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[ Recorded presentation ] Recorded presentation

Status of emergency obstetric care services in Zambia: Findings of a national assessment

Reuben Mbewe1, Robert Hollister1, Gricelia Mkumba2, Richard Hughes3, Kwibisa Liywalii4, Chipoya Chipoya2, Ethel Mangani Lyuba2, Crispin Sapele5, Batista Mwale5, and Martha Ndhlovu, Mrs6. (1) Health Services and Systems Program, c/o JHPIEGO Corporation, 1615 Thames Street, Baltimore, MD 21231, (2) Department of Obstetrics and Gynecology, University Teaching Hospital, c/o JHPIEGO Zambia, PO Box 36873, Lusaka, 10000, Zambia, (3) Zambia Country Office, JHPIEGO Corporation, 1615 Thames Street, Baltimore, MD 21231, (4) PMMZ, c/o JHPIEGO Zambia, PO Box 36873, Lusaka, 10000, Zambia, (5) Central Statistics Office, c/o JHPIEGO Zambia, PO Box 36873, Lusaka, 10000, Zambia, (6) Medical Injection Safety Project, JHPIEGO-ZAMBIA, P O Box 36873, Lusaka, Zambia, 260-01-256255, mndhlovu.misp@jhpiego.net

Zambia's high maternal mortality ratio increased over the past decade from 649 to 729 per 100,000 (DHS 1996, 2001/02), and the major causes of maternal death are pregnancy related complications which can largely be managed with appropriate emergency obstetric care.

In July-September 2005, a study was carried out to assess the availability, quality and use of emergency obstetric care (EmOC) services. Data from 230 facilities was collected and analyzed. “Basic EmOC Services” were defined as the availability of six functions: antibiotics; oxytocics; anticonvulsants; manual removal of the placenta; manual vacuum aspiration of retained products; and instrumental delivery. “Comprehensive EmOC Services” also included transfusions and Caesarean Sections.

Less than 10% of deliveries are carried out in facilities with EmOC capabilities. Only about half of the facilities assessed had at least one midwife; numerous facilities relied on untrained personnel to conduct deliveries. Caesarean section rates were found to be less than 2%, and the maternal case fatality rate among women experiencing complications was estimated to be 2.41%. Less than one quarter of services followed established maternal clinical care guidelines, and less than one in five followed infection prevention guidelines. Equipment, supply and medicine shortages exacerbate the low human resource crisis.

Serious efforts to reduce maternal mortality in Zambia must address the identified infrastructure, commodity and particularly human resource constraints. Until adequate services can be provided, it is hard to believe that the current trend toward fewer deliveries by skilled attendants and the continued high rates of maternal mortality will be reversed.

Learning Objectives: By the end of this session, participants will be able to

Keywords: Maternal Health, International MCH

Presenting author's disclosure statement:

Any relevant financial relationships? No

[ Recorded presentation ] Recorded presentation

Strategies for Improving Maternal Health and Child Survival

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA