AVAILABLITY, ACCESSIBILITY AND UTILIZATION OF EMERGENCY OBSTETRIC CARE SERVICES: A COMPARATIVE STUDY OF TWO LOCAL GOVERNMENT AREAS IN KADUNA STATE, NIGERIA

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Department of Medicine

ABSTRACT
The use of process indicators to assess availability, accessibility and utilization of emergency obstetric care servicesasa proxy for impact of standards for maternal health services was carried out in health care facilities in twolocal government areas in Kadunastate; it is an indirect measure of maternal mortality. Two local government areas were studied and compared with each other, each local government areastudied are in different senatorial zones: Kaduna North local government area is urban while Ikara local government area is rural.The aims and objectives of the study was to determine and compare the availability and distribution of emergency obstetric care services; to determine and compare the resource availability for emergency obstetric care services provision; to determine and compare the quality of existing basic emergency obstetric care and comprehensive emergency obstetric care services; to assess and compare the pattern of utilization of basic emergency obstetric care and comprehensive emergency obstetric care services in both local government areas. Recommendations were provided based on the findings from the study.It was a cross sectional study and it involved quantitative method of data collection using questionnaires. Total sampling was done for both local government areas. Only facilities (public, private and mission) that offer maternal health services and those that gave theirconsent to partake in the study were included. .A total of 87 health care facilities were assessed in both local government areas; 49 health care facilities in Kaduna North local government area and 38 health care facilities in Ikara local government area. A set of tools proposed byWHO: Guidelines for Monitoring the Availability and Use of Obstetric Services with little modification as proposed by Federal Ministry Of Health, Nigeria was used for appraisal of health facilities performance and adapted for the study. The appraisal tool looked at six key areas: availability of emergency obstetric care; accessibility of emergency obstetric care; proportion of birth that takes place in health facilities; met needs for emergency obstetric services; proportion of births by caesarian section; Case fatality rate.Emergency obstetric care facilities were classified into basic emergency obstetric care facilities and comprehensive emergency obstetric facilities. Each local government area was assessed separately and compared with the other. Data were compared using the χ2. P<0.05 was considered statistically significant.Using the WHO guidelines on emergency obstetric care services; it was observed that there were 2 basic emergency obstetric care and 21 comprehensive emergency obstetric care facilities in Kaduna North local government area (as against 3 basic emergency obstetric care and 1 comprehensive emergency obstetric care facilities per 364,575 populations) while in Ikara local government area, there were 2 basic emergency obstetric care and 2 comprehensive emergency obstetric care facilities (as against 2 basic emergency obstetric care and 1 comprehensive emergency obstetric care facilities per 194,723 populations). Using the guidelines set by Nigerian Federal Ministry of Health, in Kaduna North local government area, there were 1 basic emergency obstetric care and 10 comprehensive emergency obstetric care facilities while there was no emergency obstetric care facility in Ikara local government area. The proportion of births in Emergency obstetric carefacilities was found to be 55 % and 4.6% for Kaduna North and Ikara local government areas respectively(recommended 15%). The met need for emergency obstetric care was found to be 40.9% and 5.6% for Kaduna North and Ikara local government arearespectively(recommended; 100%), while the proportion of births by C-Section were 6.0% and 1.1% for Kaduna North and Ikara local government area respectively(recommended; 5% ). And the case fatality rates for public referral facilities were 7.6% and 5.7% for secondary and tertiaryhealth facilities respectively in Kaduna North local government area while that of secondary facility in Ikaralocal government areawas 23.4% (recommended; 1%). With the exception of meeting the required numbers for basic emergency obstetric carefacilities and proportion of birth that took placein emergency obstetric care facilities, Kaduna Northlocal government area had better results when compared to Ikara local government area in terms of met needs; proportion of birth by caesarian section and Case fatality rate. In the light of the above findings, it is recommended that mapping of health facilities in terms of emergency obstetric care services provisionshould be carried out so as to upgrade some of the PHC facilities to basic emergency obstetric care facilities. There is a need to improve the staff strength so as to ensure 24 hours coverage of skilled birth attendants at the facilities and to establish blood bank in all local government areas in the states to ensure access to blood transfusion. There is a need for community sensitization so as to improve utilization of the available emergency obstetric care services.