Factors Determining The Delay in Access to Appropriate Emergency Obstetric Care During The Lockdown Period of The COVID-19 Pandemic: An Observational Study at A Tertiary Referral Centre

Authors

  • Triveni GS Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India
  • Noopur Chawla Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India
  • Aishwarya Kapur Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India
  • Prateeksha BS Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India
  • Kavita Badal Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India
  • Manju puri Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

DOI:

https://doi.org/10.26911/jepublichealth.2024.09.03.03

Abstract

Background: The WHO declared the COVID-19 pandemic as a public health emergency of inter-national concern following which many governments around the world adopted the most radical social distancing procedure, referred to as “lockdown”, to prevent the spread of the virus. As a result, unsupervised pregnancies and the absence of routine antenatal visits lead to dreaded maternal and fetal complications. This study determines the barriers to accessing emergency care by pregnant women during the lockdown period.
Subjects and Method: This prospective study was conducted during the lockdown period in Delhi from 1 May 2021 to 31 May 2021. A total of 666 pregnant and postpartum patients admitted from casualty during this period were included. The variable of the study was various factors causing delays of more than 4 hours in accessing emergency care services by these patients after the onset of symptoms was assessed. This study used the conceptual model of Three Delays. The data was collected as per predesigned proforma. The demography, Obstetric profile, and various levels of delays were noted. The data was analyzed by frequencies and percentages using SPSS version 21.
Results: Among 666 enrolled participants, about 55.7% were multigravida and 48.04% belonged to the upper-lower class. Nearly 43% of patients were illiterate. Antenatal delay of > 4 hours was observed in 590 patients (88.6%). In Level 1 delay, the main reasons for the delay were unawareness of danger signs (45.8%) and lockdown (30.93%). The major reason for the Level 2 delay was care declined at the previous center (33.93%). Reasons for the Level 3 delay were due to either unavailability of beds or overcrowding after reaching the facility.
Conclusion: The unawareness of danger signs was the most common cause of delay. Hence, effective communication and counseling during the antenatal period have to be improved upon.

Keywords:

Lockdown, SARS-COVID-19, maternal, fetal outcome, levels of delay, emergency services

Correspondence

Aishwarya Kapur, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College. Shaheed Bhagat Singh Marg, Lady Hardinge Medical College, DIZ Area, Connaught Place, New Delhi, Delhi 110001, India. Email: Aish9kapur@gmail.com.

Author Biographies

Triveni GS, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

Associate Professor Department of Obstetrics and Gynecology

Noopur Chawla, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

Ex Senior Resident Department of Obstetrics and Gynecology

Aishwarya Kapur, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

Associate Professor Department of Obstetrics and Gynecology

Prateeksha BS, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

Ex Junior Resident Department of Obstetrics and Gynecology

Kavita Badal, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

Ex Postgratuate Resident Department of Obstetrics and Gynecology

Manju puri, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi India

Director Professor Department of Obstetrics and Gynecology

References

Burt JF, Ouma J, Lubyayi L, Amone A, Aol L, Sekikubo M, Nakimuli A, et al. (2021). Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda. BMJ Glob Health. 6: e006102. doi:1 0.1136/bmjgh-2021-006102.

Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, O'Brien P, et al. (2021). Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 9(6):759-772. doi: 10.1016/S2214-109X(21)00079-6

Doncarli A, Araujo-Chaveron L, Crenn-Hebert C, Demiguel V, Boudet-Berquier J, Barry Y, Eugenia Gomes Do Espirito Santo M, et al. (2021). Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVI-MATER cross-sectional study. BMC Pregnancy Childbirth. 21(1):799. doi: 10.1186/s12884-021-04256-9.

Goyal M, Singh P, Singh K, Shekhar S, Agrawal N, Misra S (2021). The effect of the COVID-19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center. Int J Gynaecol Obstet. 152(2): 231-235.doi: 10.1002/ijgo.13457.

Holland M, Zaloga DJ, Friderici CS (2020). COVID-19 personal protective equipment (PPE) for the emergency physician. Vis J Emerg Med. 19:100740. 10.1016/j.visj.2020.100740.

Quibel T, Winer N, Bussières L, Vayssière C, Deruelle P, Defrance M, Rozenberg P, et al. (2022). Impact of COVID-19-Related Lockdown on Delivery and Perinatal Outcomes: A Retrospective Cohort Study. J Clin Med. 11(3):756. doi: 10.3390/jcm11030756.

Riley T, Sully E, Ahmed Z, Biddlecom A (2020). Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries. Int Perspect Sex Reprod Health. 46:73–6. doi: 10.1363/46e9020.

Singh AK, Jain PK, Singh NP, Kumar S, Bajpai PK, Singh S, Jha M (2021). Impact of COVID-19 pandemic on maternal and child health services in Uttar Pradesh, India. J Family Med Prim Care.10(1):509-513. doi: 10.410-3/jfmpc.jfmpc_1550_20.

Sinha B, Dudeja N, Mazumder S, Kumar T, Adhikary P, Roy N, Rongsen C, et al. (2022). Estimating the Impact of COVID-19 Pandemic Related Lockdown on Utilization of Maternal and Perinatal Health Services in an Urban Neighbourhood in Delhi, India. Front Glob Womens Health. 3:816969. doi: 10.3389/fgwh.2022.816969.

Thaddeus S, Maine D (1994). Too far to walk: maternal mortality in context. Soc Sci Med. 38:1091-1110.

Tadesse E (2020). Antenatal care service utilization of pregnant women attending antenatal care in public hospitals during the COVID-19 pandemic period. Int J Womens Health.12:1181-1188. doi: 10.2147/IJWH.S287534.

Tiruneh GA, Arega DT, Kassa BG, Bishaw KA (2022). Delay in making decision to seek care on institutional delivery and associated factors among post-partum mothers in South Gondar zone hospitals, 2020: A cross-sectional study. Heliyon. 5;8(3):e09056. doi: 10.1016/j.heliyon.2022.e09056.

Wichaidit W, Alam MU, Halder AK, Uni-comb L, Hamer DH, Ram PK (2016). Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh. Am J Trop Med Hyg. 95(2): 298-306.

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Published
2024-07-16

Issue
Vol. 9 No. 3 (2024)

Section
flow-chart-line Articles

How to Cite
GS, T., Chawla, N., Kapur, A., BS, P., Badal, K., & puri, M. (2024). Factors Determining The Delay in Access to Appropriate Emergency Obstetric Care During The Lockdown Period of The COVID-19 Pandemic: An Observational Study at A Tertiary Referral Centre. Journal of Epidemiology and Public Health, 9(3), 300–306. https://doi.org/10.26911/jepublichealth.2024.09.03.03