Skip to main content

Advertisement

SpringerLink
Log in

Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objective To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi. Methods Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183). Results There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed. Conclusions The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. United Nations. Millennium Development Goals Indicators. http://mdgs.un.org/unsd/mdg/Data.aspx. Accessed on December 10, 2007.

  2. National Statistical Office (Malawi), ORC Macro. (2005). 2004 Malawi Demographic and Health Survey. Calverton: ORC Macro, Maryland.

  3. United Nations Development Programme. Human Development Reports: Human Development Index—going beyond income. http://hdrstats.undp.org/countries/country_fact_sheets/cty_fs_MWI.html. Accessed on January 24, 2008.

  4. WHO. Mortality and burden of disease. http://www.who.int/countries/mwi/en/. Accessed on 10/12/2007.

  5. World Health Organisation. (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF, UNFPA. Geneva: Department of Reproductive Health and Research, World Health Organisation.

  6. United Nations. (2006). Progress towards millennium development goals, 1990–2005. New York: Statistics Division, Department of Economics and Social Affairs, United Nations.

  7. Seljeskog, L., Sundby, J., & Chimango, J. (2006). Factors influencing women’s choice of place of delivery in rural Malawi—An explorative study. African Journal of Reproductive Health, 10, 66–75.

    Article  PubMed  Google Scholar 

  8. Hussein, J., Goodburn, E. A., Damisoni, H., Lema, V., & Graham, W. (2001). Monitoring obstetric services: Putting the ‘UN Guidelines’ into practice in Malawi: 3 years on. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 75, 63–73. doi:10.1016/S0020-7292(01)00474-X.

    CAS  Google Scholar 

  9. Ministry of Health (Malawi). WHO, UNICEF, UNFPA. (2004). Assessment of emergency obstetric care in Malawi. Lilongwe: Malawi Ministry of Health.

  10. AMDD Working Group Indicatiors. (2003). Group on indicators. Program note: Using UN process indicators to assess needs in emergency obstetric services: Morocco, Nicaragua and Sri Lanka. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 80, 222–230. doi:10.1016/S0020-7292(02)00390-9.

  11. Paxton, A., Bailey, P., Lobis, S., & Fry, D. (2006). Global patterns in availability of emergency obstetric care. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 93, 300–3007. doi:10.1016/j.ijgo.2006.01.030.

    CAS  Google Scholar 

  12. Chaillet, N., & Dumont, A. (2007). Evidence-based strategies for reducing Cesarean Section rates: A meta-analysis. Birth (Berkeley, Calif.), 34, 53–64. doi:10.1111/j.1523-536X.2006.00146.x.

    Google Scholar 

  13. Aziken, M., Omo-Aghoja, L., & Okonofua, F. (2007). Perceptions and attitudes of pregnant women towards Caesarean Section in urban Nigeria. Acta Obstetricia et Gynecologica Scandinavica, 86, 42–47. doi:10.1080/00016340600994950.

    Article  PubMed  Google Scholar 

  14. Hopkins, K. (2000). Are Brazilian women really choosing to deliver by cesarean? Social Science and Medicine, 51, 725–740. doi:10.1016/S0277-9536(99)00480-3.

    Article  PubMed  CAS  Google Scholar 

  15. Carroli, G., Villar, J., Piaggio, G., Khan-Neelofur, D., Gulmezoglu, M., Mugford, M., et al. (2001). WHO systematic review of randomised controlled trials of routine antenatal care. Lancet, 357, 1565–1570. doi:10.1016/S0140-6736(00)04723-1.

    Article  PubMed  CAS  Google Scholar 

  16. Ghana Statistical SErvice, Noguchi Memorial Institute for Medical Research, ORC Macro. (2003) 2003 Ghana Demographic and Health Survey. Calverton: ORC Macro, Maryland.

  17. National Institute of Statistics, ORC Macro Calverton. (2004). Cameroon Demographic and Health Survey. Calverton: ORC Macro, Maryland.

  18. Ronsmans, C., & Graham, W. J. (2006). Maternal mortality: Who, where, when and why. Lancet, 368, 1189–1200. doi:10.1016/S0140-6736(06)69380-X.

    Article  PubMed  Google Scholar 

  19. Orach, C. G., Dubourg, D., & De Brouwere, V. (2007). Costs and coverage of reproductive health interventions in three rural refugee-affected districts, Uganda. Tropical Medicine & International Health, 12, 459–469.

    Google Scholar 

  20. Chalmers, B., & Quliyeva, D. (2004). A report of women’s birth experiences in Baku, Azerbaijan. Journal of Psychosomatic Obstetrics and Gynaecology, 25, 3–14. doi:10.1080/01674820410001737397.

    Article  PubMed  CAS  Google Scholar 

  21. Lanata, C. F. (2007). Human resources in developing countries. Lancet, 369, 1238–1239. doi:10.1016/S0140-6736(07)60573-X.

    Article  PubMed  Google Scholar 

  22. Lewis, G. (2003). Beyond the numbers: Reviewing maternal deaths and complications to make pregnancy safer. British Medical Bulletin, 67, 27–37. doi:10.1093/bmb/ldg009.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish acknowledge the Health Foundation for providing financial support for this study. We also thank the staff of all the health facilities and the Health Foundation Consortium staff for the cooperation shown during the data collection phase.

Authors' Contribution

EJK wrote the protocol, collected the data, analysed and interpreted the data, and drafted the first copy and all versions of the manuscript. JH and GM participated in data collection. CM and NVDB reviewed the manuscript for important intellectual content.

Author information

Authors and Affiliations

  1. Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

    Eugene J. Kongnyuy, Jan Hofman & Nynke van den Broek

  2. The Health Foundation Consortium, Lilongwe, Malawi

    Grace Mlava

  3. Reproductive Health Unit, Ministry of Health, Lilongwe, Malawi

    Chisale Mhango

Authors
  1. Eugene J. Kongnyuy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Hofman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grace Mlava
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chisale Mhango
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nynke van den Broek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eugene J. Kongnyuy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kongnyuy, E.J., Hofman, J., Mlava, G. et al. Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi. Matern Child Health J 13, 687–694 (2009). https://doi.org/10.1007/s10995-008-0380-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-008-0380-y

Keywords

Search

Navigation