@article{fdi:010079025,
  title = {{W}hat the percentage of births in facilities does not measure : readiness for emergency obstetric care and referral in {S}enegal},
  author = {{C}avallaro, {F}. {L}. and {B}enova, {L}. and {D}ioukhane, {E}. and {W}ong, {K}. and {S}heppard, {P}. and {F}aye, {A}. and {R}adovich, {E}. and {D}umont, {A}lexandre and {M}bengue, {A}. {S}. and {R}onsmans, {C}. and {M}artinez-{A}lvarez, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {I}ncreases in facility deliveries in sub-{S}aharan {A}frica have not yielded expected declines in maternal mortality, raising concerns about the quality of care provided in facilities. {T}he readiness of facilities at different health system levels to provide both emergency obstetric and newborn care ({E}m{ONC}) as well as referral is unknown. {W}e describe this combined readiness by facility level and region in {S}enegal. {M}ethods {F}or this cross-sectional study, we used data from nine {D}emographic and {H}ealth {S}urveys between 1992 and 2017 in {S}enegal to describe trends in location of births over time. {W}e used data from the 2017 {S}ervice {P}rovision {A}ssessment to describe {E}m{ONC} and emergency referral readiness across facility levels in the public system, where 94% of facility births occur. {A} national global positioning system facility census was used to map access from lower-level facilities to the nearest facility performing caesareans. {R}esults {B}irths in facilities increased from 47% in 1992 to 80% in 2016, driven by births in lower-level health posts, where half of facility births now occur. {C}aesarean rates in rural areas more than doubled but only to 3.7%, indicating minor improvements in {E}m{ONC} access. {O}nly 9% of health posts had full readiness for basic {E}m{ONC}, and 62% had adequate referral readiness (vehicle on-site or telephone and vehicle access elsewhere). {A}lthough public facilities accounted for three-quarters of all births in 2016, only 16% of such births occurred in facilities able to provide adequate combined readiness for {E}m{ONC} and referral. {C}onclusions {O}ur findings imply that many lower-level public facilities-the most common place of birth in {S}enegal-are unable to treat or refer women with obstetric complications, especially in rural areas. {I}n light of rising lower-level facility births in {S}enegal and elsewhere, improvements in {E}m{ONC} and referral readiness are urgently needed to accelerate reductions in maternal and perinatal mortality.},
  keywords = {{SENEGAL} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {5},
  numero = {3},
  pages = {e001915 [14 ]},
  ISSN = {2059-7908},
  year = {2020},
  DOI = {10.1136/bmjgh-2019-001915},
  URL = {https://www.documentation.ird.fr/hor/fdi:010079025},
}