Assessment of unmet obstetric need in emergency obstetric Services, a two years retrospective hospital based study in tarch general hospital, dawro zone, south west Ethiopia.

Abstract

Introduction: Most maternal deaths are avoidable if women have access to emergency obstetric care (EmOC) facilities.There is limited evidence about unmet need for emergency obstetric care facilities in rural Ethiopia.This study aims at assessing the coverage of obstetric care according to the Unmet Obstetric Need (UON) concept by obtaining information on indications for, and outcomes of, major obstetric interventions. Objective: To assess unmet obstetric need in Emergency Obstetric services in Tarcha General Hospital, Dawro zone, SNNPR, south-west Ethiopia. Methodology: A two years facility based Cross-sectional retrospective study was conducted from April- June 2014 at Tarcha General Hospital south-west Ethiopia. Data were collected using structured questioners by trained data collectors from Patient medical records. Data collected included the obstetric intervention, indication, mother’s origin, and maternal and perinatal outcome. The collected data was analyzed using SPSS for windows version 16.0. Descriptive statistics was run to explore the data, Chi-square test, binary logistic regression, 95% CI and P-value <0.05 were used to examine association between dependent and independent variables. The study used a threshold of 2% major obstetric interventions for absolute major indications needed per expected birth to calculate the unmet-obstetric-need-indicator and the deficits of life saving interventions. RESULTS: During the two years study period, a total of 302 major obstetric interventions (MOI) were conducted and caesarean sections took the largest 245(81.5%)followed by laparotomies for ruptured uterus8.3% and 6.6% hysterectomies. Significant more laparotomies and hysterectomies were done for mothers coming from rural than urban areas (p=0.049 and p=0.005 respectively) .The Crude cesarean sections rate per 100 births was 0.6%which is below the minimum UN 5%-15%. The number of women with AMI was 238 where majority were cephalo-pelvic disproportion (CPD) 91(38.2%) followed by malpresentation 69 (29%) and uterine rupture 40(16.8%). The number of MOI done without AMI was 74 where majority were done for foetal distress 42(65.6%). The expected number of major obstetric interventions for absolute maternal indications per expected number of births is 0.8% which is below the minimum benchmark of 2%. The high proportion 64 (21.2%) of negative maternal outcomes in terms of morbidity22.2% and mortality2.65%, as well as the high perinatal mortality of 25.8% (still birth 18.2%, dying within 24 hours 5.6%, dying after 24 hours 2%). Higher maternal and perinatal mortality was observed for mothers coming from rural areas. The mothers who come from rural areas have 3.5 times chance to develop complications than come from urban areas. (AOR=3.501, 95%CI=1.548, 7.914) Conclusion and recommendation: Based on the 2% threshold, with an overall level of major obstetric interventions for absolute maternal indications of 0.8% and a caesarean section rate of 0.6%and high proportion of negative maternal and perinatal outcomes has significant unmet obstetric need with a considerable rural-urban disparity. Therefore estimating the amount of 'unmet need for major obstetric interventions' provide the information necessary for planning and prioritising the development of services;and lead to action for the reduction of maternal mortality at local level by changing certain attitudes, mobilising resources and more effectively adapting professional practices to the needs of patients.