Community involvement in obstetric emergency management in rural areas: a case of Rukungiri district, Western Uganda

BMC Pregnancy and Childbirth

Christopher Garimoi Orach²  Nazarius Mbona Tumwesigye¹  Robinah Najjemba²  Simon Ogwang³ 

[1] Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda;Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda;Makerere University School of Public Health, Kampala, Uganda

关键词: Uganda;    Community involvement;    Maternal deaths;    Obstetric emergency management;   

Others  :  1153047
DOI  :  10.1186/1471-2393-12-20

 received in 2011-09-04, accepted in 2012-03-29,  发布年份 2012

【 摘 要 】

Background

Maternal mortality is a major public health problem worldwide especially in low income countries. Most causes of maternal deaths are due to direct obstetric complications. Maternal mortality ratio remains high in Rukungiri district, western Uganda estimated at 475 per 100,000 live births. The objectives were to identify types of community involvement and examine factors influencing the level of community involvement in the management of obstetric emergencies.

Methods

We conducted a descriptive study during 2nd to 28th February 2009 in rural Rukungiri district, western Uganda. A total of 448 heads of households, randomly selected from 6/11 (54.5%) of sub-counties, 21/42 (50.0%) parishes and 32/212 (15.1%) villages (clusters), were interviewed. Data were analysed using STATA version 10.0.

Results

Community pre-emergency support interventions available included community awareness creation (sensitization) while interventions undertaken when emergency had occurred included transportation and referring women to health facility. Community support programmes towards health care (obstetric emergencies) included establishment of community savings and credit schemes, and insurance schemes. The factors associated with community involvement in obstetric emergency management were community members being employed (AOR = 1.91, 95% CI: 1.02 - 3.54) and rating the quality of maternal health care as good (AOR = 2.22, 95% CI: 1.19 - 4.14).

Conclusions

Types of community involvement in obstetric emergency management include practices and support programmes. Community involvement in obstetric emergency management is influenced by employment status and perceived quality of health care services. Policies to promote community networks and resource mobilization strategies for health care should be implemented. There is need for promotion of community support initiatives including health insurance schemes and self help associations; further community sensitization by empowered community based resource persons rather than health workers and improvement in quality of health care can contribute towards effective management of obstetric complications.

【 授权许可】

   
2012 Ogwang et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization: Reduction of maternal mortality. A joint WHO/UNFPA/UNICEF/World Bank Statement. Geneva: World Health Organization; 1999:9-36.
• [2]United Nations Fund for Population Activities: Distance learning system on population issues. course 6-reducing maternal deaths: selecting priorities, tracking progress. In Assessment Booklet: Student Copy 2001, 6:1-48.
• [3]Uganda Bureau of Statistics (UBOS) and Macro International Inc 2007: Uganda Demographic and Health Survey. Calverton Maryland, USA: UBOS and Macro International Inc, Report 2006, 162:181.
• [4]Reproductive Health Response in Conflict Consortium: Safe Motherhood. Report 2005, 1-2.
• [5]Orach GC, De Brouwere V: Postemergency health services for refugee and host populations in Uganda, 1999-2002. Lancet 2004, 364:611-2.
• [6]Schmid T, Kanenda O, Ahluwalia I, Kouletio M: Transportation for maternal emergencies in Tanzania: empowering communities through participatory problem solving. Am J Public Health 2001, 91(10):1589-1590.
• [7]Osungbade K, Oginni S, Olumide A: Content of antenatal care services in secondary health care facilities in Nigeria: implications for quality of maternal health care. Int J Qual Health Care 2008, 20(5):346-351.
• [8]African Population and Health Research Centre and The World Bank: Averting preventable maternal mortality: delays and barriers to the utilisation of emergency obstetric care in Nairobi's informal settlements. Nairobi, Kenya: APHRC and The World Bank; 2006. 13, 21, 30, 36-37, 40, 47-48
• [9]Rifkin SB, Muller F, Bichman W: Health planning and community participation. World Health Forum 1986, 7:156-162.
• [10]World Health Organization: Community involvement in health development: an overview. In Chapter 1 in Book on Public Health Action. Volume 1. Edited by Oakley P, Kahssay HM. Geneva: World Health Organization; 1999::3-17.
• [11]World Health Organization: Community Involvement in Health Development: a review of the concept and practice. 5th edition. Edited by Kahssay HM, Oakley P. Geneva: World Health Organization in Action; 1999.
• [12]World Health Organization: Community involvement in health development: An Examination of Critical Issues. Edited by Oakley P. Geneva: World Health Organization; 1989.
• [13]World Health Organization: Community involvement in health development: Challenging health services. report of the world health organization study group; World Health Organization Technical Report Series. Geneva: World Health Organization; 1991. No 809
• [14]Khan T: Reducing maternal mortality: emergency obstetric services for afghan refugee women in Pakistan. Power Point Presentation at International Rescue Committee Conference 2008., 19
• [15]Reproductive Health Response in Conflict Consortium: Emergency Obstetric Care Project. In Impact Report. Volume 1. Edited by Luwei Pearson, Sandra Krause, Susan Purdin, Diana Quick. United States of America; 2006::1-3. 5, 7, 11, 14, 28 - 29, 31
• [16]Themmen E: Essential obstetric care: community awareness, involvement and support. Popline document no 116841, Abstract of Report in http://www.popline.org/docs/1162/116841.html webcite accessed on 9th October 2008:1
• [17]Bank W: Health nutrition and population. Human Development Network Report 2006, 1-3:6-7.
• [18]Levine R: "Millions saved" proven successes in global health. Global Health Link, Magazine of The Global Health Council 2005, 134:7.
• [19]Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994, 38(8):1091-110.
• [20]Odimegwu C: Men's role in emergency obstetric care in Nigeria. Report to the Takemi Program in International Health. Boston: Harvard School of Public Health; 2001:2-8.
• [21]Pembe A, Urasa D, Darj E, Carlotedt A, Olsson P: Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice. Reproductive Health in Emergencies Conference Abstract Book 2008, 1:71.
• [22]Abrejo G, Farina S, Babar T, Saleem S: International conference on population and development and millennium development goals: missing links and common grounds. Reproductive Health 2008, 5(4):1-8.
• [23]Nour NM: An introduction to global women's health. Reviews in Obstetrics and Gynaecology 2008, 1(1):3-5.
• [24]Amado RP: Increasing access to reproductive health services in emergencies through partnerships in Philippines. Reproductive Health in Emergencies Conference Abstract Book 2008, 1:69.
• [25]Orach GC: Access to sexual and reproductive health services by internally displaced persons in Kitgum and Pader Districts, Northen Uganda. Reproductive Health in Emergencies Conference Abstract Book 2008, 1:68.
• [26]Post M: Preventing maternal mortality through emergency obstetric care. in http://www.popline.org/docs/1234/131099.html webcite accessed on 9th October 2008: 1
• [27]Reproductive health response in conflict consortium: Safe motherhood. Report 2007, 1-2.
• [28]Kayongo M, Esquiche E, Luna MR, Frias G, Vega-centeno L, Bailey P: Strengthening emergency obstetric care in Ayacucho, Peru. Averting maternal deaths and disability. Int J Gynaecol Obstet 2006, 92:299-3076.
• [29]Chiwuzie J, Okojie O, Okolocha C, Omorogbe S, Orosanye A, Akpala W, Ande B, Onogwe B, Oikeh E: Emergency loan funds to improve access to obstetric care in Ekpoma, Nigeria. Abstract of the Report 2008, 1.
• [30]Kisubi M, Mugaju J: Rural Health Providers in South-West Uganda. European Development Fund/Rural Health Programme. Book. First edition. Fountain Publishers Limited, Kampala, Uganda; 1999:78-94.
• [31]Republic of Uganda: A national needs assessment of emergency obstetric care process indicators. Status of Emergency Obstetric Care in Uganda Report 2004, 1:3-12.
• [32]Ministry of Health: Road Map for Accelerating the Reduction of Maternal and Neonatal Morbidity and Mortality in Uganda 2006-2015. Volume 1. Kampala, Uganda; 2009::26-27.
• [33]Rukungiri District Local Government: District Health Sector Strategic Plan II 2005/06 - 2009/10. Strategic Plan Manual 2005, 2:4-11.
• [34]Rukungiri District Local Government: District Statistical Abstract. Health Department Statistics, Rukungiri, Uganda 2007, 1:3.
• [35]Ogwang S, Halage A, Karyabakabo Z, Rutebemberwa E: Assessment of emergency obstetric care interventions in Rukungiri District, Uganda. Field Report and Makerere University College of Health Sciences 4th Scientific Conference Abstract book. Makerere University School of Public Health, Uganda 2008., 15
• [36]Rukungiri District Local Government: Rukungiri district three year development plan. Manual 2007, 1:1-3.
• [37]Atuyambe L, Mirembe F, Mbona TN, Anika J, Kirumira KE, Faxelid E: Adolescent and adult first time mothers' health seeking practices during pregnancy and early motherhood in Wakiso District, Central Uganda. Reproductive Health, Biomedical Central, Open Access 2008, 5:1-11.
• [38]Orach GC, Dubourg D, De Brouwere V: Costs and coverage of reproductive health interventions in three refugee-affected districts, Uganda. Journal of Tropical Medicine and International Health 2007, 12(3):459-69.
• [39]Kiguli J, Kiracho-Ekirapa E, Okui-Olico , Mutebi A, MacGregor H, Pariyo GW: Increasing access to quality healthcare for the poor: Community perceptions on quality care in Uganda. Open Access, Dove Medical Press Limited 2009, 3:77-85.
• [40]Orach GC, De Brouwere V: Integrating refugee and host health services in West Nile districts, Uganda. Health Policy Plan 2006, 21:53-64.
• [41]Kyomuhendo BG: Low use of rural maternity services in uganda: impact of women's status, traditional beliefs and limited resources. Reprod Health Matters 2003, 21:16-26.
• [42]Hossain J, Ross RS: The effect of addressing demand for as well as supply of emergency obstetric care in Dinajpur, Bangladesh. International Federation of Gynaecology and Obstetrics Published by Elsevier Ireland Limited 2006, 92:320-328.
• [43]Rebecca Grais F, Angela Rose MC, Jean-Paul Guthmann: Don't spin the pen: two alternative methods for second-stage sampling in urban cluster surveys. Emerging Themes in Epidemiology 2007, 4(8):1-7.