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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Conflict, Displacement & Sexual & Reproductive Health Services in Mali

Little is known specifically about the effects of conflict and displacement on provision of sexual and reproductive health (SRH) services. We aimed to understand the association between levels of conflict and displacement and the availability of SRH services in post-conflict Mali.

A national assessment was conducted between April and May 2013 employing Health Systems Availability Mapping System (HeRAMS). Data from 1581 primary care facilities were analysed, focusing on SRH services. Descriptive analyses and multivariable logistic regression models were used to examine the availability of SRH services by different levels of conflict and displacement.

Of 1581 facilities, 1551 had data available to identify the details of service provision. The majority of the facilities were part of the public sector (79.1 %), identified as basic community primary care facilities (71.9 %). Overall 15.7 % of the facilities were in the zones under occupation, 40.3 % in the areas with high concentration of displaced population and 44 % in areas with low concentration of displaced populations. Between zones of low concentration of displaced populations and under occupation the likelihood of service availability varied between OR: 2.9 (95 % CI 2.0–4.4) for basic emergency obstetric care and OR: 41.7 (95 % CI 20.4–85.3) for family planning. All of the services within the three domains of SRH were more likely to be available in the low and high concentration displaced population areas compared to the facilities in the under occupation zones, after adjusting for other facility-related variables.

Areas with high concentration of displaced population had less service availability, and areas formerly under occupation had the least service availability. This suggests that those living in conflict areas, and many of those who are internally displaced, have poor access to essential SRH interventions. The systematic measurement of the availability of health services, including SRH, is feasible and can contribute to recovery planning in post-conflict and humanitarian settings.

Below:  Distribution of districts by levels of conflict, February 2013, reproduced based on [4, 18]

Read more at:  http://ht.ly/Ssgmp 

By: Özge Tunçalp, Ibrahima Socé Fall, Sharon J. Phillips, Inga Williams, Massambou Sacko, Ousmane Boubacar Touré,Lisa J. Thomas, and Lale Say

World Health Organization, Mali Country Office, Bamako, Mali

NDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

World Health Organization, Mali Country Office, Bamako, Mali

World Health Organization, Mali Country Office, Bamako, Mali

UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland