title: Are process indicators adequate to assess essential obstetric care at district level?--a case study from Rufiji district, Tanzania.
abstract: To assess coverage and quality of essential obstetric care (EOC) and the appropriateness of using processindicators, a 3-month follow-up study was done in Rufiji district, Tanzania, involving 2 hospitals, 4 health centres, 10 large dispensaries and 10 randomly selected small dispensaries. Data collection was done on process indicators as suggested by UNICEF/WHO/UNFPA (UN) and 'unmet obstetric need (UON) for major obstetric intervention (MOI)'. With standard values in (brackets), the district had two comprehensive EOC facilities, births in EOC amounted to 62% (15%), met need for EOC was 76% (100%), caesarean section (C/S) rate 4.1% (> 5%), hospital case fatality rate (CFR) 1.0% (< 1%) and successful obstetric referrals 46% (100%). MOI for absolute maternal indication in the district was 2.6% (1-2%). All four maternal deaths occurred due to transport failures. The process indicators gave contradictory impressions on the coverage and quality of care and failed to link to the outcome of delivery complications in the study.
authors.affiliation: Department of Community Health/Obstetrics and Gynaecology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. durassa@muchs.ac.tz
authors.forename: David P
authors.initials: DP
authors.lastname: Urassa
authors.forename: Anders
authors.initials: A
authors.lastname: Carlstedt
authors.forename: Lennarth
authors.initials: L
authors.lastname: Nyström
authors.forename: Siriel N
authors.initials: SN
authors.lastname: Massawe
authors.forename: Gunilla
authors.initials: G
authors.lastname: Lindmark
mesh_terms: D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D017064:Process Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D013636:Tanzania