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Free Content Responsiveness to life-threatening obstetric emergencies in two hospitals in Abidjan, Côte d'Ivoire

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Abstract:

Summary Objectives 

To document the frequency of severe obstetric illness, and the intervals between admission or decision and life-saving surgery and the factors contributing to delays, which were reported during case reviews in two hospitals in Abidjan, Côte d'Ivoire. Methods 

The study was conducted in the teaching hospital in Cocody (CHUC) and the district hospital in Abobo (FSAS) in 2000–01. All severe obstetric cases were inventoried over a period of 1 year, and a subset of cases selected for in-depth review. For the 23 audited cases requiring emergency surgery, the interval between admission/decision and surgery was determined and reasons for the delays examined. Findings 

The yearly incidence of severe obstetric morbidity was 224.5 and 11.8 per 1000 live births in the CHUC and FSAS respectively. In CHUC, the decision-to-delivery time was extremely long (median 4.8 h) and this was largely determined by the time needed to obtain a complete surgical kit (median 2.8 h), either because the family had to pay for it in advance or because the kit lacked some essential components, which had to be bought separately. In FSAS, the decision-to-delivery time was much shorter (median 1.0 h). Conclusion 

The interval between decision and emergency obstetric surgery substantially exceeded the 30 min generally advocated in industrialized countries. The reasons for the long delays were multiple and complex, but the main factors governing them were the huge case load of severe cases and the absence of any clear policy towards ensuring prompt and adequate treatment for life-threatening emergencies. In-depth reviews of cases of severe obstetric morbidity focusing in particular on the timing of emergency treatment could increase the responsiveness of the health system and providers to the needs of women requiring emergency obstetric care.

Keywords: Caesarean section; Côte d'Ivoire; health services research; obstetric audit; pregnancy; quality assurance

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2004.01204.x

Affiliations: 1:  Institut National de Santé Publique, Abidjan, Côte d'Ivoire 2:  Department of Infectious Diseases, Maternal Health Programme, London School of Hygiene and Tropical Medicine, London, UK 3:  Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire 4:  Formation Sanitaire d'Abobo Sud, Abidjan, Côte d'Ivoire 5:  Istituto di Ricerca e Cura a Carattere Scientifico Bo Garofolo, Trieste, Italia

Publication date: 2004-03-01

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