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

Abstract

BackgroundWhile emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi.MethodsThis cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards.ResultsThe availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one.In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities.ConclusionAudits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi.Electronic supplementary materialThe online version of this article (doi:1...

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

“…This finding was similar to previous published studies where hospital levels appeared to influence resources allocation and performance outcome of health care providers providing effective care [29] as well as PPH management [6]. Although it is clear that sufficient resource allocation can prevent maternal complications after delivery [30,31], many health care institutions could not provide the standard of EmOC which is recommended by WHO [16,29,32,33].…”

Referral transit time between sending and first-line receiving health facilities: a geographical analysis in Tanzania

“…Facilities may lack infrastructure, equipment, supplies or staffing when services are actually needed. Lateral referrals may occur because of geographical proximity or convenience, without consideration for the level of care provided at the receiving facility 40. An updatable list of facilities’ current EmONC statuses, assessed quarterly, can be shared across the region, so providers can assess the most appropriate facilities for referral.…”

Implementasi Pelayanan Neonatal Emergensi Komprehensif di Rumah Sakit PONEK di Indonesia

“…4 Hasil penelitian di Congo menyatakan bahwa keterampilan petugas keperawatan, ketersediaan sarana dan prasarana, serta proses perawatan kesehatan yang terstandar sangat penting untuk mengurangi kematian maternal perinatal. 10 Di Brazil, hasil penelitian Sousa dengan menggunakan data panel tahun 1991-2000 menyatakan bahwa kematian neonatus berkaitan dengan distribusi perawat dan dokter yang kurang memadai. Hasil penelitian ini juga menyatakan bahwa setiap penambahan proporsi 1 perawat untuk 1000 penduduk dapat menurunkan kematian neonatus sebanyak 3,8%, sedangkan setiap penambahan 1 orang dokter per 1000 penduduk akan mengurangi kematian neonatus sebanyak 2.8%.…”

“…Selain dana, PONEK butuh dukungan team work yang legal, dukungan dari manajemen dan SOP yang memadai. 10 Hasil penelitian ini menyatakan bahwa rumah sakit PONEK telah melakukan KMC, dengan melakukan KMC berarti rumah sakit telah melakukan suatu metode intervensi yang sederhana, murah dan efektif dalam meningkatkan kelangsungan hidup dan kesehatan neonatal. 11,14,15,16 Intervensi efektif lainnya adalah pencegahan dan perawatan untuk menjaga agar bayi tetap hangat, menyusui dengan menjaga skin to skin kontak 17 dan pengobatan infeksi neonatal.…”

“…5 Beberapa hasil penelitian menyatakan bahwa hambatan implementasi PONEK adalah kurangnya penyediaan dan akses pelayanan kegawatdaruratan obstetri dan neonatal. 20,10,13 Hasil penelitian di daerah perdesaan Tanzania menyatakan bahwa fasilitas dan pelayanan yang memadai sangat mendukung keberhasilan pelayanan kegawatdaruratan pada maternal dan neonatal. 9…”