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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]