Background
Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district.
Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district.
Method
A
cross-sectional survey was conducted in 2011 as part of the ‘Response to
Accountable priority setting for Trust in health systems’ (REACT) project. Data
on all childbirths that occurred in emergency obstetric care facilities in 2010
were obtained retrospectively. Sources of information included registers from
maternity ward admission, delivery and operation theatre, and case records.
Data included age, parity, mode of delivery, obstetric complications, and
outcome of mother and the newborn. An approach using estimated major obstetric
interventions expected but not done in health facilities was used to assess
deficit of life-saving interventions in urban and rural areas.
Results
A
total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric
care facilities (excluding abortions) were analysed. Facility childbirth
constituted 81% of expected births in urban and 16% in rural areas. Based on
the reference estimate that 1.4% of childbearing women were expected to need
major obstetric intervention, unmet obstetric need was 77 of 106 women, thus
73% (95% CI 71–75%) in rural areas whereas urban areas had no deficit. Major
obstetric interventions for absolute maternal indications were higher in urban
2.1% (95% CI 1.60–2.71%) than in rural areas 0.4% (95% CI 0.27–0.55%), with an
urban to rural rate ratio of 5.5 (95% CI 3.55–8.76).
Conclusions
Women in rural areas had deficient obstetric care. The
likelihood of under-going a life-saving intervention was 5.5 times higher for
women in urban than rural areas. Targeting rural women with life-saving
services could substantially reduce this inequity and preventable deaths.
Below: Distribution of health facilities with and without EmONC in Kapiri Mposhi, 2010
Below: Basic and Comprehensive Emergency Obstetric and Neonatal Care
Full article at: http://goo.gl/C4S0Hl
By:
Selia Ng’anjo Phiri, Knut Fylkesnes, Karen Marie Moland
Centre for International Health, Department of Global Public
Health and Primary Care, University of Bergen, Bergen, Norway
Selia Ng’anjo Phiri, Knut Fylkesnes
Department of Public Health, School of Medicine, University
of Zambia, Lusaka, Zambia
Jens Byskov
Research Unit for Human Parasitology and the Environment,
Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej
100, DK-1870 Frederiksberg C, Copenhagen, Denmark
Torvid Kiserud
Department of Obstetrics and Gynaecology, Haukeland
University Hospital, Bergen, Norway
Torvid Kiserud
Department of Clinical Science, University of Bergen,
Bergen, Norway
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