title: Status of emergency obstetric care in four districts of Punjab, Pakistan - results of a baseline assessment.
abstract: OBJECTIVE
  To assess the availability and quality of Emergency Obstetric and Newborn Care in four districts of Punjab.
  
  
  METHODS
  The cross-sectional descriptive study was conducted in Attock, Gujranwala, Rahim Yar Khan and Khanewal districts of Pakistan's Punjab province. Data was collected in July 2012 from all District Headquarter Hospitals, Tehsil Headquarter Hospitals and selective Rural Health Centres (RHCs) using a pre-formatted questionnaire to assess availability of signal functions of Emergency Obstetric and Newborn Care, including staffing and equipment, number of births and women with complications, maternal case fatality rate and stillbirth rate. SPSS 20 was used for statistical analysis.
  
  
  RESULTS
  In total, 32 health care facilities were surveyed: 14(43.75%) providing basic care and, 18(56.25) providing comprehensive obstetric care. All required signal functions were available at 4(22%) in the latter category, and 3(21%) facilities in the former category. Met need for Emergency Obstetric and Newborn Care was 17.8%. Besides, there were 26 maternal deaths among the 1,482 women with recognised obstetric complications, indicating an overall case fatality rate for all districts of 1.75%.
  
  
  CONCLUSIONS
  Continued efforts are needed to improve the availability and quality of Emergency Obstetric and Newborn Care through targeted skill-based training and provision of adequate drugs and equipment.
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: Bettina
authors.initials: B
authors.lastname: Utz
authors.affiliation: Health Services Academy, Pakistan, Child Advocacy International, Pakistan.
authors.forename: Shamsa
authors.initials: S
authors.lastname: Zafar
authors.affiliation: Child Advocacy International, Pakistan.
authors.forename: Noreen
authors.initials: N
authors.lastname: Arshad
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: Terry
authors.initials: T
authors.lastname: Kana
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: Somla
authors.initials: S
authors.lastname: Gopalakrishnan
mesh_terms: D000900:Anti-Bacterial Agents / Q000600:supply & distribution; D000927:Anticonvulsants / Q000600:supply & distribution; D003430:Cross-Sectional Studies; D004638:Emergency Treatment / Q000592:standards / Q000706:statistics & numerical data*; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000401:mortality / Q000628:therapy*; D009774:Obstetrics; D010154:Pakistan; D011181:Postnatal Care / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care; D015149:Tocolytic Agents / Q000600:supply & distribution
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D015149:Tocolytic Agents
keywords: Pakistan, Emergency obstetric care, Skilled birth attendance, Maternal & newborn health, Emergency obstetric care signal functions.