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The state of emergency obstetric care services in Nairobi informal settlements and environs: results from a maternity health facility survey.

Ziraba AK, Mills S, Madise N, Saliku T, Fotso JC - BMC Health Serv Res (2009)

Bottom Line: Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care.Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records.The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement.

View Article: PubMed Central - HTML - PubMed

Affiliation: African Population and Health Research Center, PO Box 10787, 00100, Nairobi Kenya. akziraba@yahoo.com

ABSTRACT

Background: Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies.

Methods: We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system.

Results: Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records.

Conclusion: The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement. Specific areas that require attention include supervision, regulation of maternity facilities; and ensuring that basic equipment, supplies, and trained personnel are available in order to handle obstetric complications in both public and private facilities.

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Related in: MedlinePlus

Percent distribution of 646 skilled birth attendants in 24 health facilities, Korogocho, Viwandani and environs in Nairobi.
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Figure 1: Percent distribution of 646 skilled birth attendants in 24 health facilities, Korogocho, Viwandani and environs in Nairobi.

Mentions: There were a total of 646 skilled birth attendants in 24 health facilities (one health facility was run solely by a traditional birth attendant). Figure 1 presents the distribution of the types of skilled birth attendants. The term "skilled health worker" as defined by WHO refers to "an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns"[13]. Auxiliary nurses and traditional birth attendants whether trained or not have not been included in the category of skilled birth attendants. Slightly over half of all skilled attendants were enrolled nurses as opposed to 4% registered midwives. The latter are typically more qualified than enrolled nurses and the small proportion indicates a critical shortage of more qualified midwives. Out of the 36 obstetricians (6% of skilled birth attendants), 58% were in the national referral hospital and 17% in the obstetric specialist hospital. The way the data was collected could not allow assessment of skills per cadre. For example the respondent was asked "how many skilled birth attendants in this facility can carry out assisted vaginal delivery". Also majority of the skilled birth attendants fell in the broad category of midwife/nurse making breakdown by cadre not very useful. Majority of the skilled birth attendants could not perform some of the basic emergency obstetric procedures for example only 20% of the skilled health care workers could perform manual removal of retained placenta; 16% could do dilation and curettage; 9% could perform manual vacuum aspiration; and 8% could carry out assisted vaginal deliveries. These results demonstrate that even among skilled birth attendants, there is a skills shortage especially in the area of assisted delivery.


The state of emergency obstetric care services in Nairobi informal settlements and environs: results from a maternity health facility survey.

Ziraba AK, Mills S, Madise N, Saliku T, Fotso JC - BMC Health Serv Res (2009)

Percent distribution of 646 skilled birth attendants in 24 health facilities, Korogocho, Viwandani and environs in Nairobi.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2662828&req=5

Figure 1: Percent distribution of 646 skilled birth attendants in 24 health facilities, Korogocho, Viwandani and environs in Nairobi.
Mentions: There were a total of 646 skilled birth attendants in 24 health facilities (one health facility was run solely by a traditional birth attendant). Figure 1 presents the distribution of the types of skilled birth attendants. The term "skilled health worker" as defined by WHO refers to "an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns"[13]. Auxiliary nurses and traditional birth attendants whether trained or not have not been included in the category of skilled birth attendants. Slightly over half of all skilled attendants were enrolled nurses as opposed to 4% registered midwives. The latter are typically more qualified than enrolled nurses and the small proportion indicates a critical shortage of more qualified midwives. Out of the 36 obstetricians (6% of skilled birth attendants), 58% were in the national referral hospital and 17% in the obstetric specialist hospital. The way the data was collected could not allow assessment of skills per cadre. For example the respondent was asked "how many skilled birth attendants in this facility can carry out assisted vaginal delivery". Also majority of the skilled birth attendants fell in the broad category of midwife/nurse making breakdown by cadre not very useful. Majority of the skilled birth attendants could not perform some of the basic emergency obstetric procedures for example only 20% of the skilled health care workers could perform manual removal of retained placenta; 16% could do dilation and curettage; 9% could perform manual vacuum aspiration; and 8% could carry out assisted vaginal deliveries. These results demonstrate that even among skilled birth attendants, there is a skills shortage especially in the area of assisted delivery.

Bottom Line: Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care.Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records.The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement.

View Article: PubMed Central - HTML - PubMed

Affiliation: African Population and Health Research Center, PO Box 10787, 00100, Nairobi Kenya. akziraba@yahoo.com

ABSTRACT

Background: Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies.

Methods: We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system.

Results: Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records.

Conclusion: The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement. Specific areas that require attention include supervision, regulation of maternity facilities; and ensuring that basic equipment, supplies, and trained personnel are available in order to handle obstetric complications in both public and private facilities.

Show MeSH
Related in: MedlinePlus