title: Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya.
abstract: BACKGROUND
  Developing countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located.
  
  
  METHODS
  A facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were the magnitude of UONs and their geographical distribution.
  
  
  RESULTS
  566 women in 2008 and 724 in 2009 underwent MOI. Of these, 185 (32.7%) in 2008 and 204 (28.1%) in 2009 were for Absolute Maternal Indications (AMI). The most common MOI was caesarean section (90%), commonly indicated by Cephalopelvic Disproportion (CPD)-narrow pelvis (27.6% in 2008; 26.1% in 2009). Based on a reference rate of 1.4%, the overall MOI for AMI rate was 1.25% in 2008 and 1.3% in 2009. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009).
  
  
  CONCLUSIONS
  The findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas.
authors.affiliation: Centre for Public Health Research Institute, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. lizechokah@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Echoka
authors.forename: Dominique
authors.initials: D
authors.lastname: Dubourg
authors.forename: Anselimo
authors.initials: A
authors.lastname: Makokha
authors.forename: Yeri
authors.initials: Y
authors.lastname: Kombe
authors.forename: Oystein Evjen
authors.initials: OE
authors.lastname: Olsen
authors.forename: Moses
authors.initials: M
authors.lastname: Mwangi
authors.forename: Bjorg
authors.initials: B
authors.lastname: Evjen-Olsen
authors.forename: Jens
authors.initials: J
authors.lastname: Byskov
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007630:Kenya; D008427:Maternal Health Services / Q000592:standards*; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies