Windsma, M. (Mitchell) (2015) The capacity of health centers to provide obstetric and newborn care in the EasternGurage Zone, Ethiopia. thesis, Medicine.
Full text available on request.Abstract
Background: The maternal mortality in Ethiopia remains high and is not decreasing significantly over the last few years. Multiple factors contribute to the high mortality rates. The Health Extension Program, introduced in 2003, aimed to strengthen the health care systems in rural areas by expanding primary health care units (PHCU). While the under-five mortality declined significantly, the maternal mortality did not. The institutional birth rate is among the lowest in Ethiopia. Barriers to accessing appropriate levels of care contribute to these low rates. In an effort to enable women to reach appropriate levels of care, Maternity Waiting Homes have been used in Ethiopia, with good results. The information gathered in this study could be used by Butajira General Hospital in their effort to strengthen the capacity of health centers in the catchment area to provide obstetric and newborn care. Methods: A cross-sectional survey was undertaken at twenty health centers in three woredas, where health workers were interviewed. The survey contained questions on facility infrastructure, personnel and training, transportation and communication on referral, knowledge of health workers, performance of basic emergency obstetric and newborn care (EmONC) signal functions and Maternity Waiting Homes. Descriptive statistics were used to interpret the data. A logistic regression analysis was performed to assess any correlation between the distance to the facility to the hospital and elevation of the facility and different co-variates. Results: All health centers had access to a labor ward and delivery coaches. 68.4% had access to electricity and 63.1% had access to running water, but shortages were common and had a long duration. 68.4% had the recommended staffing, although 47.4% had at least one trained staff member. The average amount of attended deliveries was 527. Only 26.5% had a landline telephone, 100% depended on individually owned cellphones. Only two health centers owned an ambulance, all other health centers shared ambulances through the woreda. Ambulances were the most widely used mode of transport to and from the health center. All health centers had Health Extension Workers (HEW) and Health Development Armies (HDA) working in the catchment area. Some health centers didn’t have referral slips available and only 10.5% received feedback on referred patients. Three risk factors for high-risk pregnancy were mentioned by more than half of the participants. No health center provided all basic EmONC signal functions in the last three months, while no health center provided zero basic EmONC signal functions either. More than half of the health centers (83.3%) performed four or more signal functions. The lowest scoring signal functions were parenteral anticonvulsants, parenteral antibiotics and assisted vaginal delivery. The most cited reason for non-performance was ‘lack of a patient with a proper indication’, while ‘training issues’ and ‘lack of equipment or drugs’ were mentioned frequently as well. 47.3% had a functional Maternity Waiting Home, while 52.6% was building one. 100% ever heard of a Maternity Waiting Home and thought the homes would improve outcomes. 100% would support the initiative and would refer patients to the homes. No correlation was found between different co-variates and distance of to the facility to the hospital and elevation of the facility. Conclusion: In almost all fields improvements can be made. Especially lacking were access to electricity and water, trained personnel, transportation and communication for referral, knowledge of health workers and performance of basic EmONC signal functions. No correlation was found between different co-variates and distance to the facility and elevation of the facility.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Stekelenburg, Dr Jelle and Gynaecologist and Medical Centre Leeuwarden, The Netherlands |
| Supervisor name: | Vermeiden. T. (Tineke) and Hospital Administrator and Butajira General Hospital and Woredas: Mareko, Meskan and Sodo and Zone: Gurage Zone and Region: and Southern Nations, Nationalities and Peoples’ Region. and Ethiopia |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1514 |
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