Availability, utilisation and quality of maternal and neonatal health care services in Karamoja region, Uganda: a health facility-based survey

Abstract

BackgroundMaternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC) is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation’s lowest scores on key development and health indicators and presents a substantial challenge to Uganda’s stability and poverty eradication ambitions. The objectives of this study were: to establish the availability of maternal and neonatal healthcare services at different levels of health units; to assess their utilisation; and to determine the quality of services provided.MethodsA cross sectional study of all health facilities in Napak and Moroto districts was conducted in 2010. Data were collected by reviewing clinical records and registers, interviewing staff and women attending antenatal and postnatal clinics, and by observation. Data were summarized using frequencies and percentages and EmOC indicators were calculated.ResultsThere were gaps in the availability of essential infrastructure, equipment, supplies, drugs and staff for maternal and neonatal care particularly at health centres (HCs). Utilisation of the available antenatal, intrapartum, and postnatal care services was low. In addition, there were gaps in the quality of care received across these services. Two hospitals, each located in the study districts, qualified as comprehensive EmOC facilities. The number of EmOC facilities per 500,000 population was 3.7. None of the HCs met the criteria for basic EmOC. Assisted vaginal delivery and removal of retained products were the most frequently missing signal functions. Direct obstetric case fatality rate was 3%, the met need for EmOC was 9.9%, and 1.7% of expected deliveries were carried out by caesarean section.ConclusionsTo reduce maternal and newborn morbidity and mortality in Karamoja region, there is a need to increase the availability and the accessibility of skilled birth care, address the low utilisation of maternity services and improve the quality of care rendered. There is also a need to improve the availability and accessibility of EmOC services, with particular attention to basic EmOC.

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

“…Our observations concerning EmONC availability, use and quality in Lubumbashi are similar to those made in urban or urban–rural centers in several African countries [16–21]. In all these settings, between 2009 and 2015, signal functions 1 and 2 were the most often performed (70–95%) by health facilities.…”

“…In this study the authors also observed that only 48% of GRHs had provided all the signal functions. In surveys carried out in Madagascar, Mali, Ethiopia, Malawi, Zambia, Uganda, and other African countries, as in Lubumbashi, the proportion of facilities that had provided all these functions did not exceed 30% (10–30%); similarly, the proportion of deliveries in EmONC facilities did not exceed this percentage (10–30%) [16–21, 41]. The proportion of obstetrical needs met and the rates of cesarean sections reported in these studies were also weak and variable, ranging, for the obstetrical needs met, from 9.6% in Madagascar [41] to 48% in South Africa [17], and for cesarean sections, from 1.5 to 9.0%, respectively, in the same countries [17, 41].…”

“…Nevertheless, while the effectiveness of this healthcare package is known and proven, its use and quality remain matters for concern, especially within developing countries. In Africa, where maternal and perinatal mortalities are the highest, less than 30% of women who present with obstetric complications are admitted to healthcare facilities providing EmONC [15–21]. …”

Emergency obstetric and neonatal care needs assessment: Results of the 2010 and 2014 surveys in Burkina Faso

“…Improvement of emergency obstetric and neonatal care (EmONC) is an essential pillar for the reduction of maternal and neonatal mortality. Several studies have been conducted in Africa during this last five years [5–16]. However, few studies analyze the results of two or more needs assessments [9].…”

Health Infrastructure Development in Rural and Urban Areas of Iran Between 1976 and 2011

“…Studies support a close link between infrastructure development and poverty decrease (9)(10)(11). The lack of access to essential services such as piped water, housing, energy and basic health services prevent inclusive growth, decline poverty, and promote health (12,13).…”