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The status of emergency obstetric and newborn care in post-conflict eastern DRC: a facility-level cross-sectional study

Mizerero, Serge-André 京都大学 DOI:10.14989/doctor.k23781

2022.03.23

概要

Background:
Pregnancy-related mortality remains persistently higher in post-conflict areas. Part of the blame lies with continued disruption to vital care provision, especially emergency obstetric and newborn care (EmONC). In such settings, assessment of EmONC is essential for informed interventions needed to improve maternal and neonatal survival. In the North Kivu Province, the epicentre of armed conflict in eastern Democratic Republic of the Congo (DRC) between 2006-2013, the post-conflict status of EmONC is unknown. We assessed the availability, use, and quality of EmONC in 3 health zones (HZs) of the North Kivu Province.

Methods:
A cross-sectional survey of all 42 public facilities designated to provide EmONC in 3 HZs (Goma, Karisimbi, and Rutshuru), purposively selected based on their relative proximity to previous conflicts and their respective locations encompassing the entire economic landscape of the province, was conducted in 2017. Interviews, reviews of maternity ward records, and observations were used to assess the accessibility, use, and the quality of EmONC against WHO standards, using the EmONC Needs Assessment (NA) toolkit that is organised in modules of questionnaires developed and refined by the Averting Maternal Death and Disability (AMDD) programme at Columbia University Mailman School of Public Health. Data were analyzed by Stata 15, guided by the Handbook on Monitoring Emergency Obstetric Care by UN partners and the AMDD programme to assess the performance of signal functions and calculate indicators of availability, use, and quality of EmONC services in these health zones.

Results:
The 3 HZs fell short of WHO standards. Only three referral facilities (two faith-based facilities in Goma and the Médecins Sans Frontières (MSF)-run referral hospital of Rutshuru) met the criteria for comprehensive EmONC, i.e., 1.5 EmONC facilities per 500,000 population. None of the health centres qualified as basic EmONC, nor could offer obstetric and neonatal care services 24 hours, 7 days a week (24/7). Assisted vaginal delivery was the least performed signal function, followed by parenteral administration of anticonvulsants, mostly due to policy restrictions and lack of demand. Moreover, none of the HZs could achieve a direct-obstetric case facility rate of at most 1% and, the met need for EmONC was as low as 6.5% and 5.4% in Goma and Rutshuru, respectively. However, the proportion of births by caesarean section in EmONC facilities met the minimum standard in both HZs. Overall, the intrapartum and very early neonatal death rate was 1.5%.

Conclusion:
This study gives for the first time a quantitative assessment of the post-conflict status of EmONC in the North-Kivu Province in eastern DRC. It raises the prospect of evidence-based policies and programming, as well as coordinated EmONC interventions, which should encourage local and external stakeholders to improve maternal and neonatal health in the province as part of the post-conflict recovery efforts. Despite the fact that most process/performance indicators didn’t meet the WHO standards, EmONC services were provided to a degree that appeared to be more advantageous for urban populations and more comprehensive in public referral facilities, especially where the NFPO or humanitarian partners were involved. Particular attention to basic EmONC is required, focusing on strengthening human resources, equipment, supply chains, and referral capacity, on the one hand, and on tackling residual insecurities that might hinder 24/7 staff availability, on the other hand. Also, given that the number of designated basic EmNOC facilities was higher than the minimum recommended by WHO, health authorities should focus on upgrading a few HCs based on geographic location to meet basic EmONC standards instead of trying to upgrade all the designated facilities.

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参考文献

1. Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. Int J Gynecol Obstet. 2005;88(2):181-93 https://doi.org/10.101 6/j.ijg0.2004.11.026.

2. Wall SN, Lee ACC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, et al. Reducing intrapartum-related neonatal deaths in low- and middle-income countries—what works? Semin Perinatol. 2010;34(6):395-407 httpsゾ/doi. org/10.1053/j.semperi.2010.09.009.

3. Pattinson R, Kerber K, Buchmann E, Friberg IK, Belizan M, Lansky S, et al. Stillbirths: how can health systems deliver for mothers and babies? Lancet. 2011;377(9777):1610-23 https://doi.org/10.1016/S0140-6736(10)62306-9.

4. Lee AC, Cousens S, Darmstadt GL, Blencowe H, Pattinson R, Moran NF, et al. Care during labour and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect. BMC Public Health. 2011;11(3):S10 https://doi.org/10.1186/1471-2458-11-S3-S10.

5. Bhandari TR, Dangal G. Emergency obstetric care: strategy for reducing maternal mortality in developing countries. Nepal J Obstet Gynaecol. 2014; 9(1):8-16 https://doi.org/10.3126/njog.v9i1.11179.

6. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016; 387(10017):462-74 https://doi.org/10.1016/S0140-6736(15)00838-7.

7. Hug L, Alexander M, You D, Alkema L. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario­based projections to 2030: a systematic analysis. Lancet Glob Health. 2019; 7(6):e710-20 https://doi.org/10.1016/S2214-109X(19)30163-9.

8. Williams PD. Continuity and change in war and conflict in Africa. PRISM. 2017;6(4):32-45.

9. Ghobarah HA, Huth P, Russett B. The post-war public health effects of civil conflict. Soc Sci Med. 2004;594):869-84 https://doi.org/10.1016/j. socscimed.2003.11.043.

10. O'Hare BAM, Southall DP. First do no harm: the impact of recent armed conflict on maternal and child health in sub-Saharan Africa. J R Soc Med. 2007;100(12):564-70 https://doi.org/10.1177/0141076807100012015.

11. d'Harcourt E, Purdin S. Impact of wars and conflict on maternal and child health. In: Ehiri J, editor. Maternal and child health: global challenges, programs, and policies. Boston: Springer US; 2009. p.121-33. https://doi. org/10.1007/b106524_7.

12. Urdal H, Che CP. War and gender inequalities in health: the impact of armed conflict on fertility and maternal mortality. Int Interact. 2013;39(4): 489-510 https://doi.org/10.1080/03050629.2013.805133.

13. Wise PH, Darmstadt GL. Confronting stillbirths and newborn deaths in areas of conflict and political instability: a neglected global imperative. Paediatr Int Child Health. 2015;35(3):220-6 https://doi.org/10.1179/2046905515Y. 0000000027.

14. DeJong J, Ghattas H, Bashour H, Mourtada R, Akik C, Reese-Masterson A. Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using countdown indicators. BMJ Glob Health. 2017;2(3):e000302 https://doi.org/10.1136/bmjgh-2017-000302.

15. Wagner Z, Heft-Neal S, Bhutta ZA, Black RE, Burke M, Bendavid E. Armed conflict and child mortality in Africa: a geospatial analysis. Lancet Lond Engl. 2018;392(10150):857-65.

16. OECD. States of fragility 2015: meeting Post-2015 ambitions. Paris: OECD Publishing;2015. https://doi.org/10.1787/9789264227699-en

17. Boerma T, Requejo J, Victora CG, Amouzou A, George A, Agyepong I, et al. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet. 2018;391(10129): 1538-48 https://doi.org/10.1016/S0140-6736(18)30104-1.

18. Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan. 2019;34(4):257-70 https://doi.org/10.1093/heapol/czz028.

19. Say L, Chou D, Gemmill A, Tun^alp 〇, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33 https://doi.org/10.1016/S2214-109X(14)70227-X.

20. Ahmed I, Ali SM, Amenga-Etego S, Ariff S, Bahl R, Baqui AH, et al. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297-308 https:// doi.org/10.1016/S2214-109X(18)30385-1.

21. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189-200 https://doi.org/10.1016/S0140-673 6(06)69380-X.

22. World Health Organization. Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: World Health Organization; 2015.

23. Boerma T, Tappis H, Saad-Haddad G, Das J, Melesse DY, DeJong J, et al. Armed conflicts and national trends in reproductive, maternal, newborn and child health in sub-Saharan Africa: what can national health surveys tell us? BMJ Glob Health. 2019;4(Suppl 4):e001300 https://doi.org/10.1136/ bmjgh-2018-001300.

24. Foster AM, Evans DP, Garcia M, Knaster S, Krause S, McGinn T, et al. The 2018 inter-agency field manual on reproductive health in humanitarian settings: revising the global standards. Reprod Health Matters. 2017;25(51): 18-24 https://doi.org/10.1080/09688080.2017.1403277.

25. Tran N-T, Dawson A, Meyers J, Krause S, Hickling C. Inter-agency working group (IAWG) on reproductive health in crisis (2015) developing institutional capacity for reproductive health in humanitarian settings: a descriptive study. PLoS One. 2015;10(9):e0137412 https://doi.org/10.1371/ journal.pone.0137412.

26. Bailey P, Lobis S, Maine D, Fortney JA. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization; 2009.

27. Pettersson T, Oberg M. Organized violence, 1989-2019. J Peace Res. 2020; 57(4):597-613 https://doi.org/10.1177/0022343320934986.

28. Coghlan B, Brennan RJ, Ngoy P, Dofara D, Otto B, Clements M, et al. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet Lond Engl. 2006;367(9504):44-51 https://doi.org/10.1016/S0140-6736(06)67923-3.

29. Coghlan B, Ngoy P, Mulumba F, Hardy C, Bemo VN, Stewart T, et al. Update on mortality in the Democratic Republic of Congo: results from a third nationwide survey. Disaster Med Public Health Prep. 2009;3(2):88-96 https:// doi.org/10.1097/DMP.0b013e3181a6e952.

30. Save the Children, State of the World's Mothers 2014: Saving Mothers and Children in Humanitarian Crises, 2014, ISBN 1-888393-28-9. Available at: https://www.refworld.org/docid/53d60c3f4.html. Accessed 3 Nov 2017.

31. Wagner Z, Heft-Neal S, Wise PH, Black RE, Burke M, Boerma T, et al. Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood. Lancet Glob Health. 2019;7(12):e1622-31 https://doi.org/10.1016/S2214-109X(19)30407-3.

32. Cometto G, Fritsche G, Sondorp E. Health sector recovery in early post­conflict environments: experience from southern Sudan. Disasters. 2010; 34(4):885-909 https://doi.org/10.1111/j.1467-7717.2010.01174.x.

33. Bertone MP, Witter S. An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone. Soc Sci Med. 2015;141:56-63 https://doi.org/10.1016/j.socscimed.2015.07.028.

34. Ssengooba F, Kawooya V, Namakula J, Fustukian S. Application of social network analysis in the assessment of organization infrastructure for service delivery: a three district case study from post-conflict northern Uganda. Health Policy Plan. 2017;32(8):1193-202 https://doi.org/10.1093/heapol/ czx071.

35. Bwimana A. Heath sector network governance and state-building in South Kivu, Democratic Republic of Congo. Health Policy Plan. 2017;32(10):1476- 83 https://doi.org/10.1093/heapol/czx095.

36. Pavignani E, Colombo S. Analysing disrupted health sectors: a modular manual: World Health Organization; 2000. https://apps.who.int/iris/handle/1 0665/44299. Accessed 13 Dec 2018

37. Martineau T, McPake B, Theobald S, Raven J, Ensor T, Fustukian S, et al. Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Glob Health. 2017;2(2).

38. Ministere de la Sante Publique de la RDC Plan National de Developpement Sanitaire (PNDS 2011-2015). Kinshasa: 2010. [cited 2018 Mar 1].Available from: https://www.who.int/hac/techguidance/training/analysing_health_systems/5_normes_de_la_zone_de_sante_06.pdf.

39. Sundberg R, Melander E. Introducing the UCDP georeferenced event dataset. J Peace Res. 2013;50(4):523-32 https://doi.org/10.1177/00223433134 84347.

40. Ministere du Plan et Suivi de la Mise en ffiuvre de la Revolution de la Modernite - MPSMRM/Congo, Ministere de la Sante Publique - MSP/Congo and ICF International. Enquete Demographique et de Sante en Republique Democratique du Congo 2013-2014. Rockville: MPSMRM, MSP, and ICF International; 2014.

41. Krause SK, Meyers JL, Friedlander E. Improving the availability of emergency obstetric care in conflict-affected settings. Glob Public Health. 2006;1(3):205- 28 https://doi.org/10.1080/17441690600679939.

42. Elfversson E, Gusic I, Hoglund K. The spatiality of violence in post-war cities. Third World Themat TWQ J. 2019;4(2-3):81-93 https://doi.org/10.1080/23802 014.2019.1675533.

43. Chi PC, Bulage P, Urdal H, Sundby J. Barriers in the delivery of emergency obstetric and neonatal care in post-conflict Africa: qualitative case studies of Burundi and northern Uganda. PLoS One. 2015;10(9):e0139120 https://doi. org/10.1371/journal.pone.0139120.

44. Chi PC, Bulage P, Urdal H, Sundby J. A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and northern Uganda. BMC Pregnancy Childbirth. 2015;15(1):18 https://doi.org/1 0.1186/s12884-015-0449-8.

45. Mugo N, Zwi AB, Botfield JR, Steiner C. Maternal and child health in South Sudan: priorities for the Post-2015 agenda. SAGE Open. 2015;5(2): 2158244015581190.

46. Ministere de la Sante Publique [internet]. Enquete sur la Disponibilite et la capacite operationnelle des services de sante en Republique Democratique du Congo. Kinshasa: DSSP/DSNIS; 2014. [cited 2018 Mar 8]. Available from: https://apps.who.int/healthinfo/systems/datacatalog/index.php/catalog/54.

47. Bailey P, Paxton A, Lobis S, Fry D. The availability of life-saving obstetric services in developing countries: an in-depth look at the signal functions for emergency obstetric care. Int J Gynecol Obstet. 2006;93(3):285-91 https:// doi.org/10.1016/j.ijg0.2006.01.028.

48. Wilunda C, Putoto G, Riva DD, Manenti F, Atzori A, Calia F, et al. Assessing coverage, equity and quality gaps in maternal and neonatal Care in sub­Saharan Africa: an integrated approach. PLoS One. 2015;10(5):e0127827 https://doi.org/10.1371/journal.pone.0127827.

49. Fauveau V. Is vacuum extraction still known, taught and practiced? A worldwide KAP survey. Int J Gynecol Obstet. 2006;94(2):185-9 https://doi. org/10.1016/j.ijg0.2006.01.033.

50. Kongnyuy EJ, Leigh B, van den Broek N. Effect of audit and feedback on the availability, utilisation and quality of emergency obstetric care in three districts in Malawi. Women Birth. 2008;21(4):149-55 https://doi.org/10.1016/j. wombi.2008.08.002.

51. Ameh CA, Weeks AD. The role of instrumental vaginal delivery in low resource settings. BJOG Int J Obstet Gynaecol. 2009;116(s1):22-5 https://doi. org/10.1111/j.1471-0528.2009.02331.x.

52. Bailey PE, van Roosmalen J, Mola G, Evans C, de Bernis L, Dao B. Assisted vaginal delivery in low and middle income countries: an overview. BJOG Int J Obstet Gynaecol. 2017;124(9):1335-44 https://doi.org/10.1111/1471-052 8.14477.

53. World Health Organization, International Confederation of Midwives and Federation internationale de Gynecologie et d'Obstetrique. Making pregnancy safer: the critical role of the skilled attendant : a joint statement by WHO, ICM and FIGO. Geneva: WHO; 2014. [cited 2018 July 26]. Available from: https://apps.who.int/iris/handle/10665/42955

54. Ameh CA, van den Broek N. Making it happen: training health-care providers in emergency obstetric and newborn care. Best Pract Res Clin Obstet Gynaecol. 2015;29(8):1077-91 https://doi.org/10.1016/j.bpobgyn.2015. 03.019.

55. Otolorin E, Gomez P, Currie S, Thapa K, Dao B. Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care. Int J Gynecol Obstet. 2015;130:S46-53 https://doi.org/10.1016/j.ijgo.2015.03.007.

56. Kruk ME, Rockers PC, Williams EH, Varpilah ST, Macauley R, Saydee G, et al. Availability of essential health services in post-conflict Liberia. Bull World Health Organ. 2010;88(7):527-34 https://doi.org/10.2471/BLT.09.071068.

57. Ronsmans C, Campbell O. Quantifying the fall in mortality associated with interventions related to hypertensive diseases of pregnancy. BMC Public Health. 2011;11(:3):S8 https://doi.org/10.1186/1471-2458-11-S3-S8.

58. Shamsuddin L, Nahar K, Nasrin B, Nahar S, Tamanna S, Kabir RMA, et al. Use of parenteral magnesium sulphate in eclampsia and severe pre-eclampsia cases in a rural set up of Bangladesh. Bangladesh Med Res Counc Bull. 2005; 31(2):75-82.

59. Phiri SN, Fylkesnes K, Moland KM, Byskov J, Kiserud T. Rural-urban inequity in unmet obstetric needs and functionality of emergency obstetric Care Services in a Zambian District. PLoS One. 2016;11(1):e0145196 https://doi. org/10.1371/journal.pone.0145196.

60. Wichaidit W, Alam M-U, Halder AK, Unicomb L, Hamer DH, Ram PK. Availability and quality of emergency obstetric and newborn Care in Bangladesh. Am J Trop Med Hyg. 2016;95(2):298-306 https://doi.org/10.42 69/ajtmh.15-0350.

61. Casey SE, Chynoweth SK, Cornier N, Gallagher MC, Wheeler EE. Progress and gaps in reproductive health services in three humanitarian settings: mixed- methods case studies. Confl Heal. 2015;9(1):S3 https://doi.org/10.1186/1 752-1505-9-S1-S3.

62. Casey SE, Mitchell KT, Amisi IM, Haliza MM, Aveledi B, Kalenga P, et al. Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo. Confl Heal. 2009;3⑴:12 https:// doi.org/10.1186/1752-1505-3-12.

63. Ntambue AM, Malonga FK, Cowgill KD, Dramaix-Wilmet M, Donnen P. Emergency obstetric and neonatal care availability, use, and quality: a cross­sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011. BMC Pregnancy Childbirth. 2017;17(1):40 https://doi.org/10.11 86/s12884-017-1224-9.

64. Musango L, Elovainio R, Nabyonga Orem J, Toure B. HealtH monitor the Contents: Health Monit; 2013.

65. World Health Organization. Improving health system efficiency: Democratic Republic of the Congo: improving aid coordination in the health sector.Geneva: WHO; 2015. [cited 2018 Oct 26]. Available from: https://apps.who. int/iris/handle/10665/186673

66. Adebisi YA, Umah JO, Olaoye OC, Alaran AJ, Sina-Odunsi AB. Assessment of Health Budgetary Allocation and Expenditure Toward Achieving Universal Health Coverage in Nigeria. Int J Health Life Sci. 2020;6:2.

67. Le Gargasson J-B, Mibulumukini B, Gessner BD, Colombini A. Budget process bottlenecks for immunization financing in the Democratic Republic of the Congo (DRC). Vaccine. 2014;32(9):1036-42 https://doi.Org/10.1016/j.vaccine.2 013.12.036.

68. Barroy H, Andre F, SMN M, Samaha HN. Investing in universal health coverage : opportunities and challenges for health financing in the Democratic Republic of Congo. Washington, D.C: World Bank Group; 2014. [cited 2019 May 19]. Available from http://documents.worldbank.org/curated/en/782781468196751651/Investing-in-universal-health-coverage-opportunities-and-challenges-for-health-financing-in-the-Democratic-Republic-of-Congo

69. Laokri S, Soelaeman R, Hotchkiss DR. Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection? BMC Health Serv Res. 2018;18⑴:451 https://doi.org/10.1186/s12913-018-3211-x.

70. Tappis H, Koblinsky M, Doocy S, Warren N, Peters DH. Bypassing primary care facilities for childbirth: findings from a multilevel analysis of skilled birth attendance determinants in Afghanistan. J Midwifery Womens Health. 2016; 61(2):185-95 https://doi.org/10.1111/jmwh.12359.

71.Salazar M, Vora K, Costa AD. Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India. Glob Health Action. 2016; 9(1):32178 https://doi.org/10.3402/gha.v9.32178.

72. Mubiri P, Kajjo D, Okuga M, Marchant T, Peterson S, Waiswa P, et al. Bypassing or successful referral? A population-based study of reasons why women travel far for childbirth in eastern Uganda. BMC Pregnancy Childbirth. 2020;20(1):497 https://doi.org/10.1186/s12884-020-03194-2.

73. Tabatabai P, Henke S, Susac K, Kisanga OME, Baumgarten I, Kynast-Wolf G, et al. Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data. Glob Health Action. 2014;7(1):22883 https://doi.org/10.3402/gha.v7.22883.

74. Kante AM, Exavery A, Phillips JF, Jackson EF. Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: a case study in three rural districts of Tanzania. Tropical Med Int Health. 2016; 21(4):504-14 https://doi.org/10.1111/tmi.12672.

75. Allen SM, Opondo C, Campbell OMR. Measuring facility capability to provide routine and emergency childbirth care to mothers and newborns: an appeal to adjust for delivery caseload of facilities. PLoS One. 2017;12(10): e0186515 https://doi.org/10.1371/journal.pone.0186515.

76. Lagrou D, Zachariah R, Bissell K, Van Overloop C, Nasim M, Wagma HN, et al. Provision of emergency obstetric care at secondary level in a conflict setting in a rural area of Afghanistan - is the hospital fulfilling its role? Confl Heal. 2018;12(1):2 https://doi.org/10.1186/s13031-018-0137-1.

77. Fogliati P, Straneo M, Mangi S, Azzimonti G, Kisika F, Putoto G. A new use for an old tool: maternity waiting homes to improve equity in rural childbirth care. Results from a cross-sectional hospital and community survey in Tanzania. Health Policy Plan. 2017;32(10):1354-60 https://doi.org/1 0.1093/heapol/czx100.

78. Ravit M, Audibert M, Ridde V, De Loenzien M, Schantz C, Dumont A. Removing user fees to improve access to caesarean delivery: a quasi- experimental evaluation in western Africa. BMJ Glob Health. 2018;3(1).

79. Maini R, Lohmann J, Hotchkiss DR, Mounier-Jack S, Borghi J. What happens when donors pull out? Examining differences in motivation between health workers who recently had performance-based financing (PBF) withdrawn with workers who never received PBF in the Democratic Republic of Congo. Int J Health Policy Manag. 2019;8(11):646-61 https://doi.org/10.15171/ ijhpm.2019.55.

80. Pearson L, Shoo R. Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynecol Obstet. 2005; 88(2):208-15 https://doi.org/10.1016/j.ijgo.2004.09.027.

81. Admasu K. Haile- Mariam A, Bailey P. Indicators for availability, utilization, and quality of emergency obstetric care in Ethiopia, 2008. Int J Gynecol Obstet. 2011;115(1):101 -5 https://doi.org/10.1016/j.ijgo.2011.07.010.

82. Wilunda C, Oyerinde K, Putoto G, Lochoro P, Dall'Oglio G, Manenti F, et al. Availability, utilization and quality of maternal and neonatal health care services in Karamoja region, Uganda: a health facility-based survey. Reprod Health. 2015;12(1):30 https://doi.org/10.1186/s12978-015-0018-7.

83. Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: application of the three delays model. BMC Pregnancy Childbirth. 2017;17(1):219 https://doi.org/10.1186/s12884-01 7-1406-5.

84. Hussein J, Hirose A, Owolabi O, Imamura M, Kanguru L, Okonofua F. Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care. Reprod Health. 2016;13:1-11.

85. Holmer H, Oyerinde K, Meara JG, Gillies R, Liljestrand J, Hagander L. The global met need for emergency obstetric care: a systematic review. BJOG Int J Obstet Gynaecol. 2015;122(2):183-9 https://doi.org/10.1111/1471-052 8.13230.

86. Altare C, Malembaka EB, Tosha M, Hook C, Ba H, Bikoro SM, et al. Health services for women, children and adolescents in conflict affected settings: experience from North and South Kivu, Democratic Republic of Congo. Confl Heal. 2020;14(1):31.

87. McKay G, Black B, Mbambu Kahamba S, Wheeler E, Mearns S, Janvrin A. Not all that bleeds is Ebola: how has the DRC Ebola outbreak impacted sexual and reproductive health in north-Kivu. New York: The International Rescue Committee; 2019.

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