title: The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire.
abstract: OBJECTIVE
  To conduct a needs assessment for emergency obstetric care (EmOC) to address the unacceptably high maternal and newborn mortality indices in Sierra Leone 8 years after the end of the civil war.
  
  
  METHODS
  From June to August 2008, a cross-sectional survey was conducted of health facilities in Sierra Leone offering delivery services. Assessment tools were local adaptations of tools developed by the Averting Maternal Death and Disability program at Columbia University, New York, USA.
  
  
  RESULTS
  There were enough comprehensive EmOC (CEmOC) facilities in the country but they were poorly distributed. There were no basic EmOC (BEmOC) facilities. Few facilities (37% of hospitals and 2% of health centers) were able to perform assisted vaginal delivery (AVD), and 3 potentially BEmOC facilities did not meet the standard only because they did not perform AVD. Severe shortages in staff, equipment, and supplies, and unsatisfactory supply of utilities severely hampered the delivery of quality EmOC services. Demand for maternity and newborn services was low, which may have been related to the poor quality and the high/unpredictable out-of-pocket cost of such services.
  
  
  CONCLUSIONS
  Significant increases in the uptake of institutional delivery services, the linkage of remote health workers to the health system, and the recruitment of midwives, in addition to rapid expansion in the training of health workers (including training in midwifery and obstetric surgery skills), are urgently needed to improve the survival of mothers and newborns.
authors.affiliation: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA. kao2127@columbia.edu
authors.forename: Koyejo
authors.initials: K
authors.lastname: Oyerinde
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Harding
authors.forename: Philip
authors.initials: P
authors.lastname: Amara
authors.forename: Rugiatu
authors.initials: R
authors.lastname: Kanu
authors.forename: Rumishael
authors.initials: R
authors.lastname: Shoo
authors.forename: Kizito
authors.initials: K
authors.lastname: Daoh
mesh_terms: D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000191:economics / Q000458:organization & administration; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology* / Q000639:trends; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008427:Maternal Health Services; D008428:Maternal Mortality / Q000639:trends*; D008880:Midwifery / Q000191:economics / Q000458:organization & administration; D020380:Needs Assessment / Q000191:economics / Q000458:organization & administration; D011247:Pregnancy; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration; D012807:Sierra Leone; D000078329:Workforce