The Quality of Intra-Partum Care in a Gambian Rural Major Health Centre

Abstract

Background: The health of women and children remain to be a major challenge in the world, particularly in developing countries. It has been proven that rendering quality maternity care means providing care that is evidence-based, and practices that are have proven to be effective need to be encouraged. The instrument for the non-participant observation aimed to collect information on practices performed on laboring women from admission to discharge. This was compared with the World Health Organization Technical Working Group’s categorization on Normal Birth. Direct observation of laboring women with established normal labour and review of records of those observed was conducted for the quantitative paper. Women’s views were explored using the different interview guides: one for the exit interview, the other for the focus group discussion. The women were asked about the care they receive, perception on quality of care; on the environment of the delivery ward; and on the health care providers; and what will be their recommendations for better quality of care for women who come for labour and delivery care. The in-depth interview for health care providers was to know what are their views and perceptions of quality of care and the use of evidence-based practices; and also their suggestive recommendations for improvement. An assessment of facility’s readiness for emergency obstetric care was conducted, exploring the various service areas of the facility that have a link with labour and delivery, with the maternity unit included in this assessment. A staff audit was also conducted with special focus on health workers who are assigned to the delivery ward. OBJECTIVES: To assess practices and quality of delivery care during normal childbirth in Soma Major Health Centre in The Gambia. MATERIALS AND METHODS: The study was both a retrospective and prospective cross-sectional design combining both quantitative and qualitative methods. Maternity service data for the previous year (2010) was explored. A total of 101 labouring women were observed as part of the quantitative part. A total of fifteen post-partum women who were not part of the non-participant observation were interviewed, whereas twenty post-partum women who were not also part of the non-participant observation were invited to a focus group discussion. In-depth interview guide and focus group discussion guide were used. A total of eleven health care providers were also invited to an in-depth interview on a one-on-one basis. These health care providers work in the delivery ward, although two of these care providers who had one time worked in the delivery ward but currently assigned to the Reproductive and Child Health Clinic of the facility were also included. An interview guide was used for health care providers too. RESULTS: All women [101] were instructed to be in lithotomy position during delivery. Examination of the placenta was found to be low, 20 [19%], women allowed to take oral fluids was found in 50 [49%] of the women observed. The parenteral prophylactic use of oxytocin was found to be 62 [61%], whereas that of ergometrine use was 29 [28%]. Manual exploration of the uterus was found to be common, observed in 81 [80%] of the 101 deliveries, which is not in line with evidence. Although assessment of vital observations for blood pressure and temperature taking and recording was found to be high, the use of the partograph throughout the labour process was found to be very low [13, n=101]. Routine episiotomy was given to 29 [28%] women, out of whom 28 were primi-parous women. Infection control practices through application of the universal precautions and health care provider giving of information on results of examination were found to be infrequent. Unfortunately in 99% [n = 101] of the deliveries observed, the instruments were regarded unsterile. Information on results of examination at time of admission was observed in only 3 [n =101] of the women. Baby placed on the abdomen of the mother immediately after delivery was found to be very low, 15 [n =101]. Practices which are clearly harmful or ineffective and should be eliminated were common in this study; therefore most practices were not evidence-based, although there seem to be a high awareness amongst health care providers on these evidence-based intra-partum care practices. Problems of staff attitudes, poor communication /interpersonal skills, inadequate midwives, insufficient resources, supplies, equipment; medicines for maternity care have been mentioned by both the health care providers and women. CONCLUSION: In the overall, it may be concluded that most practices in this delivery ward are not evidence-based, and care is substandard.