Effective Coverage of Emergency Obstetric and Newborn Care Services in Africa: A Scoping Review

Abstract

Objective

This scoping review aimed to map the evidence of effective coverage (EC) of EmONC (Emergency Obstetric and Neonatal Care) services and associated factors in Africa.

Methodology

The review used PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) checklist to select, appraise, and report the findings. We searched four databases (PubMed, Web of Science, Google Scholar, and Scopus) and grey literature published between Jan 01, 2011 – Dec 31, 2020. The search terms included “emergency”, “obstetric”, “newborn”, “effective coverage”, and “quality” with Boolean terms, AND and OR. The review was conducted using title, abstract, and full-article screenings. The results were analyzed thematically using NVivo v12 qualitative research data analysis software.

Results

Of the 1811 searched studies, 32 met the eligibility criteria for review. The majority of the studies were from East (56.3%) and Western (28.1%) Africa. Most studies were cross-sectional, had targeted health facilities, and combined two or more data collection techniques. The thematic analysis yielded three themes: EmONC service utilization, quality of EmONC service, and factors associated with the quality of EmONC services. The review showed a scarcity of evidence and variations regarding the crude coverage, quality of care, and factors affecting the quality of EmONC services in Africa.

Conclusion

The review reported that the utilization of EmONC services was below the WHO-recommended 100% in all studies, though some reported improvements over time. Disparities in EmONC services quality were paramount across studies and contexts. However, the methodological and analytical incongruity across studies brought difficulties in tracing and comparing the progress made in EmONC services utilizations.

Registration

This scoping review protocol was first registered on the Open Science Framework (OSF) on Aug 27, 2021 (https://osf.io/khcte/).

Keywords:

• maternal health
• newborn health
• obstetric care
• perinatal care
• emergency medicine

Abbreviations

BEmONC, Basic Emergency Obstetric and Newborn Care; CEmONC, Comprehensive Emergency Obstetric and Newborn Care; CFR, Case Fatality Rate; DHS, Demographic and Health Survey; DOCFR, Direct Obstetric Case Fatality Rate; DRC, Democratic Republic of Congo; EC, Effective Coverage; EmONC, Emergency Obstetric and Newborn Care; EmOC, Emergency Obstetric Care; FGD, Focus Group Discussion; IDI, Individual In-depth Interview; IQR, Inter-quartile Range; JBI, Joanna Briggs Institute; KII, Key-Informant Interview; LMIC, Low and Middle-income Country; MMAT, Mixed Methods Appraisal Tool; MeSH, Medical Subject Heading; OSF, Open Science Framework; PCC, Population, Concept, and Context; PRISMA-ScR, Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews; SDG, Sustainable Development Goal; UNICEF, United Nations Children’s Fund; WHO, World Health Organization.

Data Sharing Statement

All data used for this study are cited and presented as references.

Acknowledgment

Our gratitude goes to the School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, and Wolaita Sodo University for assistance with the protocol and provision of necessary resources.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.