Improving obstetric care at the district hospital, Ekpoma, Nigeria. The Benin PMM Team

Abstract

Preliminary studies: Facility reviews and focus group discussions revealed several factors at the district hospital contributing to maternal deaths in Ekpoma District, Nigeria.

Interventions: In response, the necessary equipment for the operating theater, labor suite and laboratory were repaired or purchased. A blood bank and standby generator were repaired. Drugs and consumable material were purchased and a revolving fund established. Refresher courses were held for medical officers, nursing staff and laboratory technicians. At a later stage, community interventions focused on improving access and reducing delay in seeking care.

Results: The number of cesarean sections performed increased from zero in 1990-1991 to between seven and 13/year in the period 1992-1995. The number of women with major obstetric complications seen at the hospital increased from seven in 1990 (5% of obstetric admissions) to a high of 29 (20% of obstetric admissions) in 1993. These gains were not sustained, however. In 1995, only 12 women with complications (9% of obstetric admissions) were seen.

Costs: The cost of improvements was approximately US $12,800, of which 41% was paid by the government and the rest by the project.

Conclusions: Improving obstetric care at the district hospital can increase use by women with complications. However, sociopolitical and economic problems can hamper success.