IMPROVING THE QUALITY OF OBSTETRIC CARE AT THE TEACHING HOSPITAL, ZARIA, NIGERIA

Preliminary studies: Research at Ahmadu Bello University Teaching Hosp ital (ABUTH), Zaria, Nigeria, showed delay in treating women with obst etric complications and highlighted multiple contributing factors. Int erventions: In response, a surgical theater was restored to working or der, the maternity ward renovated, resident physicians trained in obst etrics and an emergency drug pack system instituted. A system of blood donation from families of women attending antenatal clinics was intro duced. Later, community interventions focused on improving access and reducing delay in seeking care. Results: Mean admission-to-treatment i nterval was reduced by 57%, from 3.7 h in 1990 to 1.6 h in 1995. The p roportion of women treated in less than 30 min increased from 39% in m id-1993 to 87% in late 1995. Case fatality rate (CFR) among women with major obstetric complications fell from 14% in 1990 to 11% in 1995. T he annual number of women with complications seen, however, declined f rom 326 in 1990 to 65 in 1995. Costs: Cost of material improvements wa s approximately US$135000, of which 65% was provided by government. An additional $8000 per year in new staff salaries was paid by the gover nment. Conclusions: Hospital obstetric services can be improved and go vernment can be mobilized to contribute. Treatment delay and obstetric CFR can be reduced. Deteriorating economic conditions, however, may d iminish utilization of services despite improvements. (C) 1997 Interna tional Federation of Gynecology and Obstetrics.