title: Measuring access to emergency obstetric care in rural Zambia.
abstract: BACKGROUND
  Global health experts identify emergency obstetric care (EmOC) as the most important intervention to improve maternal survival in low- and middle-income countries. In Zambia, 1 in 27 women will die of maternal causes, yet the level of availability of EmOC is not known at the provincial level.
  
  
  OBJECTIVE
  Our goal was to develop a tool to measure the availability of EmOC in rural Zambia in order to estimate pregnant women's access to this life-saving intervention.
  
  
  METHODS
  We created an instrument for determining the availability of EmOC based on the supplies and medicines in stock at health facilities as well as the skill level of health workers. We then surveyed a random sample of 35 health centres in the Central Province of Zambia using our novel instrument.
  
  
  RESULTS
  We graded health centres based on their ability to provide the six basic functions of EmOC: administering parenteral antibiotics, administering parenteral oxytocics, administering parenteral anticonvulsants, performing manual removal of the placenta, removing retained products of conception and performing assisted vaginal delivery. Of the 29 health centres providing delivery care, 65% (19) were graded as level 1 or 2, 28% (8) as level 3 or 4 and 7% (2) as level 5. No health centre received a grade of level 6.
  
  
  CONCLUSIONS
  The availability of EmOC in the Central Province of Zambia is extremely limited; the majority of health centres provide only one or two basic functions of EmOC, and no health centres perform all six functions. Our grading system allows for inter- and intra-country comparisons by providing a systematic process for monitoring access to EmOC in rural, low-income countries similar to Zambia.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. alevine2@partners.org
authors.forename: Adam C
authors.initials: AC
authors.lastname: Levine
authors.forename: Regan H
authors.initials: RH
authors.lastname: Marsh
authors.forename: Sara W
authors.initials: SW
authors.lastname: Nelson
authors.forename: Lynda
authors.initials: L
authors.lastname: Tyer-Viola
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke