AVAILABLITY, ACCESSIBILITY AND UTILIZATION OF EMERGENCY OBSTETRIC CARE SERVICES: A COMPARATIVE STUDY OF TWO LOCAL GOVERNMENT AREAS IN KADUNA STATE, NIGERIA
AVAILABLITY, ACCESSIBILITY AND UTILIZATION OF EMERGENCY OBSTETRIC CARE SERVICES: A COMPARATIVE STUDY OF TWO LOCAL GOVERNMENT AREAS IN KADUNA STATE, NIGERIA
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Date
2011-10
Authors
BAKARE, Adeola B. Fatimah
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Abstract
The use of process indicators to assess availability, accessibility and utilization of emergency
obstetric care servicesasa proxy for impact of standards for maternal health services was carried
out in health care facilities in twolocal government areas in Kadunastate; it is an indirect
measure of maternal mortality. Two local government areas were studied and compared with
each other, each local government areastudied are in different senatorial zones: Kaduna North
local government area is urban while Ikara local government area is rural.The aims and
objectives of the study was to determine and compare the availability and distribution of
emergency obstetric care services; to determine and compare the resource availability for
emergency obstetric care services provision; to determine and compare the quality of existing
basic emergency obstetric care and comprehensive emergency obstetric care services; to assess
and compare the pattern of utilization of basic emergency obstetric care and comprehensive
emergency obstetric care services in both local government areas. Recommendations were
provided based on the findings from the study.It was a cross sectional study and it involved
quantitative method of data collection using questionnaires. Total sampling was done for both
local government areas. Only facilities (public, private and mission) that offer maternal health
services and those that gave theirconsent to partake in the study were included. .A total of 87
health care facilities were assessed in both local government areas; 49 health care facilities in
Kaduna North local government area and 38 health care facilities in Ikara local government area.
A set of tools proposed byWHO: Guidelines for Monitoring the Availability and Use of
Obstetric Services with little modification as proposed by Federal Ministry Of Health, Nigeria
was used for appraisal of health facilities performance and adapted for the study. The appraisal
tool looked at six key areas: availability of emergency obstetric care; accessibility of emergency
obstetric care; proportion of birth that takes place in health facilities; met needs for emergency
obstetric services; proportion of births by caesarian section; Case fatality rate.Emergency
obstetric care facilities were classified into basic emergency obstetric care facilities and
comprehensive emergency obstetric facilities. Each local government area was assessed
separately and compared with the other. Data were compared using the χ2. P<0.05 was
considered statistically significant.Using the WHO guidelines on emergency obstetric care
services; it was observed that there were 2 basic emergency obstetric care and 21 comprehensive
emergency obstetric care facilities in Kaduna North local government area (as against 3 basic
emergency obstetric care and 1 comprehensive emergency obstetric care facilities per 364,575
populations) while in Ikara local government area, there were 2 basic emergency obstetric care
and 2 comprehensive emergency obstetric care facilities (as against 2 basic emergency obstetric
care and 1 comprehensive emergency obstetric care facilities per 194,723 populations). Using
the guidelines set by Nigerian Federal Ministry of Health, in Kaduna North local government
area, there were 1 basic emergency obstetric care and 10 comprehensive emergency obstetric
care facilities while there was no emergency obstetric care facility in Ikara local government
area. The proportion of births in Emergency obstetric carefacilities was found to be 55 % and
4.6% for Kaduna North and Ikara local government areas respectively(recommended 15%). The
met need for emergency obstetric care was found to be 40.9% and 5.6% for Kaduna North and
Ikara local government arearespectively(recommended; 100%), while the proportion of births
by C-Section were 6.0% and 1.1% for Kaduna North and Ikara local government area
respectively(recommended; 5% ). And the case fatality rates for public referral facilities were
7.6% and 5.7% for secondary and tertiaryhealth facilities respectively in Kaduna North local
government area while that of secondary facility in Ikaralocal government areawas 23.4%
(recommended; 1%). With the exception of meeting the required numbers for basic emergency
obstetric carefacilities and proportion of birth that took placein emergency obstetric care
facilities, Kaduna Northlocal government area had better results when compared to Ikara local
government area in terms of met needs; proportion of birth by caesarian section and Case
fatality rate. In the light of the above findings, it is recommended that mapping of health
facilities in terms of emergency obstetric care services provisionshould be carried out so as to
upgrade some of the PHC facilities to basic emergency obstetric care facilities. There is a need to
improve the staff strength so as to ensure 24 hours coverage of skilled birth attendants at the
facilities and to establish blood bank in all local government areas in the states to ensure access
to blood transfusion. There is a need for community sensitization so as to improve utilization of
the available emergency obstetric care services.
Description
BEING A DESERTATION PRESENTED TO THE DEPARTMENT OF COMMUNITY
MEDICINE,FACULTY OF MEDICINE, IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH (MPH)
DEGREE OF THE AHMADU BELLO UNIVERSITY, ZARIA
OCTOBER,2011
Keywords
AVAILABLITY, ACCESSIBILITY AND UTILIZATION,, EMERGENCY OBSTETRIC CARE SERVICES,, COMPARATIVE STUDY,, TWO LOCAL GOVERNMENT AREAS,, KADUNA STATE,, NIGERIA