Background
Methods
Results
Socio-demographic characteristics of respondents
Characteristic | Frequency | Percent (%) |
---|---|---|
Sex | ||
Male | 4 | 33.3 |
Female | 8 | 66.7 |
Age | ||
20–29 | 2 | 16.7 |
30–39 | 4 | 33.3 |
40–49 | 2 | 16.7 |
50–59 | 4 | 33.3 |
Level of education | ||
Tertiary | 12 | 100.0 |
Religion | ||
Christian | 9 | 75.0 |
Muslim | 3 | 25.0 |
Marital status | ||
Never married | 2 | 16.7 |
Married | 8 | 66.7 |
Divorced | 1 | 8.3 |
Widowed | 1 | 8.3 |
Duration of working at the hospital | ||
<1 year | 3 | 25.0 |
1–5 years | 5 | 41.7 |
6–10 years | 3 | 25.0 |
>10 years | 1 | 8.3 |
Total | 12 | 100.0 |
Availability of human resources and essential logistics for preventing maternal mortality cases
“Yes! There is an inadequacy in terms of the size of staff we have here. This is because we have a room for handling minor cases and another for major cases. Sometimes, we have three nurses on duty in the morning shift, and one person can be assigned to the minor operating room while the other two people can be assigned to the major operating room. So when more hands are needed and somebody is busy, they would have to leave there and come. But on most occasions, there is still not enough personnel. We have to call on the afternoon staff from their homes. And sometimes, we do not even get the extra hand that is needed. So yes, in this context, there is the inadequacy of staff” (Respondent 6, 32 years).
“Yes! It (inadequacy of health professionals) is a contributing factor. Because, in handling a lot of cases, like here in the theatre, you need team work. So if you do not have a lot of staff around, then there is a problem. Sometimes too, it (inadequacy of health professionals) leads to inadequate monitoring. You see? We usually have the situation where instead of one person monitoring a mother in labour closely every 15 min, because of too much work, they are not able to do that. Complications, therefore, arise out of that leading to maternal deaths” (Respondent 5, 54 years).
“Yes, we have enough (anesthetic agents); we have never run short of them. Currently, we are also using ketamine and devakane (hevimakane) as our main anesthetic agents. Other supplementary drugs are atropine, pethidine and so on. We have never run short of those anesthetic agents. We always make sure that before they get finished, we had a replacement. And the intravenous fluids too, we have always ensured that they are available” (Respondent 4, 33 years).
“....but blood is not always available. When you go to the blood bank, they will not be able to give it to you. The relatives’ blood are usually not compatible or sometimes do not have enough to donate. So in that case, there is normally a problem” (Respondent 7, 29 years).
“It is not always about unavailability but the staff preparing for emergency cases always, you understand. When nurses go off duty, as part of their shift handing over, they have to hand over every equipment such as the suction machine, the oxygen and the other monitors. Sometimes, somebody may be vomiting and it is then that they are going to look for a suction machine. They may not know where it is at that moment. Whether it was used for somebody somewhere or maybe they dismantled it and had not yet set it up, no one knows. In this case, it is not only about the availability but the emergency preparedness that is accorded to maternal emergency cases by the staff” (Respondent 5, 54 years).
“Yes, we always make sure that we have our instruments. They are always intact. Even when there is none, in all the various surgeries that we had, for instance, the hernia myomectomy, we have sets which we use. If the caesarean section (CS) set is exhausted, we normally break other sets to get instruments for the CS” (Respondent 7, 29 years).
“The few equipment and other logistics we have are available, if the staff can put them in right use, it will save lives. But, issues concerning the availability of staff, preparedness and human errors which occasionally come in, are the some of the challenges we face” (Respondent 5, 54 years).
Factors contributing to high maternal mortality at the facility
“Yes! Education is given individually according to the patient’s needs. We educate each mother after examination and palpation. So, whatever we think they need to know, we teach them” (Respondent 2, 50 years).
No! Sometimes, they do not. I do not know what is wrong with most of them. They undermine the education given them about the emergency of the situation. They do not see it to be realistic until it happens to them.
“Ideally, if you come to the antenatal clinic (ANC), after one hour you should leave, but the two midwives there have retired and are on contract. So the number of mothers who come there are too many to handle and that is how come the mothers waste time” (Respondent 12, 49 years).
“For that one, yes and no. Yes because we have only three labour wards. The way the places are, when there are other women there, the husbands (of the women) cannot come, but when she is alone in the labour ward, we do allow them” (Respondent 1, 24 years).
“Yes! As for that yes. The women here are stubborn. They sit at home and when they are unable to deliver, they then come here in a deteriorated condition. That is the problem we face here. They will do their own things at home and when the condition is worse then they come and die here” (Respondent 3, 52 years).
“The equipment may be there, but if we are not always prepared for emergency cases, it becomes a problem. Whenever emergency cases come, we will now be running to search for equipment and then becomes difficult to find. Later on, you will realize that it was lying somewhere. I am very sure that if I go now and ask any of the staff whether they have magnesium sulphate, they may say they do not know. So, it is the way we are prepared mentally to respond to emergency cases” (Respondent 4, 33 years).
“Sometimes, when they come to the facility, the way some of us doctors and midwives talk to them, we abuse them. Especially teenage pregnancy, when they come the way we insult them; like, ‘you small girl, why?’ So next time, when something is happening, she would not want to come back” (Respondent 5, 54 years).