Signal functions for emergency obstetric care as an intervention for reducing maternal mortality: a survey of public and private health facilities in Lusaka District, Zambia

Abstract

BackgroundZambia’s maternal mortality ratio was estimated at 398/100,000 live births in 2014. Successful aversion of deaths is dependent on availability and usability of signal functions for emergency obstetric and neonatal care. Evidence of availability, usability and quality of signal functions in urban settings in Zambia is minimal as previous research has evaluated their distribution in rural settings. This survey evaluated the availability and usability of signal functions in private and public health facilities in Lusaka District of Zambia.MethodsA descriptive cross sectional study was conducted between November 2014 and February 2015 at 35 public and private health facilities. The Service Availability and Readiness Assessment tool was adapted and administered to overall in-charges, hospital administrators or maternity ward supervisors at health facilities providing maternal and newborn health services. The survey quantified infrastructure, human resources, equipment, essential drugs and supplies and used the UN process indicators to determine availability, accessibility and quality of signal functions. Data on deliveries and complications were collected from registers for periods between June 2013 and May 2014.ResultsOf the 35 (25.7% private and 74.2% public) health facilities assessed, only 22 (62.8%) were staffed 24 h a day, 7 days a week and had provided obstetric care 3 months prior to the survey. Pre-eclampsia/ eclampsia and obstructed labor accounted for most direct complications while postpartum hemorrhage was the leading cause of maternal deaths. Overall, 3 (8.6%) and 5 (14.3%) of the health facilities had provided Basic and Comprehensive EmONC services, respectively. All facilities obtained blood products from the only blood bank at a government referral hospital.ConclusionThe UN process indicators can be adequately used to monitor progress towards maternal mortality reduction. Lusaka district had an unmet need for BEmONC as health facilities fell below the minimum UN standard. Public health facilities with capacity to perform signal functions should be upgraded to Basic EmONC status. Efforts must focus on enhancing human resource capacity in EmONC and improving infrastructure and supply chain. Obstetric health needs and international trends must drive policy change.

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

“…Health service factors also influence the rates of PPH including, physical resources (characteristics of the hospital, equipment and supplies) and human resources (health care providers). There is evidence that hospitals with number of deliveries < 200 cases per year had higher odds of PPH than in high-volume delivery hospitals [15] and that some hospitals could not provide emergency obstetric care (EmOC) as they lacked equipment and supplies [16,17]. Moreover, it has been shown that a larger number of patients to nurse ratio, increased the incidence of patients adverse health outcomes [18,19].…”

Assessing geographical distribution and accessibility of emergency obstetric care in sub-Saharan Africa: a systematic review

“…Of the 15 studies, seven were assessed to be of high quality [8,9,16-20], 4 were medium quality [21-24] and the remaining 4 studies were assessed as being of low quality [25-28] (See Quality assessment of studies in Appendix S2 in Online Supplementary Document ).…”

“…The peak publication year was in 2011 [8,22,24,25] and 2016 [16,17,21,27] when 4 articles were published in each year ( Figure 2 ). 2 studies have each been published in Burkina-Faso [26,27], Ethiopia [8,25], Ghana [17,19], Tanzania [20,21] and Zambia [22,28]. Guinea [16], Kenya [18], Malawi [23], Sierra-Leone [24], Rwanda [9] each have 1 published study ( Figure 2 ).…”

“…8 of the 15 studies were conducted on a national scale [16,17,19,22,24-27], while the remaining 7 studies assessed sub-national levels – regions or districts [8,9,18,20,21,23,28] ( Table 2 ).…”

“…8 articles focused on the UN EmOC indicator 1 and 2 (availability and geographical distribution) [8,9,17,19,20,22,26,28]. 1 study looked at both indicator 1 and 2 as well as indicator 5 [18], while the remaining 6 studies assessed 5 or more of the 8 EmOC indicators [16,21,23-25,27].…”