Emergency obstetric care as the priority intervention to reduce maternal mortality in Uganda

  • International Journal of Gynecology and Obstetrics, Volume 96, No. 3, Year 2007

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Study Justification:
The purpose of this study was to assess the availability of emergency obstetric care (EmOC) in Uganda in order to establish a baseline for monitoring obstetric care services. The study aimed to identify the main causes of maternal mortality and the missing signal functions contributing to these deaths. By understanding the gaps in EmOC provision, the study aimed to inform interventions to reduce maternal mortality in Uganda.
Highlights:
– The study found a maternal mortality ratio (MMR) of 671/100,000 live births in Uganda.
– Hemorrhage was identified as the leading direct cause of maternal deaths, accounting for 42.2% of cases.
– Malaria was found to be the main indirect cause of maternal deaths, accounting for 65.5% of cases.
– Abortion and malaria were identified as the main obstetric complications contributing to maternal deaths.
– The study identified the missing signal functions that were contributing to maternal deaths, including the removal of retained products, assisted vaginal delivery, and blood transfusion.
– The study also found that most health facilities expected to offer basic EmOC were not providing these services.
Recommendations:
– The study recommends implementing an integrated programming approach to increase access to EmOC, malaria treatment, and prevention services.
– Improving the availability of the missing signal functions, such as the removal of retained products, assisted vaginal delivery, and blood transfusion, is crucial to reducing maternal mortality.
– Efforts should be made to ensure that health facilities offering basic EmOC actually provide these services.
Key Role Players:
– Ministry of Health: Responsible for policy development and coordination of interventions to reduce maternal mortality.
– District Health Offices: Responsible for implementing interventions at the district level and monitoring progress.
– Health Facility Managers: Responsible for ensuring the availability and provision of EmOC services.
– Health Workers: Responsible for delivering EmOC services and providing appropriate care to pregnant women.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training health workers on the missing signal functions and improving their skills in EmOC provision.
– Equipment and Supplies: Budget for procuring necessary equipment and supplies for EmOC services, including items for blood transfusion and assisted vaginal delivery.
– Infrastructure Improvement: Budget for renovating and upgrading health facilities to ensure they meet the requirements for providing EmOC.
– Monitoring and Evaluation: Budget for monitoring the implementation of interventions and evaluating their impact on reducing maternal mortality.
– Community Engagement: Budget for community awareness campaigns and education programs to promote the utilization of EmOC and malaria prevention services.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The survey conducted in 54 districts and 553 health facilities provides a good sample size. The recorded maternal mortality ratio and the leading causes of maternal deaths are clearly stated. The missing signal functions contributing to maternal deaths are identified. However, the abstract does not provide details on the methodology used in the survey or the performance improvement process implemented in the 20 district hospitals. To improve the strength of the evidence, the abstract could include more information on the study design, data collection methods, and statistical analysis performed.

Purpose: We conducted a survey to determine availability of emergency obstetric care (EmOC) to provide baseline data for monitoring provision of obstetric care services in Uganda. Methods: The survey, covering 54 districts and 553 health facilities, assessed availability of EmOC signal functions. Following this, performance improvement process was implemented in 20 district hospitals to scale-up EmOC services. Findings: A maternal mortality ratio (MMR) of 671/100,000 live births was recorded. Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and malaria accounted for 65.5% of the indirect causes. Among the obstetric complications, abortion accounted for 38.9% of direct and malaria 87.4% of indirect causes. Removal of retained products (OR 3.3, P < 0.002), assisted vaginal delivery (OR 3.3, P < 0.001) and blood transfusion (OR 13.7, P < 0.001) were the missing signal functions contributing to maternal deaths. Most health facilities expected to offer basic EmOC, 349 (97.2%) were not offering them. Using the performance improvement process, availability of EmOC in the 20 hospitals improved significantly. Conclusion: An integrated programming approach aiming at increasing access to EmOC, malaria treatment and prevention services could reduce maternal mortality in Uganda. © 2007 International Federation of Gynecology and Obstetrics.

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The study conducted in Uganda found that prioritizing emergency obstetric care (EmOC) is crucial to reducing maternal mortality. The survey assessed the availability of EmOC signal functions in 54 districts and 553 health facilities in Uganda and revealed a high maternal mortality ratio (MMR) of 671/100,000 live births. Hemorrhage and malaria were identified as the leading causes of maternal deaths.

The study identified missing signal functions, such as the removal of retained products, assisted vaginal delivery, and blood transfusion, which contributed to maternal deaths. It was also observed that many health facilities expected to offer basic EmOC were not providing these services.

To address these gaps, a performance improvement process was implemented in 20 district hospitals, resulting in a significant improvement in the availability of EmOC in these hospitals.

Based on these findings, the recommendation is to adopt an integrated programming approach that focuses on increasing access to EmOC, malaria treatment, and prevention services. By addressing these key areas, maternal mortality in Uganda can be reduced.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health in Uganda is to prioritize emergency obstetric care (EmOC) as the key intervention to reduce maternal mortality. The study conducted a survey to assess the availability of EmOC signal functions in 54 districts and 553 health facilities in Uganda. The findings revealed a high maternal mortality ratio (MMR) of 671/100,000 live births, with hemorrhage and malaria being the leading causes of maternal deaths.

The study identified the missing signal functions contributing to maternal deaths, including the removal of retained products, assisted vaginal delivery, and blood transfusion. It was also observed that most health facilities expected to offer basic EmOC were not providing these services.

To address these gaps, the study implemented a performance improvement process in 20 district hospitals to scale up EmOC services. This approach significantly improved the availability of EmOC in these hospitals.

Based on these findings, the recommendation is to adopt an integrated programming approach that focuses on increasing access to EmOC, malaria treatment, and prevention services. By addressing these key areas, maternal mortality in Uganda can be reduced.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health in Uganda, the following methodology can be used:

1. Data Collection: Collect baseline data on the availability of emergency obstetric care (EmOC) signal functions in various health facilities across Uganda. This can be done through surveys and assessments similar to the one conducted in the study mentioned.

2. Identify Gaps: Analyze the collected data to identify the missing signal functions contributing to maternal deaths, as well as the health facilities that are not providing basic EmOC services.

3. Intervention Implementation: Implement a performance improvement process in a selected number of district hospitals, similar to the approach used in the study. This process should focus on scaling up EmOC services, including the provision of the missing signal functions.

4. Monitoring and Evaluation: Continuously monitor and evaluate the impact of the intervention on improving access to maternal health. This can be done by tracking changes in maternal mortality ratios (MMR) and the availability of EmOC signal functions in the selected district hospitals.

5. Data Analysis: Analyze the collected data to assess the effectiveness of the intervention in reducing maternal mortality and improving access to EmOC services. Compare the MMR and availability of signal functions before and after the intervention.

6. Scaling Up: If the intervention proves to be successful in the selected district hospitals, consider scaling up the approach to other health facilities and districts in Uganda. This can be done by replicating the performance improvement process and integrating it into the existing healthcare system.

7. Continuous Improvement: Continuously assess and improve the intervention based on the findings and lessons learned from the monitoring and evaluation process. This may involve refining the approach, addressing any remaining gaps, and adapting to changing healthcare needs.

By following this methodology, it will be possible to simulate the impact of prioritizing emergency obstetric care and implementing an integrated programming approach on improving access to maternal health in Uganda.


Statistics:
Citations: 61
Identifiers:
DOI: 10.1016/j.ijgo.2006.12.017
ISSN: 00207292
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Uganda
Study Design:
Cross Sectional Study, randomised-control-trial
Study Approach:
Quantitative
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