A Rapid Assessment of the Availability and Use of Obstetric Care in Nigerian Healthcare Facilities

Abstract

BackgroundAs part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities.FindingsMost of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC) services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery.ConclusionsIn conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

Assessment of Emergency Obstetric Care Services in Ibadan-Ibarapa Health Zone, Oyo State, Nigeria

“…These facilities were also clustered around the urban and peri urban areas, adjacent to the roads while a large proportion of people in the rural and remote areas remain virtually without services. This finding corroborates those of a study done in Nepal to assess the geographical distribution of facilities 19 and another study carried out in Zambia which reported that geographical access to EmOC services in rural areas was very low with less than 25% of the population living within 15km of any EmOC facility 20 .…”

Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability

“…Of these, 3 publications met the inclusion criteria and were included in our analysis (Ethiopia, The Gambia, and Nigeria) 19 - 21 . The studies for Ethiopia and Nigeria focused specifically on electricity access for facilities providing emergency obstetric and newborn care services.…”

Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011

“…The reluctance of health care staff to use assisted vaginal delivery for fear of maternal and neonatal complications is unjustified. It reveals a lack of provider training and experience, both of which are determinants of the outcome of vacuum- or forceps-assisted delivery [16, 19]. In Lubumbashi, this lack of training is one of the main obstacles to the introduction of vacuum extraction by ventouse as the tool of choice for instrument-assisted delivery.…”