Background: Malawi has one of the highest maternal mortality levels in the world. Maternal deaths are to a large extent preventable. Provision of quality emergency obstetric care has been advocated as one of the most important strategies for preventing maternal deaths. In an effort to contribute towards the reduction of maternal mortality in Malawi, it became necessary to conduct a study to assess quality of care which women who suffer major emergency complications receive at Mwanza district hospital. Mwanza is one of the districts which registered the highest number of women dying due to emergency obstetric complications during the nation wide assessment on availability, utilization and quality of emergency obstetric care.
Objectives: To understand the increased obstetric CFR and barriers to provision of efficient obstetric care; the following objectives were set for the study: to assess availability of logistics (essential drugs, staffing, equipment and supplies) for managing obstetric complications, to determine if women who suffer major obstetric complications are managed according to established national management guidelines, to assess providers’ perspective on the quality of emergency obstetric provided and identify barriers to provision of effective care.
Methodology: This was a cross sectional descriptive prospective study combining both qualitative and quantitative approaches. The study was conducted for a period of three months. Data was generated through inventory of logistics for management of obstetric complications, non participant observations of management of women with obstetric complications, prospective record reviews of women managed for obstetric complications and in depth interviews with 14 health workers to understand their perspective regarding the quality of care rendered to women who experience obstetric emergency complications.
Results: A total of 42 women who suffered emergency obstetric complications were observed and their records reviewed. Eclampsia/preeclampsia was the most common complication observed accounting for 12 cases, postpartum hemorrhage accounted for 11 cases, obstructed labour 8 cases, ruptured uterus 6 cases and puerperal sepsis 5 cases. Out of the 42 cases, 9 patients died representing a CFR of 21%. There were 799 births during this period. This gives the proportion of major obstetric complications of about 5.3%.The study further revealed that most of the logistics for managing patients with obstetric complications were available; however some were not used despite being available. For example; patients who suffered eclampsia and severe preeclampsia did not get full course of magnesium sulphate according to protocol.Generally, women with obstetric complications were not managed according to established management guidelines.
Health workers reported that emergency obstetric care being provided to women is poor. They attributed this to women arriving late at the referral hospital for various reasons and several barriers to provision of quality care.
Conclusion: The study has shown that poor quality of emergency obstetric care is rendered to women with obstetric complications; guidelines are not followed when managing obstetric patients. Logistics for management of patients were available, however they were underutilized. Several health service factors also affected provision of quality obstetric care. Efforts should focus on how quality can be assessed, improved and sustained. To improve management of obstetric complications, there is need to conduct clinical audit and feedback, improve supervision, trainings and refresher courses.