essential obstetric and newborn care pdf

Essential obstetric and newborn care pdf

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Basic and comprehensive care


Original Research ARTICLE

Biomedical Journal of Scientific & Technical Research

Background: Despite improvements in health-care utilization, disadvantages persist among rural, less educated, and indigenous populations in Ecuador. The United States Agency for International Development-funded Cotopaxi Project created a provincial-level network of health services, including community agents to improve access, quality, and coordination of essential obstetric and newborn care. We evaluated changes in participating facilities compared to non-participating controls.

Basic and comprehensive care

Metrics details. Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan.

This cross-sectional survey was conducted in twelve districts of the Sindh province in Pakistan. The districts were selected based on the maternal neonatal and child health indicators. Data were collected from 63 public-sector health facilities including district, Taluka subdistrict headquarters hospitals and rural health centers. Basic and comprehensive emergency obstetric newborn care services were assessed through direct observations and interviews with the heads of the health facilities by using a World Health Organization pretested and validated data collection tool.

Participants interviewed in this study included the managers and auxiliary staff and in health facilities. Peer Review reports. A lack of access and availability of emergency obstetric care accounts for a large majority of maternal mortality in these countries [ 2 ]. Although maternal mortality ratio in Pakistan declined from in to in , the country still faces a high maternal mortality ratio compared to the regional countries. In bordering India, maternal mortality ratio declined from to , in Bangladesh from to , in Afghanistan from to , between and [ 3 ].

The Pakistan Demographic and Health Survey in — reported a maternal mortality ratio of per , and a neonatal mortality rate of 55 per [ 4 ]. In the province of Sindh, the maternal mortality ratio reported was , which was much higher than the national average, indicating wide disparities within country with regard to access to maternal and child healthcare services [ 5 ].

The country also faltered in its achievement of Millennium Development Goal of reducing maternal mortality ratio by three quarters, between and [ 6 ]. Such a failure is reflected by the fact that maternal mortality burden has increased from previous estimates for some parts of Pakistan.

Maternal and newborn deaths in Pakistan could be prevented by improving the access to and availability of basic emergency obstetric and newborn care BEmONC and comprehensive emergency obstetric and newborn care CEmONC [ 9 ]. BEmONC services including the normal vaginal deliveries, administer oxytocin, newborns resuscitation services are expected to be provided at primary healthcare facilities.

CEmONC services were offered for breech presentation, prolonged labor and caesarean section, blood transfusion and care of sick newborns is provided at secondary and tertiary care hospitals. Despite of health facility availability in almost all administrative areas in the province, the availability of and access to quality maternal and newborn care services has been poor [ 10 , 11 ].

The present study was sanctioned considering the need for an evaluation of the essential services and resources related to maternal and newborn care provision in the province of Sindh. The study was aimed to encompass the level of infrastructure, equipment and commodities required to deliver emergency obstetric and newborn care services in the province.

This cross-sectional study was conducted in twelve of the 29 districts of Sindh Province Fig. The province had a total population of These districts had poor maternal and child health indicators according to a ranking based on the multiple indicator cluster survey conducted in Sindh in The main maternal and child healthcare indicators in the survey were: antenatal and postnatal care, contraception use rate, breastfeeding rate, vaccination coverage, institutional births with skilled providers and proportion of low birth weight babies.

The tool comprised of items on demographic information, availability of equipment and instruments necessary for EmONC. It also contained a checklist to assess EmONC and other maternal child healthcare services like; availability of newborn ward, kangaroo mother care, skilled birth attendance, caesarean section, facility environment and assessment of signal functions of BEmONC and CEmONC.

A team of data collectors was trained and data collection quality was ensured by the principal investigator. The data were entered in Microsoft Excel and imported into Statistical Package for Social Sciences version 20 for analysis. Ethical approval was obtained from the Institutional Review Board of Health Services Academy, Islamabad; administrative permission from health department of Sindh province was also taken for the study. These services have been verified through observation of the previous hospital record.

Guidelines and polices related to maternal and child healthcare provision, case management and quality control mechanism were available in most of the surveyed health facilities; however, these guidelines were more likely to be available within DHQ hospitals compared to lower level health facilities. Less than half of the healthcare staff including doctors and paramedics had received any refresher training on EmONC service provision in the past 6 months. Most health facilities responded that they were gathering and communicating health data regularly Table 4.

In the present study, availability of BEmONC and CEmNOC signal functions was assessed at the three levels of health care system in twelve districts of Sindh province where the status of maternal and child health, and other social indicators has been historically low. Even though most of the health facilities we surveyed reported high availability of the BEmONC services, the availability of CEmONC sginal functions of cesarean section and blood transfusion was substandard.

Almost half of these health facilities lacked necessary guidelines and policies to manage maternal and child health related cases and about half of their staff lacked a recent training on maternal and child health related topic.

Our findings are consistent with a previous multi-country survey which reported high availability of BEmONC services [ 16 ]. Studies have consistently showed that a low EmONC coverage in developing countries is linked with poor maternal and child health indicators [ 17 , 18 , 19 ]. The reason for this is that very few health facilities provide accessible caesarean section and blood transfusion services in many developing countries [ 15 ]. Most of the maternal and newborn deaths in Pakistan occur at birth and improving access to EmONC services can tremendously improve birth outcomes [ 9 ].

Availability of CEmONC signal functions in secondary and tertiary level health facilities is necessary to ensure women and children have access to essential emergency care at birth. Not only the THQ hospitals in our study had low availability of caesarean section service; alarmingly, even most of the DHQ hospitals lacked it. Considering that these districts are geographically large, unavailability of an affordable caesarean section service within their main hospitals may result in access related challenges to the communities.

These communities may not afford expenses related to caesarean birth in private hospitals and possibly experience hardships while travelling to the districts where such care may be available. This usually leads to families spending out of pocket leading to catastrophic expenditures.

Nevertheless, private hospitals in some districts offer an alternative to absent caesarean section service in public sector hospitals [ 11 ]. As with caesarean section, blood transfusion availability as part of the national blood transfusion system, even in the hospitals offering CEmONC services, is still a challenge in countries like Pakistan. Previous research has also identified similar challenges to the provision of blood transfusion in other parts of Pakistan [ 21 ], as well as in other countries including Malawi and India which also have high maternal and child mortality [ 22 ].

Most patients in Pakistan access blood transfusion service through private blood transfusion centers by paying out of pocket; these facilities often require patients to arrange a blood donor [ 23 ]. Ensuring the availability of blood transfusion facilities could prevent a significant proportion of maternal deaths This is crucial considering that post-partum hemorrhage causes one-fourth maternal mortality burden in the developing countries [ 24 ].

Inadequately trained staff with less exposure to refresher trainings was another aspect of poor readiness of the health facilities to provide EmONC services. Availability of skilled and trained human resources for health could also be another challenge for the high maternal mortality ratio in surveyed districts, because employees are often poorly satisfied with their jobs and their work environment is usually suboptimal [ 25 , 26 ].

Adequate training of health workers is another area of concern where the trained staff would be able to perform their responsibilities more efficiently which can impact better maternal and newborn health outcomes [ 27 ]. Direct access to the health facilities, use of a standard validated checklist and observations of the key structures and functions in the facilities was a strength of this study.

However, since our data collectors relied upon health facility staff and managers for reporting, the actual availability of the services could be lower than is presented. Also, observations of the health facilities were conducted, yet they did not focus on the real time utilization of services by the patients. Although, it was found that the equipment and infrastructure for emergency obstetric care were available in the 12 surveyed districts of Sindh, and some of the health facilities also provided CEmONC services, the quality and patient satisfaction with the range of services was not assessed as it was not one of the aims of the present study.

Further research is recommended to directly determine the utilization and quality of EmONC services in the health facilities. World Health Organization.

Google Scholar. Hammonds R, Ooms G. The emergence of a global right to health norm—the unresolved case of universal access to quality emergency obstetric care. Global, regional, and national levels and trends in maternal mortality between and , with scenario-based projections to a systematic analysis by the UN maternal mortality estimation inter-agency group.

National Institute of Population Studies. Pakistan Demographic and Health Survey — A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform? Maternal mortality for countries, — a systematic analysis of progress towards millennium development goal 5.

Reprod Health. Expenditure tracking and review of reproductive maternal, newborn and child health policy in Pakistan. Health Policy Plan. Maternal mortality: who, when, where, and why. Maternal, neonatal and child health in Pakistan: towards MDGs by moving from desire to reality. East Mediterr Health J. Access to comprehensive emergency obstetric and newborn care facilities in three rural districts of Sindh province, Pakistan.

Health Res Policy Syst. Pakistan Bureau of Statistics. Population Census. Multiple Indicator Cluster Survey of Sindh. Monitoring emergency obstetric care: a handbook. World Health Organization; Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh. PLoS One. Status of emergency obstetric care in six developing countries five years before the MDG targets for maternal and newborn health.

Emergency obstetric care in Punjab, Pakistan: improvement needed. Global patterns in availability of emergency obstetric care. Int J Gynecol Obstet. Indicators of availability, use, and quality of emergency obstetric and neonatal care in Togo in Int J Gynaecol Obstet.

Status of emergency obstetric care in four districts of Punjab, Pakistan—results of a baseline assessment. J Pak Med Assoc. Contextual determinants of maternal mortality in rural Pakistan. Soc Sci Med. Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals. Int J Obstet Anesth. Job satisfaction among public health professionals working in public sector: a cross sectional study from Pakistan.

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Dec 7, News , Tanzania. Comprehensive Emergency Obstetric and Newborn Care services, more commonly known as CEmONC, are the interventions provided to pregnant women and newborns experiencing fatal complications, including severe bleeding, infection, prolonged or obstructed labor, eclampsia, and asphyxia in the newborn. CEmONC interventions include safe blood transfusion, providing oxytocin and antibiotics, performing cesarean sections, manual removal of the placenta, assisted vaginal delivery, abortion and resuscitation of the newborn. The availability of CEmONC services also persuades women to give birth safely while being looked after by trained professionals. This is a truly successful intervention. The documentary focused on one of the poorest districts in Tanzania called Kakonko, in the Kigoma Region.

Essential obstetric and newborn care. Practical guide for midwives, doctors with obstetrics training and health care personnel who deal with obstetric.

Original Research ARTICLE

Metrics details. Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan. This cross-sectional survey was conducted in twelve districts of the Sindh province in Pakistan.

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Basic emergency obstetric and newborn care is critical to reducing maternal and neonatal death. This care, which can be provided with skilled staff in health centres, large or small, includes the capabilities for :. Comprehensive emergency obstetric and newborn care, typically delivered in hospitals, includes all the basic functions above, plus capabilities for:. The handbook details the newly revised indicators for assessing the availability, use and quality of obstetric services.

Essential obstetric and newborn care

Research Article. Author Affiliations. Received: April 15, Published: April 25,

Biomedical Journal of Scientific & Technical Research

Background: Maternal mortality rates continue to soar high in Northern Nigeria despite all sorts of interventions being put in place. This has necessitated the need to emphasize on Emergency Obstetric Care EmOC to tackle obstetric complications which are the largest direct causes of maternal mortality. Data was collected from seven public health facilities using a structured interviewer administered questionnaire.

These Needs Assessments go a step further to provide details for planning to address gaps or problems in EmOC services. This is a first and critical step to improving equitable access to EmOC and to strengthening the overall health system. Contact amdd columbia.

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