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Background: Uganda is far from meeting the sustainable development goals on maternal and neonatal mortality with a maternal mortality ratio of 383/100,000 live births, and 33% of the women gave birth by 18 years. The neonatal mortality ratio was 29/1000 live births and 96 stillbirths occur every day due to placental abruption, and/or eclampsia – preeclampsia and other unkown causes. These deaths could be reduced with access to timely safe surgery and safe anaesthesia if the Comprehensive Emergency Obstetric and Newborn Care services (CEmONC), and appropriate intensive care post operatively were implemented. A 2013 multi-national survey by Epiu et al. showed that, the Safe Surgical Checklist was not available for use at main referral hospitals in East Africa. We, therefore, set out to further assess 64 government and private hospitals in Uganda for the availability and usage of the WHO Checklists, and investigate the post-operative care of paturients; to advocate for CEmONC implementation in similarly burdened low income countries. Methods: The cross-sectional survey was conducted at 64 government and private hospitals in Uganda using preset questionnaires. Results: We surveyed 41% of all hospitals in Uganda: 100% of the government regional referral hospitals, 16% of government district hospitals and 33% of all private hospitals. Only 22/64 (34.38%: 95% CI = 23.56-47.09) used the WHO Safe Surgical Checklist. Additionally, only 6% of the government hospitals and 14% not-for profit hospitals had access to Intensive Care Unit (ICU) services for postoperative care compared to 57% of the private hospitals. Conclusions: There is urgent need to make WHO checklists available and operationalized. Strengthening peri-operative care in obstetrics would decrease maternal and neonatal morbidity and move closer to the goal of safe motherhood working towards Universal Health Care.
The cross-sectional survey was conducted in Uganda from September 2014 to August 2015. A total of 64 hospitals across Uganda were selected based on the criteria that they provided obstetric anaesthesia At least 15 hospitals from each region; East, West, North and Central were included:- 13 regional referral, 21 general (district), 7 private for profit and 7 private not for profit hospitals across the country. Our study represents 41% of all the hospitals in the country and 100% of the government regional referral hospitals, 15% of government general (district) hospitals and 33% of all private hospitals in Uganda. This included 26% of private for profit and 37% of the private non-for profit hospitals. As published in by Epiu et al.** survey tool to evaluate compliance to the World Federation of Societies’ of Anaesthesiologists (WFSA) international guidelines for safe anaesthesia was developed [19]. These included quantitative and qualitative data on pre-operative assessment of patients, staffing and continuous monitoring intra-operatively and post-operatively. In this report we have included the peri-operative components on the use of the WHO Safe surgical Checklist, and documented the postoperative care of the parturient. I.E and trained research assistants interviewed on anaesthetist at each hospital, the hospital director and using a checklist assessed the theatre and recovery areas. We purposefully selected all 14 regional referral hospitals as they are tertiary centres and serve as the surgical referral hospitals for lower health centres. We also randomly selected hospitals from other types of hospitals present in Uganda to include general (government district hospitals), private for profit and private not for profit hospitals. With the help of a statistician, data was subsequently cleaned and coded into Epidata version 3.1. Range. Consistency and Validity checks were built in to minimize errors. Data was exported and analyzed using STATA version 14 (Statcorp, College Station, Texas, USA). Ethical approval was obtained from Makerere University School of Medicine Research and Ethics Committee (SOMREC) REC REF No 2014–133, the appropriate participating hospitals, and the Uganda National Council for Science and Technology. Informed consent was obtained from all individuals participating in the study.
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