Abstract
BackgroundProvision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. In a conflict-affected province of Afghanistan (Khost), we assessed the performance of an Médecins Sans Frontières (MSF) run CEmONC hospital without a primary care and referral system. Performance was assessed in terms of hospital utilisation for obstetric emergencies and quality of obstetric care.MethodsA cross-sectional study using routine programme data (2013–2014).ResultsOf 29,876 admissions, 99% were self-referred, 0.4% referred by traditional birth attendants and 0.3% by health facilities. Geographic origins involved clustering around the hospital vicinity and the provincial road axis. While there was a steady increase in hospital caseload, the number and proportion of women with Direct Obstetric Complications (DOC) progressively dropped from 21% to 8% over 2 years. Admissions for normal deliveries continuously increased. In-hospital maternal deaths were 0.03%, neonatal deaths 1% and DOC case-fatality rate 0.2% (all within acceptable limits).ConclusionsDespite a high and ever increasing caseload, good quality Comprehensive EmONC could be offered in a conflict-affected setting in rural Afghanistan. However, the primary emergency role of the hospital is challenged by diversion of resources to normal deliveries that should happen at primary level. Strengthening Basic EmONC facilities and establishing an efficient referral system are essential to improve access for emergency cases and increase the potential impact on maternal mortality.
Highlights
Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between
An important way of reducing maternal mortality is scaling up the provision of Emergency Obstetric and Neonatal Care (EmONC) for the management of complications that arise during pregnancy and childbirth
Expressed as a percentage of expected deliveries, utilisation of the Médecins Sans Frontières (MSF) maternity hospital ranged from 3% to 70% between districts (Fig. 1)
Summary
Provision of Emergency Obstetric and Neonatal Care (EmONC) reduces maternal mortality and should include three components: Basic Emergency Obstetric and Neonatal Care (BEmONC) offered at primary care level, Comprehensive EmONC (CEmONC) at secondary level and a good referral system in-between. Evidence-based strategies for providing this care promote a comprehensive approach that links primary and secondary levels of care, as follows: 1) provide accessible, acceptable and good quality Basic Emergency Obstetric and Neonatal Care (BEmONC) at the primary health care level, 2) ensure efficient referral from primary level of mothers with complications to Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) provided at a secondary level facility, and 3) ensure quality of care in these CEmONC services [1,2,3,4] This three-pronged approach has been shown to reduce maternal mortality, but little is known about the performance of the individual components when they are offered in isolation. Several factors are likely to be responsible for this situation, in particular the three decades of conflict that have debilitated the health and transportation infrastructure and resulted in the vast majority of women and newborns not having access to good quality care [6,7,8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
