzzo, Nayara Malheiros, Ramirez, Thais, Reynolds, Lindy, Sakita, Francis, Van Vleet, Lee, von Isenburg, Megan, Yaffee, Anna Quay, Staton, Catherine, Vissoci, Joao Ricardo Nickenig
• Format: Journal Article
• Language: English
• Published: San Francisco, CA USA Public Library of Science 04.06.2021; Public Library of Science (PLoS)
• Subjects: Engineering and Technology; Evaluation; Medical care; Medicine and Health Sciences; Obstetrics; Utilization; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252583

Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context. The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach. A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention.