Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Reproductive Health
Published in: Reproductive Health 1/2009

Open Access 01-12-2009 | Research

Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies

Authors: Mamady Cham, Johanne Sundby, Siri Vangen

Published in: Reproductive Health | Issue 1/2009

Login to get access

Abstract

Background

Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital.

Methods

From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge.

Results

Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs.

Conclusion

The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.
Literature
1.
World Health Organization: Maternal mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA and the World Bank. 2007, Geneva: World Health Organization
2.
World Health Organization: Health and the Millennium Development Goals. 2005, Geneva: World Health Organization
3.
Paxton A, Maine D, Freedman L, Fry D, Lobis S: The evidence for emergency obstetric care. Int J Gynaecol Obstet. 2005, 88 (2): 181-193. 10.1016/j.ijgo.2004.11.026.CrossRefPubMed
4.
Graham W: Can skilled attendance at delivery reduce maternal mortality in developing countries?. Stud Health Serv Organ Policy. 2001, 17: 97-129.
5.
AMDD: Program note: using UN process indicators to assess needs in emergency obstetric services: Morocco, Nicaragua and Sri Lanka. Int J Gynaecol Obstet. 2003, 80 (2): 222-230. 10.1016/S0020-7292(02)00390-9.CrossRef
6.
Lobis S, Fry D, Paxton A: Program note: applying the UN process indicators for emergency obstetric care to the United States. Int J Gynaecol Obstet. 2005, 88 (2): 203-207. 10.1016/j.ijgo.2004.11.025.CrossRefPubMed
7.
AMDD: Program note. Using UN process indicators to assess needs in emergency obstetric services: Pakistan, Peru and Vietnam. Int J Gynaecol Obstet. 2002, 78 (3): 275-282. 10.1016/S0020-7292(02)00190-X.CrossRef
8.
AMDD: Program note. Using UN process indicators to assess needs in emergency obstetric services: Niger, Rwanda and Tanzania. Int J Gynaecol Obstet. 2003, 83 (1): 112-120. 10.1016/S0020-7292(03)00187-5.CrossRef
9.
Fauveau V: Program Note: Using UN process indicators to assess needs in emergency obstetric services: Gabon, Guinea-Bissau, and The Gambia. Int J Gynaecol Obstet. 2007, 96 (3): 233-240. 10.1016/j.ijgo.2006.12.004.CrossRefPubMed
10.
Telfer ML, Rowley JT, Walraven GE: Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia. Afr J Reprod Health. 2002, 6 (1): 74-83. 10.2307/3583148.CrossRefPubMed
11.
Ministry of Health: Drug Revolving Fund accounting and procedure manual. 1988, Banjul: Gambia Government
12.
Langer A, Villar J, Romero M, Nigenda G, Piaggio G, Kuchaisit C: Are women and providers satisfied with antenatal care? Views on a standard and a simplified, evidence-based model of care in four developing countries. BMC Womens Health. 2002, 2 (1): 7-10.1186/1472-6874-2-7.CrossRefPubMedPubMedCentral
13.
Mbaruku G, Bergstrom S: Reducing maternal mortality in Kigoma, Tanzania. Health Policy Plan. 1995, 10 (1): 71-78. 10.1093/heapol/10.1.71.CrossRefPubMed
14.
World Health Organization: Beyond the numbers: reviewing maternal deaths and complication to make pregnancy safer 2004. 2005, Geneva: World Health Organization
15.
Mantel GD, Buchmann E, Rees H, Pattinson RC: Severe acute maternal morbidity: a pilot study of a definition for a near-miss. BJOG. 1998, 105 (9): 985-990. 10.1111/j.1471-0528.1998.tb10262.x.CrossRef
16.
Stones W, Lim W, Al-Azzawi F, Kelly M: An investigation of maternal morbidity with identification of life-threatening 'near miss' episodes. Health Trends. 1991, 23 (1): 13-15.PubMed
17.
18.
World Health Organization Arica Regional Office: The Health of the People: The African Regional Health Report. Brazzaville. 2006
19.
Department of State for Health: The Gambian road map to accelerate the reduction of maternal & newborn morbidity & mortality. 2005, Banjul: Gambia Government
20.
Department of State for Health: Public Expenditure Review 2001: Health Sector Situation Analysis. 2005, Banjul: Gambia Government
21.
Anya SE: Seasonal variation in the risk and causes of maternal death in the Gambia: malaria appears to be an important factor. Am J Trop Med Hyg. 2004, 70 (5): 510-513.PubMed
22.
Department of State for Health: The standard drug treatment manual. 2005, Banjul: Gambia Government
23.
Dahlgren L, Emmelin M, Winkvist A: Qualitative methodology for international public health. 2004, Umea: International School of Public Health
24.
Naef R, Washburne J, Martin R, Magann E, Scanlon P, Morrison J: Hemorrhage Associated with Cesarean Delivery: When is Transfusion Needed?. J Perinatol. 1995, 15 (1): 32-35.PubMed
25.
Cruz JR: Reduction of maternal mortality: the need for voluntary blood donors. Int J Gynaecol Obstet. 2007, 98 (3): 291-293. 10.1016/j.ijgo.2007.01.020.CrossRefPubMed
26.
Cham M, Sundby J, Vangen S: Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005, 2 (1): 3-10.1186/1742-4755-2-3.CrossRefPubMedPubMedCentral
27.
Hoestermann CF, Ogbaselassie G, Wacker J, Bastert G: Maternal mortality in the main referral hospital in The Gambia, west Africa. Trop Med Int Health. 1996, 1 (5): 710-717.CrossRefPubMed
28.
Walraven G, Telfer M, Rowley J, Ronsmans C: Maternal mortality in rural Gambia: levels, causes and contributing factors. Bull World Health Organ. 2000, 78 (5): 603-613.PubMedPubMedCentral
29.
Walraven G, Scherf C, West B, Ekpo G, Paine K, Coleman R: The burden of reproductive-organ disease in rural women in The Gambia, West Africa. Lancet. 2001, 357 (9263): 1161-1167. 10.1016/S0140-6736(00)04333-6.CrossRefPubMed
30.
Fleming A: Blood transfusion facilities: a pre-requisite for safe motherhood. Maternity Care in Developing Countries. Edited by: Lawson J, Harrison K, Bergstrom S. 2001, London: Cromwell Press Ltd
31.
Cruz JR, Perez-Rosales MD: Availability, safety and quality of blood for transfusion in the Americas. World Hosp Health Serv. 2005, 41 (1): 27-31.
32.
Leigh B, Kandeh HB, Kanu MS, Kuteh M, Palmer IS, Daoh KS: Improving emergency obstetric care at a district hospital, Makeni, Sierra Leone. The Freetown/Makeni PMM Team. Int J Gynaecol Obstet. 1997, 59 (Suppl 2): 55-65. 10.1016/S0020-7292(97)00148-3.CrossRef
33.
Kowalewski M, Mujinja P, Jahn A: Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania. Afr J Reprod Health. 2002, 6 (1): 65-73. 10.2307/3583147.CrossRefPubMed
34.
Berman P, Orman P, Gani A: Treatment use and expenditure on curative care in rural Indonesia. Health Policy and Plann. 1987, 2 (4): 289-300. 10.1093/heapol/2.4.289.CrossRef
35.
Storeng KT, Baggaley RF, Ganaba R, Outtara F, Akoum MS, Filippi V: Paying the price: the cost and consequences of emergency obstetric care in Burkina Faso. Soc Sci Med. 2008, 66 (3): 545-557. 10.1016/j.socscimed.2007.10.001.CrossRefPubMed
36.
Afsana K: The tremendous cost of seeking hospital obstetric care in Bangladesh. Reprod Health Matters. 2004, 12 (24): 171-180. 10.1016/S0968-8080(04)24142-8.CrossRefPubMed
37.
World Health Organization: Guidelines for monitoring the availability and use of obstetric services. 1997, Geneva: World Health Organization
38.
Sitzia J, Wood N: Patient satisfaction: a review of issues and concepts. Soc Sci Med. 1997, 45 (12): 1829-1843. 10.1016/S0277-9536(97)00128-7.CrossRefPubMed
39.
McClure EM, Goldenberg RL, Bann CM: Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries. Int J Gynaecol Obstet. 2007, 96 (2): 139-146. 10.1016/j.ijgo.2006.10.010.CrossRefPubMed
40.
Fitzpatrick C, Halligan A, Mckenna P, Coughlan BM, Darling MR, Phelan D: Near miss maternal mortality (NMM). Ir Med J. 1992, 85 (1): 37-PubMed
41.
Barnes-Josiah D, Myntti C, Augustin A: The "three delays" as a framework for examining maternal mortality in Haiti. Soc Sci Med. 1998, 46 (8): 981-993. 10.1016/S0277-9536(97)10018-1.CrossRefPubMed
42.
Kowalewski M, Jahn A, Kimatta SS: Why do at-risk mothers fail to reach referral level? Barriers beyond distance and cost. Afr J Reprod Health. 2000, 4 (1): 100-109. 10.2307/3583247.CrossRefPubMed
43.
Cham M, Vangen S, Sundby J: Maternal deaths in rural Gambia. Global Public Health. 2007, 2 (4): 359-372. 10.1080/17441690600918188.CrossRefPubMed
44.
Jeng B: Practices and quality of intrapartum care in the main referral hospital of The Gambia. 2008, Oslo: University of Oslo
Metadata
Title
Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies
Authors
Mamady Cham
Johanne Sundby
Siri Vangen
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2009
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/1742-4755-6-5

Other articles of this Issue 1/2009

Reproductive Health 1/2009 Go to the issue

Research

Religiosity and teen birth rate in the United States

Study protocol

Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences

Research

Design and validity of a questionnaire to assess sexuality in pregnant women

Study protocol

Active management of the third stage of labour without controlled cord traction: a randomized non-inferiority controlled trial

Research

Audit of short term outcomes of surgical and medical second trimester termination of pregnancy

Research

High rate of unintended pregnancy among pregnant women in a maternity hospital in Córdoba, Argentina: a pilot study