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Open Access Research article

Assessment of facility readiness and provider preparedness for dealing with postpartum haemorrhage and pre-eclampsia/eclampsia in public and private health facilities of northern Karnataka, India: a cross-sectional study

Krishnamurthy Jayanna12*, Prem Mony3, Ramesh BM12, Annamma Thomas4, Ajay Gaikwad1, Mohan HL12, James F Blanchard2, Stephen Moses2 and Lisa Avery2

Author Affiliations

1 Karnataka Health Promotion Trust, IT Park, 5th floor, No 1-4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560044, India

2 Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg MB R3E 0W3, Canada

3 Depart of Epidemiology, St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India

4 Depart of Obstetrics, St John’s Medical College and Hospital, St John’s National Academy of Health Sciences, Bangalore, India

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BMC Pregnancy and Childbirth 2014, 14:304  doi:10.1186/1471-2393-14-304

Published: 4 September 2014

Abstract

Background

The maternal mortality ratio in India has been declining over the past decade, but remains unacceptably high at 212 per 100,000 live births. Postpartum haemorrhage (PPH) and pre- eclampsia/eclampsia contribute to 40% of all maternal deaths. We assessed facility readiness and provider preparedness to deal with these two maternal complications in public and private health facilities of northern Karnataka state, south India.

Methods

We undertook a cross-sectional study of 131 primary health centres (PHCs) and 148 higher referral facilities (74 public and 74 private) in eight districts of the region. Facility infrastructure and providers’ knowledge related to screening and management of complications were assessed using facility checklists and test cases, respectively. We also attempted an audit of case sheets to assess provider practice in the management of complications. Chi square tests were used for comparing proportions.

Results

84.5% and 62.9% of all facilities had atleast one doctor and three nurses, respectively; only 13% of higher facilities had specialists. Magnesium sulphate, the drug of choice to control convulsions in eclampsia was available in 18% of PHCs, 48% of higher public facilities and 70% of private facilities. In response to the test case on eclampsia, 54.1% and 65.1% of providers would administer anti-hypertensives and magnesium sulphate, respectively; 24% would administer oxygen and only 18% would monitor for magnesium sulphate toxicity. For the test case on PPH, only 37.7% of the providers would assess for uterine tone, and 40% correctly defined early PPH. Specialists were better informed than the other cadres, and the differences were statistically significant. We experienced generally poor response rates for audits due to non-availability and non-maintenance of case sheets.

Conclusions

Addressing gaps in facility readiness and provider competencies for emergency obstetric care, alongside improving coverage of institutional deliveries, is critical to improve maternal outcomes. It is necessary to strengthen providers’ clinical and problem solving skills through capacity building initiatives beyond pre-service training, such as through onsite mentoring and supportive supervision programs. This should be backed by a health systems response to streamline staffing and supply chains in order to improve the quality of emergency obstetric care.

Keywords:
Postpartum haemorrhage; Pre-eclampsia; Eclampsia; Facility readiness; Provider preparedness; Quality; Maternal care; Public sector; Private sector