Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

Abstract

Background: Ethiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia.

Methods: A facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People's Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care.

Results: One third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%).

Conclusion: Substantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

Keywords: Delivery; Ethiopia; Hospital; Labor; Quality; SNNPR; Structure.

Fig. 1

Availability of essential drugs, supplies and equipment in the L&D ward at public hospital in SNNPR, Ethiopia, 2016. Notes: The following essential drugs, supplies and equipment should be available in the emergency drug cabinet of L&D ward. Drugs: Oxytocin injection, Misoprostol PO, Ergometrine, Nifedipine, Hydralazine, MgSO4, Diazepam, Lidocaine, Atropine, Calcium gluconate, Vit K, TTC eye ointment, Ampicillin IV, TDF/3TC/EFV (ARV drugs), Nevirapine syrup, Aminophylline, Adrenaline, and Hydrocortisone. Supplies: HIV test kits, 40% glucose, IV fluids (crystalloids), IV Cannula, Syringe & needle, Sterile gloves, IV stand, Mask for oxygen administration, Towels for drying and wrapping new-born babies, and Long sleeve glove for removal of retained placenta. Equipment: Sphygmomanometer, Stethoscope, Portable suction machine, Pinnard stethoscope (fetoscope)/doppler, Ultra sound, Thermometer, Filled oxygen tank with flow meter, Nasal prongs for oxygen administration, Catheter for oxygen administration, 5 delivery sets (at least 2 sterile), Sterile suture kit, Forceps, Vacuum extractor, Urinary catheter, Stand lamp, Speculum for vaginal examination, Craniotomy set, Sterilizer (steam or dry), a new born sized ambubag (with volume of 250 ml/less), Bed with accessories, Cord cutting/clumping set, Radiant warmer, Weighing scale for baby, Tape to measure baby length and head circumference, Functioning clock, 2 episiotomy sets, Suction bulb for new-born resuscitation, Emergency drug cabinet, and a functional refrigerator

Fig. 2

Distribution of median percentage scores of different structural attributes of quality L&D care at public hospitals in SNNPR, Ethiopia, 2016