We conducted a survey to determine availability of emergency obstetric care (EmOC) to provide baseline data for monitoring provision of obstetric care services in Uganda. Methods: The survey, covering 54 districts and 553 health facilities, assessed availability of EmOC signal functions.
Following this, performance improvement process was implemented in 20 district hospitals to scale-up EmOC services. Findings: A maternal mortality ratio (MMR) of 671/100,000 live births was recorded. Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and malaria accounted for 65.5% of the indirect causes. Among the obstetric complications, abortion accounted for 38.9% of direct and malaria 87.4% of indirect causes.
Removal of retained products (OR 3.3, P<0.002), assisted vaginal delivery (OR 3.3, P<0.001) and blood transfusion (OR 13.7, P<0.001) were the missing signal functions contributing to maternal deaths. Most health facilities expected to offer basic EmOC, 349 (97.2%) were not offering them. Using the performance improvement process, availability of EmOC in the 20 hospitals improved significantly.
Globally, reduction of maternal and new born mortality remains a high priority in the Sustainable Development targets as unfinished MDG agenda. In 2013, about 0.3 million women died as result of pregnancy related causes. Sub-Saharan Africa alone contributed more than half of these deaths.
Uganda is among those countries struggling with high maternal mortality rates at 336/100,000 live births. Globally 2.7 million neonatal deaths and a similar number of still births occur. Neonatal mortality in Uganda is estimated to be 27 deaths per 1000 live births and accounts for 45% of the under-five mortality.
Maternal and perinatal death reviews (MPDR) help to understand the circumstances around the death of a mother or newborn in order to identify factors contributing to death and then
develop strategies to address them
