title: Availability, utilisation and quality of basic and comprehensive emergency obstetric care services in Malawi.
abstract: OBJECTIVE
  To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi.
  
  
  METHODS
  Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183).
  
  
  RESULTS
  There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed.
  
  
  CONCLUSIONS
  The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy73@yahoo.com
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Kongnyuy
authors.forename: Jan
authors.initials: J
authors.lastname: Hofman
authors.forename: Grace
authors.initials: G
authors.lastname: Mlava
authors.forename: Chisale
authors.initials: C
authors.lastname: Mhango
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
mesh_terms: D002662:Child Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data / Q000600:supply & distribution*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008427:Maternal Health Services / Q000592:standards / Q000706:statistics & numerical data / Q000600:supply & distribution*; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care