A survey on obstetric care,factors affecting provision of care and pregnancy outcome in Dar es Salaam District hospitals 2002

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.