Assessment of the provision of emergency obstetric care services in Rachuonyo north sub-county, Homa bay county, Kenya

Abstract

Emergency obstetric care (EmOC) is a package of medical interventions required to manage the major direct obstetric complications. Provision of EmOC services averts direct maternal mortalities from these complications. Maternal mortality ratio (MMR) still remains high worldwide. Global MMR is estimated to be 251 per 100,000 live births; Sub-Saharan Africa has the highest MMR in the world at 900 per 100,000 live births. Whereas Kenya and Homa Bay County has MMR of 362 and 583 per 100,000 live births, Rachuonyo North Sub-County in Homa Bay County, has limited information on MMR. Documentation on the status of EmOC services in the Sub-County remains unknown. Aim of the study was to assess the provision of EmOC services in Rachuonyo North Sub-County, Homa Bay County, Kenya. The specific objectives were; to assess the availability of EmOC services, to determine the utilization of EmOC services and to determine the quality of EmOC services in Rachuonyo North Sub-County. The study was a health-facility based cross-sectional study. All 30 health facilities offering maternity services were surveyed. Data collection tools as outlined in WHO standard guidelines for monitoring EmOC were applied. Availability was measured by interviewing service providers on performance of signal functions at least once in the previous 3 months. Proportions of EmOC facilities in relation to population were obtained. Utilization was determined by inspecting facility registers to extract records on use of EmOC services. Differences in utilization between basic and comprehensive EmOC facilities were compared using chi-square at 95% confidence interval. Furthermore, quality was determined by obtaining direct obstetric case fatality rate, intra-partum and very early neonatal death rate. Results showed that 2 health facilities offered EmOC services in a population of 177,587. The WHO recommendation on availability of 5 EmOC facilities per population of 500000 was met. Utilization of EmOC facilities by women with obstetric complications was low at 6.2% in comparison to the WHO recommendation that 100% of women with obstetric complications be treated in EmOC facilities. In addition, there was no difference between utilization of services in basic and comprehensive EmOC facilities (p>0.05). Caesarean section rate of 2% in the Sub-County was lower than recommended of 5-15%. The quality of EmOC services was low due to lack of referral system and inadequate human resource in the basic EmOC facility. There was no direct obstetric fatality in EmOC facilities. This was equivalent to recommendation of ≤1%, while the figure was higher in all surveyed facilities at 6.25%. The intra-partum death rate was found to be 1.98% in EmOC facilities. The MMR was estimated at 90 per 100000 live births. In conclusion, EmOC services are available in Rachuonyo Sub-County with low utilization. Furthermore, there was low quality of EmOC services in basic EmOC facility. Recommendations include increasing resources to facilities in the Sub-County, educating women to utilize EmOC services, have a system to continually monitor quality of services offered in the facilities. Results would improve knowledge-base on availability, utilization and quality of EmOC services in order to develop interventions for managing obstetric complications.