Location of Repository

The state of emergency obstetric care services in Nairobi informal settlements and environs: results from a maternity health facility survey.

By Abdhalah K. Ziraba, Samuel Mills, Nyovani Madise, Teresa Saliku and Jean-Christophe Fotso

Abstract

Background: maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies.<br/>Methods: we used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system.<br/>Results: out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records.<br/>Conclusion: the quality of emergency obstetric care services in Nairobi slums is poor and needs improvement. Specific areas that require attention include supervision, regulation of maternity facilities; and ensuring that basic equipment, supplies, and trained personnel are available in order to handle obstetric complications in both public and private facilitie

Topics: HQ, RA0421, DT
Year: 2009
OAI identifier: oai:eprints.soton.ac.uk:71064
Provided by: e-Prints Soton

Suggested articles

Preview

Citations

  1. (2004). Agency for Population and Development MoH, Central Bureau of Statistics, and ORC Macro: Kenya Service Provision Assessment Survey
  2. (1997). Akalin MZ, JE B: Guidelines for monitoring the availability and use of obstetric services.
  3. (2002). APHRC: Population and Health Dynamics in Nairobi's Informal Settlements. Nairobi (Kenya): African Population and Health Research Center;
  4. (2001). Bullough CH: Can Skilled Attendance at Delivery Reduce Maternal Mortality in Developing Countries?
  5. (2004). Improving technologies to reduce abortion-related morbidity and mortality. doi
  6. (2006). Kimani E: &quot;The place of cool waters&quot;: Women and water in the slums of
  7. (2005). Lobis S: The evidence for emergency obstetric care. doi
  8. (2005). Magnesium sulfate prophylaxis in preeclampsia: evidence from randomized trials. Clin Obstet Gynecol doi
  9. (2003). Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF AND UNFPA.
  10. (2000). Nations Millennium Declaration. Fifty-fifth Session of the United Nations General Assembly. doi
  11. (2004). New and underutilized technologies to reduce maternal mortality: call to action from a Bellagio workshop. doi
  12. Obstetric Care
  13. (1999). Organizing delivery care: what works for safe motherhood? Bull World Health Organ
  14. (2002). Questioning the indicators of need for obstetric care. Bull World Health Organ
  15. (2003). Report on Human Settlement.
  16. (2005). The disappearing art of instrumental delivery: time to reverse the trend. doi
  17. (2007). Vacuum assisted delivery in Ecuador for prolonged second stage of labor: maternal-neonatal outcome. doi
  18. (1994). WHO: Preventing Prolonged Labour: a practical guide. The Partograph Part I: Principles and Strategy.
  19. (2008). WHO: Proportion of births attended by a skilled health worker
  20. (2006). WHO: Skilled attendant at birth doi
  21. (2006). WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.