Availability and use of essential emergency obstetric care services in the Bosomtwe District in Ashanti Region

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Improving maternal health by reducing maternal mortality constitutes the fifth Millennium Development Goal that represents a key challenge in Ghana. All pregnant women are at risk of obstetric complications. In roughly 15 percent of deliveries, an unpredictable complication occurs, such as severe bleeding, hypertension, infection, and obstructed labour. Emergency obstetric care interventions carried out in the Bosomtwe district over the years remain fairly similar. The objective was to investigate the utilization of essential emergency obstetric care services in the Bosomtwe district of the Ashanti Region. The survey was carried out in the months of August and September, 2014. The interviewer administered questionnaires and information was elicited from 398 selected respondents. These were nursing mothers in households who had their deliveries through cesarean section, vacuum and forceps and manual removal of placenta within the year 2013. The maternal and child health facility, delivery, antenatal and postnatal registers were used to select the women using simple random sampling. In addition, facility heads (policy makers) and one midwife each from all the fourteen facilities was included in the study. This study has shown that percentage of expected deliveries in EmOC facilities gave 79% compared with the UN Guidelines minimum accepted threshold of 15%. There was high availability of Comprehensive EmOC (20%) and relatively high basic EmOC units (80%) in the district. However there is only one Gynaecologist in the district who super sees all referral cases of mothers in the district. The pregnant women (84%) in the district were highly knowledgeable on when to seek for EmOC services The respondents who patronized private clinics reported that the quality of services rendered was very good and expressed the desire to use the same facility when the need arises. On the perspective of those who used the government hospitals, they were of the opinion that the services rendered to them were poor and some also indicated that the quality of service was close to average. The study indicated that there were availability of EmOC services. There were 3 and 11 comprehensive and basic EmOC facilities respectively per 101724 populations indicating a higher coverage of EmOC services in the district compared with the UN standard of 500,000 population and these were made accessible to pregnant women in the district. In addition, women’s knowledge on EmOC services was found to be high and therefore utilized the services. Mothers rated attitude of midwives in the public facilities to be poor. It is recommended that the DHMT take steps to maintain the EmOC and keep it functioning. Also the DHMT should collaborate with RHD for additional Gynaecologist to support work done at the district.
A thesis submitted to the Department of Health Policy, Management And Economics College of Health Sciences, School of Public Health, in partial fulfillment of the requirements for the Degree Oof Master of Public Health in Health Services Planning and Management,