Maternal health care services provision in Sub-Saharan Africa: a scooping review

Abstract

Maternal mortality remains one of the most sensitive pointers of the quality of maternal healthcare. Maternal mortality remains an excessive concern with approximately 99% of maternal deaths occurring in developing countries and more than half in low and middle-income countries (Billah, Chowdhurry, Khan, Karim, Hassan, Zaka,Arifaan & Manu,2019). The U.S has the highest maternal mortality rate (MMR) among developed countries as evidenced by an increase from 754 to 861 in 2020 (National centre for health statistics, 2022). 85 000 women die due to pregnancy complications and during childbirth in Asian countries. Moreover, nearly 15% occur in India and Pakistan only (Silva, Panisi, Lindquist, Cluver, Middleton, Koete, Vogel, Walker, Tong & Hastie, 2021).
Even though in many areas of the world MMR is still unacceptably high, in the WHO European region MMR deteriorated by roughly 50% (Larroca, Serrano, Minaya, Martinez, Pacheco, Bonelli & Luis, 2022). Out of the 99% of maternal deaths occurring globally, more than half occur in sub-Saharan Africa (SSA). The maternal mortality estimation interagency group (MMEIG) estimated that 295 000 maternal deaths occurred globally of which 196 000 (66%) were from SSA (Musarandega, Nyakura, Machekano, Pattison & Munjanja, 2021). Which lead to SSA MMR being 542 deaths per 100 000 live births compared to a global ratio of 216 deaths per 100 000. Therefore, the purpose of this scoping review is to explore the quality of maternal health care services provision in sub-Saharan Africa.
Methodology: This scooping review was conducted using the Arksey and O’Malley framework. The search was conducted in four electronic databases namely Sabinet, Web of science, Jstor and Science direct. The search included articles/journals published between January 2017-January 2022; and articles/journals in English. About 1057 articles including 23 from hand search were identified. Only 41 articles were included for final discussion
Results: Results indicates that poor maternal health care provision persist, characterized by poor communication, lack of privacy, neglect, physical and verbal abuse, and disrespect from health care providers during labour and delivery. Unmanageable work-pressures among health care workers and inadequate resources were pointed as a major cause of poor maternal health care provision and outcomes. The government implemented policies, strategies, and guidelines such as Traditional approach and Basic antenatal care to support maternal healthcare. Moreover, MMR decreased by 38% from 342 deaths to 211 deaths per 100 000 live births which is 2.9% annual proportion. However, the annual average is less than half of the percentage needed to meet the Sustainable Development Goal (SDG) (South African National Department of Health, 2021)
Conclusion and recommendation/s: The study concludes that despite a noticeable reduction of MMR in countries like Zimbabwe, Nigeria, and South Africa more strategies still need to be developed to improve the quality of maternal healthcare services provision in Sub-Saharan Africa, which will help in achieving the SDG 3.1, to reduce the global maternal mortality ratio to less than 70 per 100 000 live births. Furthermore, Ministry of health in SSA should re-look the strategy they use to monitor if healthcare facilities are equipped with adequate human resources, equipment, infrastructure, and logistics as well as adherence to protocols and standard operating procedure.