Unmet obstetric needs in post-conflict settings in Kitgum and Pader Districts, Northern Uganda

Abstract

Introduction: The two decades of civil war of the Lord’s Resistant Army rebels led to the displacement of over 1.6 million people in internally displaced persons camps in Northern and Eastern Uganda. Displacement greatly affects the health status of affected communities and increases morbidity and mortality. Kitgum and Pader districts have high maternal mortality ratios of 526 and 700 per 100,000 live births respectively. Objective: To estimate the extent of unmet obstetric needs in the post-conflict settings of Kitgum and Pader districts. Methodology: Data were collected using quantitative and qualitative techniques. Quantitative data were collected retrospectively in three hospitals in Kitgum and Pader districts during the year 2007-2009. Qualitative data were collected using key informant interviews. Quantitative data were analysed using Microsoft Excel and SPSS version 12.0 soft ware packages. Results: A total of 1,743 mothers had major obstetrical interventions (MOI) 990 (56.8%) in Pader and 753 (43.2%) in Kitgum district. A total of 1,157 mothers 527 (45.5%) and 630 (54.5%) in Kitgum and Pader districts had major obstetrical interventions for absolute maternal indications (AMI) respectively The commonest major obstetric intervention for absolute maternal indications was caesarean sections (99.4%) and hysterectomy (0.6%) in both Kitgum and Pader respectively. The overall deficits in MOI/AMI performed in Kitgum was 2,057 (82.6%) and in Pader 2,667 (82%) respectively. In both Kitgum and Pader deficit in MOI/AMI performed in urban setting was 209 (45.1%) versus rural 4,438 (85%). The main factors contributing to unmet needs were lack of qualified health personnel, distance to health facilities and lack of equipment. Conclusions and recommendation: There is a high unmet obstetrical need in Kitgum and Pader post conflict districts in northern Uganda. Unmet obstetric needs are higher in rural compared to urban settings. Key stakeholders including government and humanitarian organizations including United Nation agencies and Non- governmental organizations should support efforts to improve maternal health services in the entire post conflict northern districts of Uganda.