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.
Highlights
Uganda has an estimated population of 35.8 million people and is experiencing a rapid population growth
A Health centre (HC) III should be able to function as a basic emergency obstetrics care (EmOC) (BEmOC) facility [18]
HC IV provides all the services of HCs III, plus surgery, supervises the HCs II and III, and in theory, should be able to function as a comprehensive EmOC (CEmOC) facility [18]
Summary
Uganda has an estimated population of 35.8 million people and is experiencing a rapid population growth. Uganda signed on to the Millennium Development Goals (MDGs) of which the targets of the fifth MDG (MDG 5) are to reduce the MMR by 75%, between 1990 and 2015, and to increase coverage of skilled attendance at birth to 95% by 2015 [5]. Achieving these targets in Uganda is challenging because of many barriers to accessing health care as reflected in institutional delivery rate which remains unacceptably low in spite of increases in recent years: 37% in 2001, 42% in 2006 and 57% in 2011 [3]. 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
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