Upgrading obstetric care at a secondary referral hospital, Ogun State, Nigeria

Preliminary studies: A 1991 inventory at the State Hospital, Ota, in Ogun State, Nigeria, showed inadequate surgical equipment, drugs, blood and power supply. A time-motion study indicated substantial delays in receiving obstetric care. Interventions: In 1994, medical officers and midwives were given refresher courses in emergency obstetric skills. In 1995, the surgical theater, labor ward and laboratory were provided with the necessary supplies and equipment. A reliable electrical supply was set up, but problems were encountered in establishing blood services. Subsequent community interventions focused on improving access and reducing delay in seeking care. Results: The annual number of women with complications seen, which had been declining - from 123 in 1992 to 55 in 1994 - increased to 91 in 1995. Case fatality rate (CFR) due to major direct obstetric complications did not change appreciably, i.e. it was 6.6% in 1995, as compared with 7.3%, 8.3% and 7.3% for the years 1992-1994, respectively. Costs: The cost of hospital improvements was approximately US $46,000. Conclusions: The facility improvements were completed only recently in mid-1995. It is hoped that improved services will result in reductions in CFR and motivate more women with complications to seek hospital care, despite difficult economic conditions prevailing in Nigeria.