Improving obstetric care at the district hospital, Ekpoma, Nigeria. The Benin PMM Team.
BACKGROUND
Facility reviews and focus group discussions revealed several factors at the district hospital contributing to maternal deaths in Ekpoma District, Nigeria.


METHODS
In response, the necessary equipment for the operating theater, labor suite and laboratory were repaired or purchased. A blood bank and standby generator were repaired. Drugs and consumable material were purchased and a revolving fund established. Refresher courses were held for medical officers, nursing staff and laboratory technicians. At a later stage, community interventions focused on improving access and reducing delay in seeking care.


RESULTS
The number of cesarean sections performed increased from zero in 1990-1991 to between seven and 13/year in the period 1992-1995. The number of women with major obstetric complications seen at the hospital increased from seven in 1990 (5% of obstetric admissions) to a high of 29 (20% of obstetric admissions) in 1993. These gains were not sustained, however. In 1995, only 12 women with complications (9% of obstetric admissions) were seen.


RESULTS
The cost of improvements was approximately US $12,800, of which 41% was paid by the government and the rest by the project.


CONCLUSIONS
Improving obstetric care at the district hospital can increase use by women with complications. However, sociopolitical and economic problems can hamper success.
Ande
B
B
Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin City, Nigeria.
Chiwuzie
J
J
Akpala
W
W
Oronsaye
A
A
Okojie
O
O
Okolocha
C
C
Omorogbe
S
S
Onoguwe
B
B
Oikeh
E
E
D004630:Emergencies; D005260:Female; D006767:Hospitals, District / Q000592:standards; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D009549:Nigeria; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011787:Quality of Health Care