title: Availability, utilisation and quality of maternal and neonatal health care services in Karamoja region, Uganda: a health facility-based survey.
abstract: BACKGROUND
  Maternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC) is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation's lowest scores on key development and health indicators and presents a substantial challenge to Uganda's stability and poverty eradication ambitions. The objectives of this study were: to establish the availability of maternal and neonatal healthcare services at different levels of health units; to assess their utilisation; and to determine the quality of services provided.
  
  
  METHODS
  A cross sectional study of all health facilities in Napak and Moroto districts was conducted in 2010. Data were collected by reviewing clinical records and registers, interviewing staff and women attending antenatal and postnatal clinics, and by observation. Data were summarized using frequencies and percentages and EmOC indicators were calculated.
  
  
  RESULTS
  There were gaps in the availability of essential infrastructure, equipment, supplies, drugs and staff for maternal and neonatal care particularly at health centres (HCs). Utilisation of the available antenatal, intrapartum, and postnatal care services was low. In addition, there were gaps in the quality of care received across these services. Two hospitals, each located in the study districts, qualified as comprehensive EmOC facilities. The number of EmOC facilities per 500,000 population was 3.7. None of the HCs met the criteria for basic EmOC. Assisted vaginal delivery and removal of retained products were the most frequently missing signal functions. Direct obstetric case fatality rate was 3%, the met need for EmOC was 9.9%, and 1.7% of expected deliveries were carried out by caesarean section.
  
  
  CONCLUSIONS
  To reduce maternal and newborn morbidity and mortality in Karamoja region, there is a need to increase the availability and the accessibility of skilled birth care, address the low utilisation of maternity services and improve the quality of care rendered. There is also a need to improve the availability and accessibility of EmOC services, with particular attention to basic EmOC.
authors.affiliation: Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy. calistuswilunda@yahoo.co.uk.
authors.forename: Calistus
authors.initials: C
authors.lastname: Wilunda
authors.affiliation: Averting Maternal Death and Disability Program, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. kao2127@gmail.com.
authors.forename: Koyejo
authors.initials: K
authors.lastname: Oyerinde
authors.affiliation: Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy. g.putoto@cuamm.org.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.affiliation: Doctors with Africa CAUMM, 7214, Kampala, Uganda. p.lochoro@cuamm.org.
authors.forename: Peter
authors.initials: P
authors.lastname: Lochoro
authors.affiliation: Doctors with Africa CAUMM, 7214, Kampala, Uganda. g.dalloglio@cuamm.org.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dall'Oglio
authors.affiliation: Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy. f.manenti@cuamm.org.
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
authors.affiliation: Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy. giulia.segafredo@gmail.com.
authors.forename: Giulia
authors.initials: G
authors.lastname: Segafredo
authors.affiliation: Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy. a.atzori@cuamm.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Atzori
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium. bcriel@itg.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
authors.affiliation: College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand. alessio3108@hotmail.com.
authors.forename: Alessio
authors.initials: A
authors.lastname: Panza
authors.affiliation: Doctors with Africa CUAMM, Via San Francesco 126, 35121, Padua, Italy. gianluca.quaglio@ospedaleuniverona.it.|Department of Internal Medicine, Verona University Hospital, Verona, Italy. gianluca.quaglio@ospedaleuniverona.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Quaglio
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004864:Equipment and Supplies; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D014454:Uganda