Availability of emergency obstetric and newborn care services at public health facilities of Sindh province in Pakistan

Ramesh Kumar,Jamil Ahmed,Fozia Anwar,Ratana Somrongthong

doi:10.1186/s12913-019-4830-6

Abstract

BackgroundBasic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan.MethodsThis cross-sectional survey was conducted in twelve districts of the Sindh province in Pakistan. The districts were selected based on the maternal neonatal and child health indicators. Data were collected from 63 public-sector health facilities including district, Taluka (subdistrict) headquarters hospitals and rural health centers. Basic and comprehensive emergency obstetric newborn care services were assessed through direct observations and interviews with the heads of the health facilities by using a World Health Organization pretested and validated data collection tool. Participants interviewed in this study included the managers and auxiliary staff and in health facilities.ResultsAvailability of caesarean section (23, 95% C.I. 14.0–35.0) and blood transfusion services (57, 95% CI. 44.0–68.0), the two components of comprehensive emergency obstetric and newborn care, was poor in our study. However, assessment of the seven components of basic emergency obstetric and newborn services showed that 92% of the health facilities (95% C.I. 88.0–96.0) had parenteral antibiotics, 90%, (95% C.I. 80.0–95.0) had oxytocin, 92% (95% CI 88.0–96.0) had manual removal of the placenta service, 87% (95%, C.I. 76.0–93.0) of the facilities had staff who could remove retained products of conception, 82% (95% C.I. 71.0–89.0) had facilities for normal birth and 80% (95% C.I. 69.0–88.0) reported presence of neonatal resuscitation service.ConclusionThough the basic obstetric and newborn services were reasonably available, comprehensive obstetric and newborn services were not available as per the World Health Organization’s standards in the surveyed public health facilities. Ensuring the availability of caesarean section and blood transfusion services within these facilities may improve population’s access to these essential services around birth.

Highlights

Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality
Questionnaire from World Health Organization (WHO) monitoring emergency obstetric care tool in developing countries was adapted and used after pretesting in adjacent district of Sindh and the availability of Emergency Obstetric and Newborn Care (EmONC) signal functions was assessed by adopting the direct observations WHO recommended check list during this study as described in Table 2 [14, 15]
Newborn care services were available in 51(81%) of the health facilities

Summary

Introduction

Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan. In 2015, 303,000 maternal deaths were reported globally, of which 99% occurred in developing countries. The country faltered in its achievement of Millennium Development Goal of reducing maternal mortality ratio by three quarters, between 1990 and 2015 [6]. Such a failure is reflected by the fact that maternal mortality burden has increased from previous estimates for some parts of Pakistan. The maternal mortality ratio in Thatta district, in Southern Sindh province, increased more than 50% from 219 in 2010 to 333 per 100,000 live births in 2013 [7]

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