Magnitude and Causes of Maternal Deaths at Health Facilities in Eritrea in 2007.

Objective: To measure the level of maternal mortality in health facilities as well as the magnitude and proportion of obstetric complications in health facilities in Eritrea. Methods: The study was a cross-sectional survey of all hospitals and health centers in Eritrea and a random sample of around a third of health stations. Medical records of all patients who encountered obstetric complications in 2007 were reviewed. Findings: The main causes of obstetric complications among hospital admissions in 2007 were abortion complications (45.6%), obstructed/prolonged labor (18.4%), abnormal fetal presentation (10.3%) and preeclampsia/ eclampsia (7.7%). The number of maternal deaths at facilities was relatively small. Out of the 6,315 patients who were admitted for obstetric complications in 2007, 41 were classified as maternal deaths. The leading causes of maternal deaths included pre-eclampsia/ eclampsia in 22.0 percent of the cases, abortion complications in 19.5 percent of the cases and postpartum sepsis in 17.1 percent of the cases and post-partum hemorrhage in 14.6 percent of cases. The case-fatality rate for obstetric complications was low at 0.75 percent. The majority of maternal deaths (65 percent) occurred in the post-partum period, while 32 percent occurred during the ante-partum period, and 3 percent during intra-partum or during labor or delivery Conclusion: Over all it can be concluded that the Eritrean health system is performing well with the current demand for services. The issue of abortion requires special attention because it is the leading obstetric complication, which accounts for 46 percent of maternal complications and is responsible for one fifth of maternal deaths. Although the case fatality rate of all obstetric complications combined is not high (0.75 percent), the cause specific case fatality rates for the leading causes of maternal mortality was high Keywords: Maternal mortality, obstetric complications, abortion, case fatality rat

Quality of Care in Humanitarian Surgery

Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more humanitarian surgeons is desperately needed. Standard perioperative protocols for the humanitarian setting after common procedures such as Cesarean section, burn care, open fractures, and amputations and antibiotic prophylaxis, and post-operative pain management must be developed. Outcome data, especially long-term outcomes, are difficult to collect as patients often do not return for follow-up and may be difficult to trace; standard databases for post-operative infections and mortality rates should be established. Checklists have recently received significant attention as an instrument to support the improvement of surgical quality; knowing which items are most applicable to humanitarian settings remains unknown. In conclusion, the quality of surgical services in humanitarian settings must be regulated. Many other core medical activities of humanitarian organizations such as therapeutic feeding, mass vaccination, and the treatment of infectious diseases, such as tuberculosis and human immunodeficiency virus, are subject to rigorous reporting of quality indicators. There is no reason why surgery should be exempted from quality oversight. The surgical humanitarian community should pull together before the next disaster strikes

Editorial: Cervical cancer can be controlled

(East African Medical Journal: 2001 78(2): 53-54

Quality of Maternity Care at Health Facilities in Eritrea in 2008

Objective: To examine the quality of maternal health services at health facilities in Eritrea. Methods: The study was a cross-sectional survey of all hospitals and health centers and a random sample of a third of health stations. Extensive interviews with health providers and facility managers were undertaken using structured questionaires. Findings: The key findings of the study include: All hospitals and all health centers provided Basic Obstetric Emergency Care. However, only 11 of the 18 hospitals provided Comprehensive Obstetric Emergency Care including caesarian section. The national referral hospital treated 54 percent of obstetric complications, while health centers and health stations are not proportionally sharing the burden of work. Recommendations: Eritrean health system which was performing well with the current demand for services can improve its outputs. Upgrading of the function of existing facilities by strengthening the human resource capacity is needed to increase availability of emergency obstetric care by more than one third, using the existing physical structure of health facilities. Keywords: Maternity care, Quality, availability, accessibility, continuity, management, infrastrScope, Editoria

Maternal mortality in Kenya: the state of health facilities in a rural district

(East African Medical Journal 2001 78 (9): 468-472