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Table 1 Thematic summary of barriers to access and utilization of EmOC in different sub-Saharan Africa

From: Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature

Main themes

The emerged sub-themes

Factors contributing to the delay in seeking EmOC services

Studies

Delay I

Socio-demographic and economic factors

Young age

[53, 59]

Uneducated women

[49, 73]

Attending only primary/secondary education

[53, 61, 62]

Unemployment

[53, 61, 62]

Rural residence

[40, 47, 49, 53, 64, 66, 67, 69]

Poverty and low income

[39, 40, 49, 51, 59, 63]

Unmarried

[53]

Language issues

[49]

Lack of information about service

[49, 51]

Being occupied with harvest and other duties

[46]

Community perception about obstetric complications

Socio-cultural

[48, 49, 63, 65, 72]

Belief in alternative method

[39, 45, 58, 68, 73]

Negative perception of the service

[53, 66]

Social stigma

[48]

Lack of trust in HCW

[44, 65]

Expecting improvement over time

[63]

Fear of procedure like surgery and blood donation

[38, 51, 58, 72]

Desire for home delivery

[45, 58]

Lack of women’s autonomy and poor male involvement

Women not involved in decision-making

[46, 49]

Poor male involvement

[43, 61, 62]

Knowledge of obstetric danger signs

Lack of awareness about obstetric complications

[39, 45, 49, 57, 59, 63, 66, 68, 72, 73]

Inability to identify complications

[49, 53, 59, 61, 62, 64, 68, 73]

Obstetric history and health service use

Inadequate ANC use

[39, 45, 59, 61, 62]

Higher parity and gravidity

[51, 59, 62, 73]

Previous uncomplicated pregnancy

[46, 66]

Poor birth preparedness and complication readiness

[39, 57]

Unwanted pregnancy

[53]

Previous bad experiences at facility and dissatisfaction

[51, 60, 72]

Delay II

Poor transport infrastructure

Lack of vehicles

[39, 45, 49, 51, 59, 65, 66, 68]

Shortage of ambulances

[51, 56, 66, 69, 72]

Poor road infrastructure and geography

[52, 63, 66, 68, 72]

Distance from health facilities

Long distance from facility

[42, 46, 51,52,53, 60, 63, 64, 68]

Lack of health facility in rural area

[49, 65, 67, 69]

Poor referral communication

[23, 42, 72]

Sought care first from dispensary or health centre

[51, 54]

Lack of finance for transportation

Lack of money for transportation

[42, 45, 46, 51, 58, 63, 66, 70, 72]

Delay III

Lack of EmOC services and supplies

Unavailability of EmOC services

[41, 47, 48, 51, 65, 67, 69, 70]

Lack of drugs, medical supplies, and equipment

[41, 47,48,49,50, 55, 56, 60, 68,69,70,71]

Shortage of rooms and utilities

[38, 41, 44, 46, 49,50,51, 60, 71]

Lack of blood

[41, 45, 63, 68, 69]

Sub-standard care at facility

[39, 45, 58, 65, 68,69,70,71,72]

Healthcare providers’ training and attitude

Shortage of healthcare providers

[38, 41, 44, 48,49,50,51, 54, 56, 60, 65, 69, 71]

Lack of competence among providers

[23, 44, 45, 50, 56, 60, 72]

Misdiagnosis and inappropriate treatment

[39, 45, 58, 69, 70, 72]

Shortage of training

[41, 44, 48, 50, 51, 56, 60, 69,70,71,72]

Long waiting time

[41, 45, 52, 65, 66, 68]

Provider’s poor attitude

[38, 44, 46, 48, 51, 54, 55, 58, 60, 65]

Lack of privacy

[41, 44, 58, 60, 65]

Poor management system

Poor supportive supervision

[23, 48, 50, 69]

Poor staff motivation

[41, 51, 54, 55, 69, 72]

Staff absenteeism

[41, 54]

Lack of coordination and feedback

[41, 51, 54, 55, 69, 72]

Heavy workload

[48, 49, 54, 69]

High staff turnover

[23, 69]

Poor communication system

[44, 60, 65, 72]

Patient overcrowding

[23, 38, 41, 46]

Delayed referral

[41, 42, 45, 68, 69]

Lack of guidelines and protocol

[48, 50, 54, 71]

Unaccountability

[54, 55, 69]

High treatment cost

[38, 39, 58, 60, 72]

Simplicity of obtaining drugs

[60]