Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District

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.

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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Infrastructural Challenges to Better Health in Maternity Facilities in Rural Kenya: Community & Healthworker Perceptions

The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas.

This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities.

The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations.

The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

Below:  Map showing Kenyan provinces

Full article at:  http://goo.gl/y23XTk

By: Hildah Essendi^1*, Fiifi Amoako Johnson¹, Nyovani Madise¹, Zoe Matthews¹, Jane Falkingham¹, Abubakr S Bahaj², Patrick James² and Luke Blunden²

¹Department of Social Statistics and Demography, University of Southampton, Southampton, SO17 1BJ, UK

²Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK

 

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