ArticleBMJ open2020
Delays in emergency obstetric referrals in Addis Ababa hospitals in Ethiopia: a facility-based, cross-sectional study.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Delays in the decision to seek care and associated factors among women in Ethiopia: systematic review and meta-analysis.BMC pregnancy and childbirth · 2025Pooled it
- Nonpneumatic anti-shock garment utilization for obstetric hemorrhage management and its predictors among obstetric care providers in Ethiopia: a systematic review and meta-analysis.BMC health services research · 2024Pooled it
- Male partners' participation in birth preparedness and complication readiness in low- and middle-income countries: a systematic review and meta-analysis.BMC pregnancy and childbirth · 2021Pooled it
- Prevalence of Maternal Third Delays in Emergency Obstetric Care and Determinant Factors Among Women Giving Birth in Government Hospitals in East Gojjam Zone, Northwest Ethiopia: A Cross-Sectional Study.Health science reports · 2026Article
- Midwives' Perspective on Birth Preparedness and Complication Readiness Structure: A Qualitative Study.International journal of community based nursing and midwifery · 2026Article
- The three obstetrics delays determine uterine rupture at Nekemte specialized hospital: a hospital-based case-control study.Scientific reports · 2026Article
- The Six Delays Model: expanding the three delays model with evidence from Madagascar for maternal referrals in LMICs.BMJ global health · 2026Review
- Determinants of maternal transportation mode and travel time for timely emergency obstetric care in selected public hospitals, Addis Ababa, Ethiopia, 2025.AJOG global reports · 2026Article
- Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review.PloS one · 2026Article
- Understanding the maternal sepsis patient journey in Malawi: "I called for help, but they showed no interest in helping me".BMC health services research · 2025Article
- Exploring evidence of healthcare-seeking pathways for maternal complications in Sub-Saharan Africa: a scoping review.BMC pregnancy and childbirth · 2025Article
- Reasons for maternal near-miss in Bahir Dar city administration, northwest Ethiopia: a qualitative interview approach using socio-ecological model.Frontiers in global women's health · 2025Article
- Perceptions and experiences of women referred during obstetric complications in Eastern Uganda: A qualitative study.PLOS global public health · 2025Article
- Severe postpartum haemorrhage at a large referral hospital in Uganda: A prospective observational pilot study.PloS one · 2025Observational
- Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study.BMC pregnancy and childbirth · 2024Article
- Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.BMC pregnancy and childbirth · 2024Article
- Third delay and associated factors among women who gave birth at public health facilities of Gurage zone, southern Ethiopia.BMC women's health · 2023Article
- Article
- Emergency obstetric referrals in public health facilities: A descriptive study from urban Maharashtra, India.Frontiers in health services · 2023Article
- Maternal Third Delay and Associated Factors among Women Admitted for Emergency Obstetric Care in Public Hospitals in Sidama Regional State, Ethiopia.Journal of pregnancy · 2023Article
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2 authors.
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Abstract
objectiveTo assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model.
designThe study was a facility-based, cross-sectional study.
settingTwo public and tertiary hospitals in Addis Ababa.
participantsAll pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model.
resultsA total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays. CONCLUSION AND RECOMMENDATION: This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals' set-up and readiness to manage obstetric emergencies.
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