Availability and Quality of Emergency Obstetric and Neonatal Care and status of MPDR implementation in Health facilities providing maternity services in Arua District, Northern Uganda

Abstract

Background: Obstetric emergencies are recognized as a leading cause of premature death and disability among women of childbearing age especially in developing countries where 99% of the 303, 000 global maternal deaths occurred in 2015. UNFPA estimates about 80% of deaths from pregnancy complications can be avoided using quality EmONC services. Unfortunately, access to quality EmONC remains low to pregnant mothers and their neonates in Uganda in general and Arua district in particular. Objectives: The study assessed availability and quality of EmONC services and status of MPDR implementation in health facilities providing maternity services in Arua District in order to inform policy and implementation of maternal and neonatal health interventions. Methodology: Health facility based cross-sectional study using mixed methods of data collection was conducted in 24(60%) health facilities providing maternity services. Purposive sampling of all 3 hospitals and 4 Health Centre IVs; and stratified systematic sampling of 17 (50%) Health Centre IIIs was conducted. Data was collected on availability and quality of EmONC services and status of MPDR implementation using standard tools and methods such as document reviews of health records, Key Informant Interviews with facility/maternity in-charges and Focus Group Discussions with post-natal mothers. Results: There was inadequate availability of EmONC services for population of Arua District in 2016. There was 1.3 fully functional CEmONC facilities per 500,000 populations, but no fully functional BEmONC facility. The quality of EmONC services provided was low with average quality score of 59.3% against set target of 60% and FGD of postnatal mothers managed for obstetric complications reported quality of care was poor. The MPDR implementation was defective, average score of only 17.6% against target of 60%. Only 3 (12%) facilities were implementing maternal death reviews without perinatal death reviews. Conclusion and Recommendations: The study identified inadequate availability and low quality of EmONC services provided in Arua District. Most facilities had high scores for quality element of structure, while majority had low scores for quality element of process. Limited number of functional EmONC facilities can expose mothers and neonates to risk of obstetric morbidity and mortality. There is need to equip all facilities providing delivery services and support them to offer quality EmONC.