[Audit of the quality of treatment of "near miss" patients in referral maternities in Southern Benin]

Abstract

Objectives: Maternal mortality is highly associated with the provision of obstetric care. The provision of safe and timely emergency obstetric care (EOC) for women with severe obstetric complications is one of the main components of safe motherhood programs. In this research the objective was to determine the quality of EOC by examining its availability and its provision in a timely fashion.

Design: prospective observational study in qualified facilities providing EOC.

Setting: two teaching, two regional and three district hospitals in the southern part of Benin, West Africa.

Method: The study was conducted from July to October 2003. Data collection tools used were based on the World Health organisation Guidelines for monitoring EOC. The midwives in charge of the survey started observation from the admission room and followed the provision of the care offered to the women admitted with near miss complications until they were discharged from hospital. The information about EOC, its availability, timeliness and patients' follow-up were recorded.

Results: The study sample included 557 women; immediate emergency care was given within 30 minutes for 61% of the patients. Surgical care (caesarean section and ectopic pregnancies surgery) was started within 60 minutes for 42% and 45 % of the women. In the near miss cases suffering anaemia, blood was not available for 12% of patients and blood transfusions were started within 60 minutes in 10% of cases. In the case of uterine rupture or pre-rupture, the time for starting caesarean section was 60 minutes for 58% of women. As to haemorrhagic near-miss cases, blood was not available in 44% of cases and if caesarean section was indicated, it was done within 60 minutes in 47% of the cases. Half of the patients with hypertension received treatment within 60 minutes after the decision to do so was taken. In infection cases, 53% of the patients received antibiotics treatment within 60 minutes. Generally, the quality of providing EOC in the facilities of the study was good in only 16.4% of cases. The quality of care was good in 31.4% of the cases with dystocia, 19% of the cases with hypertension, in 18% of the cases with haemorrhage, in 13.4% of the cases with infection, and in 6.4% of the cases with anaemia.

Conclusion: Our study has shown that, often, EOC was not provided in a timely fashion. A reflection with all the health providers involved should lead to a better understanding of better ways to improve the quality of EOC.