Evaluation of emergency obstetric care implementation by midwives in Botswana

Abstract

Background: Maternal mortality is a serious concern worldwide and the death of a woman is really the fall of a country. Evidence shows that most of the high number of deaths in the world occurs in the developing countries. Within the eight (8) MDGs that were formulated, were the fifth (5th) MDG that targeted reducing maternal mortality by three quarters between 1990 and 2015, and the sixth (6th) MDG that aimed at achieving universal access to reproductive health by 2015. The Government of Botswana has made efforts by developing EmOC manual and other interventions to provide skilled attendance during pregnancy, childbirth and postnatal period at all levels of the health care delivery system. Despite several interventions, women are still dying from circumstances that are avoidable such as eclampsia, immediate postpartum haemorrhage and sepsis following abortion. Purpose: The purpose of this study is to evaluate the implementation of emergency obstetric care services rendered by midwives in Gaborone, Botswana. Design: The study is a quantitative cross sectional approach which is descriptive in nature, conducted on midwives in Gaborone, Botswana. From a population of 223 midwives, 168 of these were sampled to participate in the study. A self-administered questionnaire was used to collect data. Confidentiality, anonymity and informed consent were ensured throughout the study. A descriptive data analysis using the SPSS software version 24 was used to interpret and evaluate the data. Results: The midwives are knowledgeable as 92.9% were able to define anaemia and prolonged labour while others (79.8%) did not even undergo training in EmOC. Midwives confirmed that they are skilful in managing some emergency conditions, but showed low confidence in performing some activities. Out of thirteen facilities, only nine managed to perform all the functional signals designated for the level of the facility. Drugs, equipment and guidelines were available in the facilities. About 66.1% of the sampled midwives stated lack of technical support, supervision and audits. Haemorrhages and anaemia (19.0%) are the leading causes of maternal mortality in the area of study. Conclusion: There is a need for all midwives to be trained on EmOC, and in-service training sessions must be conducted to improve midwives' skills and knowledge. The EmOC implementation in the area of study is currently ineffective.