Introduction
Methods
Study setting
Study design
Data collection tool | Sample size | Focus of data collection | ||
---|---|---|---|---|
Target | Achieved | |||
Facility/ Staffing | Facility management | 20 | 20 | Management of services; staffing; services provided; EmOC services; availability of registers/cards (neonatal register, delivery register, ANC register, family planning register, etc.); key infrastructure; equipment, consumables, essential drugs; facility statistics etc. |
Midwife or maternity nurse interview | - | 29 | Practice of midwifery skills by midwives/nurses; knowledge on maternal and neonatal care; recent nurse/midwife practice of life-saving skills | |
Clinical
| Normal delivery record review | 334 | 337 | Assessment of quality of normal delivery practice using indicators of performance. |
Caesarean section record | 140 | 140 | Speed of caesarean section efficiency of caesarean section service; quality of post caesarean section care | |
Eclampsia record review | -- | 9 | Indicators of good management of eclampsia | |
Obstructed labour record review | 57 | 57 | Outcomes of obstructed labour | |
Outpatient
| Antenatal care exit interview | 384 | 347 | Services received by antenatal women on the day of the visit or at any time during the current pregnancy; services received during any antenatal visits; knowledge of warning signs during pregnancy. |
Antenatal client record review | 384 | 332 | Services received by antenatal clients: Intermittent preventive therapy iron/folic supplementation, tetanus toxoid administration, insecticide-treated bed net provision, provision of de-worming medication, syphilis test, haemoglobin test, etc. | |
Postnatal exit interview | 379 | 215 | Length of stay at the health facility after delivery; timing after delivery of postpartum visit; postpartum services provided |
Sample size, sampling and data analysis
Results
Availability of maternal and neonatal health care services
Characteristic | Type of facility | Total | |
---|---|---|---|
Hospital | Health centre* | ||
Number of health units | 2 | 11 | 13 |
Services provided within the past 3 months (EmOC signal functions) | |||
1. Parental antibiotics | 2 | 11 | 13 |
2. Parental oxytocics | 2 | 10 | 12 |
3. Parental sedatives/anticonvulsants | 2 | 10 | 12 |
4. Manual removal of placenta | 2 | 7 | 9 |
5. Removal of retained products | 2 | 4 | 6 |
6. Assisted vaginal delivery | 2 | 0 | 2 |
7. Neonatal resuscitation with bag and mask | 2 | 5 | 7 |
8. Blood transfusion provided | 2 | NA | 2 |
9. Caesarean section | 2 | NA | 2 |
Current EmOC Status | |||
Comprehensive EmOCa | 2 | NA | 2 |
Basic-EmOCb | 0 | 0 | 0 |
Non EmOCc | 0 | 11 | 11 |
Signal function | No. of HCs that did not perform signal function | Number of HCs that did not perform signal function due toa: | ||
---|---|---|---|---|
Lack of trained staff | Supplies/ equipment | No indication | ||
Parenteral oxytocics | 1 | 0 | 0 | 1 |
Manual removal of placenta | 4 | 2 | 0 | 2 |
Neonatal resuscitation | 6 | 0 | 6 | 2 |
Removal of retained products | 7 | 6 | 7 | 1 |
Assisted vaginal delivery | 11 | 5 | 9 | 2 |
Parenteral anticonvulsants | 1 | 0 | 1 | 0 |
HCs mentioning the reason for non-performance of any of the functions | 13 | 23 | 8 |
Indicator | Value | Minimum acceptable |
---|---|---|
Population | 276000 | - |
Expected number of deliveries in 2009 | 13386 | - |
CEmOC facilities per 500,000 population | 3.7 (2/276000) | 1 |
BEmOC facilities per 500,000 population | 0.0 (0/276000) | 4 |
Met need for EmOC services | 9.9% (198/2008) | 100% |
Direct obstetric case fatality rate | 3% (6/198) | <1% |
Deliveries conducted in EmOC facilities | 10.1% (1352/13386) | 15% |
Deliveries conducted in all health facilities | 15.4% (2055/13386) | - |
Population based caesarean section rate | 1.7% (229/13386) | 5% |
Antenatal care availability | 75% (15/20) | - |
Antenatal care 1 visit | 61.9% (8288/13386) | - |
Antenatal care 4 visits | 31.7% (4238/13386) | - |
Intermittent preventive therapy 1st dose | 47.7% (6386/13386) | - |
Intermittent preventive therapy 2nd dose | 27.7% (3714/13386) | - |
Postnatal care availability | 65% (13/20) | - |
Postnatal care coverage | 31.3% (4187/13386) | - |
Health facilities with family planning services | 50% (10/20) | - |
Utilisation of maternal and neonatal health care services
Quality of maternal and neonatal health care services
Facility inventory checklist
Staffing
Maternity staff interview
Antenatal client exit interview
Activity | Number (n = 347) | % (95% CI) |
---|---|---|
Received iron supplements | 318 | 92 (88–94) |
Blood sample taken | 302 | 87 (83–90) |
Sexually transmitted diseases, HIV/AIDS talked about | 278 | 80 (76–84) |
Advice on how to take care of your baby provided | 265 | 76 (72–81) |
Benefit of birth in the health facility discussed | 263 | 76 (71–80) |
Medical history taken | 252 | 73 (68–77) |
Family planning discussed | 239 | 69 (64–74) |
What to do if there is a problem with pregnancy discussed | 238 | 69 (64–73) |
Place of birth discussed | 236 | 68 (63–73) |
Information about diet and nutrition provided | 227 | 65 (60–70) |
Urine sample taken | 25 | 7 (5–11) |
Antenatal client record review
Postnatal care exit interview
Normal delivery record review
Action recorded | Number (n = 273) | % (95% CI) |
---|---|---|
Mother received oxytocic after delivery | 245 | 90 (86–93) |
Status of the placenta and membranes | 244 | 89 (85–93) |
Birth weight* | 289 | 86 (82–89) |
Amount of blood loss | 229 | 84 (79–88) |
Any APGAR score* | 275 | 82 (77–85) |
Vaginal examination at least 1 every 4 hours | 187 | 69 (63–74) |
Foetal heart rate at least hourly | 161 | 59 (53–65) |
Pelvic exam done on admission | 111 | 41 (35–47) |
Post-delivery blood pressure of mother | 107 | 39 (34–45) |
Temperature checked on admission | 106 | 39 (33–45) |
Post-delivery pulse of mother | 106 | 39 (33–45) |
Post-delivery mother’s temperature | 105 | 39 (33–44) |
Uterine involution | 98 | 36 (30–42) |
Condition of lochia | 77 | 28 (23–34) |
Blood pressure at least hourly | 45 | 16 (13–21) |