Quality of midwifery care in Soroti district, Uganda

Objectives: To determine the quality of care provided by midwives in Soroti district; and specifically, to identify training needs, gaps in knowledge and other barriers to accessibility of emergency obstetric care (EmOC) serv ices in Soroti district. Design: Cross-sectional descriptive study. Setting: One regional hospital, one district hospital, two health centres a nd four dispensaries, all health units in the district. Subjects: Patients admitted in the health units with pregnancy complication s; attendants of patients (above); midwives delivering health care at the h ealth units; pregnant women exiting from (after attending) antenatal clinic s; and health unit records. Interventions: Participatory observation, midwife and client interviews, re cords review, facility assessment and focus group discussions with clients and patients. Main outcome measures: Ability of midwives to provide antenatal care of a m inimum standard, or recall causes, signs, symptoms or the management of com mon obstetric complications; and patients and patient attendants' perceptio n of care received. Results: Many midwives were providing care of poor quality for both antenat al and delivery care due to their inability to identify and manage women wi th or at risk of pregnancy complications. Conclusion: The main factors identified as responsible for the poor quality of care were inadequate pre-service and in-service training, lack of techn ical support supervision and absence of standard treatment guidelines.