Patient and health facility factors associated with prolonged decision-delivery interval of emergency caesarian sections done at Tororo General Hospital

Abstract

Background: The continents of Africa and Asia account for 95% of maternal deaths and around 90% of newborn deaths worldwide. The high maternal and neonatal morbidity and mortality ratios in Uganda and other low- and middle-income countries are perpetuated by the 3 major delays, which are all affected by inadequate or lack of birth preparedness and complication readiness (BPCR). One of the contributors to the third delay is the prolonged decision-to-delivery interval (DDI). A DDI of 30 minutes for emergency caesarian section (CS) has been widely recommended, but achievement is 0 -65% worldwide. Factors associated with prolonged DDI have been documented in studies done in specialized urban hospitals in Uganda, but none in a lower-level hospital like Tororo general hospital (TGH). Objectives: The aim of this study was to determine the average DDI, and the patient and facility factors associated with prolonged DDI of emergency CS done in TGH Methods: This was a quantitative cross-sectional study among 332 consecutively sampled post-natal mothers delivered by emergency CS in TGH during the 5-month study period in 2021. Data was collected from the mothers and their case files using a pretested semi-structured questionnaire, entered into Epidata 3.1, then exported and analysed using Stata 14.0. A logistic regression model was used to measure the strength of associations between the prolonged DDI and the associated factors. Prolonged DDI was taken as values above the average DDI when maternal and neonatal complications appeared in a similar study. Results: The average DDI for caesarian delivery in TGH was 152 minutes, which is prolonged. Factors associated with prolonged DDI for emergency CS at TGH included facility factors like theater-related delay and working during-office hours which were due to the resource-limited setting of the hospital; and patient factors like mothers not being informed about the theater requirements for CS before coming to TGH, and inability to save enough money for caesarian delivery which were due to poverty of the mothers.