Emergency obstetric care: how do we stand in Malawi?
OBJECTIVE
To assess the availability, accessibility, utilization, and quality of emergency obstetric care (EmOC) services in Malawi.


METHODS
A complete enumeration was made of all hospitals and a 25% random sample of all health centers, in all districts of Malawi. Enumerators (nurses and midwives) collected data by reviewing facility registers and records, observations, and interviews with health workers to determine extent of utilization of services. In-depth interviews and focus group discussions were also held with key informants to identify barriers to utilization of services and explore participants' perceptions of quality of care.


RESULTS
Almost twice the minimum number of recommended comprehensive EmOC facilities exist (1.8 facilities per 500,000 population), but only 2% of the recommended number of basic EmOC facilities. Met need was only 18.5%; cesarean delivery rate was less than 3%. The case fatality rate was 3.4% indicating poor quality of care, attributable partly to absence of skilled birth attendants and motivated staff, and the frequent shortage of drugs and medical supplies.


CONCLUSIONS
Malawi needs to improve the provision of quality EmOC services by implementing evidence-based strategies for the reduction of maternal mortality. Consequently, the Malawi Road Map for accelerating improvement was developed through multidonor and multisector collaboration with the Reproductive Health Unit of the Ministry of Health. This Road Map is now being implemented in all districts of Malawi.
Leigh
Bailah
B
Liverpool Associates in Tropical Health, Malawi Ministry of Health, Malawi. bailahlee@yahoo.co.uk
Mwale
Theresa Gloria
TG
Lazaro
Dorothy
D
Lunguzi
Juliana
J
D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data* / Q000600:supply & distribution; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008295:Malawi; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data / Q000600:supply & distribution; D008428:Maternal Mortality; D009774:Obstetrics / Q000458:organization & administration*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011787:Quality of Health Care