title: The state of emergency obstetric care services in Nairobi informal settlements and environs: results from a maternity health facility survey.
abstract: BACKGROUND
  Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies.
  
  
  METHODS
  We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system.
  
  
  RESULTS
  Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records.
  
  
  CONCLUSIONS
  The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement. Specific areas that require attention include supervision, regulation of maternity facilities; and ensuring that basic equipment, supplies, and trained personnel are available in order to handle obstetric complications in both public and private facilities.
authors.affiliation: African Population and Health Research Center, PO Box 10787, 00100, Nairobi Kenya. akziraba@yahoo.com
authors.forename: Abdhalah K
authors.initials: AK
authors.lastname: Ziraba
authors.forename: Samuel
authors.initials: S
authors.lastname: Mills
authors.forename: Nyovani
authors.initials: N
authors.lastname: Madise
authors.forename: Teresa
authors.initials: T
authors.lastname: Saliku
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Fotso
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006280:Health Workforce / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya; D008427:Maternal Health Services / Q000592:standards* / Q000600:supply & distribution; D009774:Obstetrics / Q000592:standards*; D011203:Poverty; D011247:Pregnancy; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires