Abstract:
take place in a few available
public facilities mainly district hospitals and Muhimbili national hospital. While the
population in Dar es Salaam has remarkably increased from 1.5 to 2.55 million (1988 -
2002) the number and capacities of public referral facilities have remained the same
throughout this period.
/
Objectives: To assess the current state of obstetric care including coverage of esse~tial
obstetric functions, pregnancy outcome, and underlying factors in the first-referral
hospitals in Dar es Salaam.
Design: Rapid assessment method for health facilities
Setting: All three-district hospitals in Dar es Salaam.
Data Collection: Three nursing officers and the principal investigator collected data
from all hospitals. The coverage of essential obstetric services was assessed in all
facilities. Data on the available staff, equipment, supplies, drugs and, maternal and fetal
outcome were. obtained from .medical record reviews. Health providers and
administrators were interviewed for the health facility-related factors that affected
obstetric care and outcome in their respective facilities .
Results: All facilities had sub-optimal provision of essential obstetric functions,
especially the obstetric emergencies. Caesarean section services were given only for 12
hours of the day at Temeke and Amana hospitals, and very irregularly at Mwananyamala
hospital giving nse to the caesarean section rates that ranged from 0.9% to 3.0%.
Vl
Obstetric emergency-referral rates were very high up to 59% as found among patients
who had obstructed labour at Mwananyamala hospital. Obstetric premises, staffing and
equipment were grossly inadequate in these facilities, particularly at Temeke and
Mwananyamala hospitals. The postnatal bed occupancy rates ranged from 113% to
255% and nurse-to-patient ratios in the matemity wards were as high as one nurse to
seven patients in the labour ward.
Conclusion: The results show a widening gap between provision and the needs for
essential obstetric services in these facilities. This gap is a health system problem that
must be bridged urgently.
