Community involvement in obstetric emergencies in Rukungiri district, Uganda.

Abstract

INTRODUCTION: Worldwide most causes of maternal deaths are related to obstetric emergencies. Rukungiri district has a high maternal mortality ratio estimated at 475 / 100,000 live births. Community involvement in obstetric emergencies enhances access and use of emergency obstetric care which is vital for reduction of maternal morbidity and mortality.

OBJECTIVE: To investigate factors associated with community involvement in obstetric emergencies in Rukungiri district. METHODLOGY: This was a cross-sectional study conducted in Rukungiri district during Feb 2009. Data collection was carried out using quantitative and qualitative methods. The study population included heads of households. The sample size was 448 head of households. Respondents were selected through multi stage sampling, purposively from two counties and randomly from 6/11 sub counties, 21/42 parishes and 32/212 villages (clusters) in the district. The WHO modified cluster sampling was used to randomly select respondents from clusters. A total of 8 focus group discussions and 8 key informant interviews were conducted. Quantitative data was entered into EPIDATA version 3.1 and analysed using STATA version 10.0. Qualitative data were analysed using manifest content analysis. RESULTS: Most respondents (85.4%) were adults aged 25-54 years. Overall, mean age was 32.5 years (range: 16-54 years), males 33.9 years (range: 16-54 years) and females 28.3 years (range: 18-42 years) respectively. Mean distance to nearest maternity unit is 5.0 kilometres (range: 0.5-30.0 kilometres). The most known signs of obstetric emergencies were vaginal bleeding, swelling of feet, labour lasting more than 8 hours and fits during pregnancy. The most known consequences of obstetric emergencies were maternal death, loss of a baby and haemorrhage. Factors associated with community involvement in obstetric emergencies include being employed (AOR=1.91, 95%CI: 1.02-3.54, P<0.05), not saving money (AOR=0.48, 95%CI:0.25-0.94, P<0.05, rating quality of maternal health care as good (AOR=2.22, 95%CI:1.19-4.14, P<0.05), Lack of sensitization of communities by local leaders (AOR=0.12, 95%CI:0.03-0.47, P<0.01) and lack of health education of communities by health workers (AOR=2.22, 95% CI:1.18-4.19, P<0.05). CONCLUSION AND RECOMMENDATION: The study shows that several factors are associated with community involvement in obstetric emergencies including community members being employed (formal/self), saving money, rating of quality of maternal health care as being good, sensitization of communities by local leaders and health education of communities by health workers. The findings suggest the need to train community members including village health team members, improve quality of health care and promote income gainful initiatives for community members.