Observed versus expected obstetric complications: an assessment of coverage of obstetric care in developing countries

The objective of this study was to evaluate access to obstetric care in a rural district in East Africa using easily collected and evaluated data and avoiding expensive field surveys, complicated study design or statistical methods. The number of observed obstetric complications occurring during 12 months in a rural East African district hospital (the only institution with surgical facilities and access to blood transfusion in the district) were compared to the number of expected complications the district should 'generate'. Of the expected > 10000 deliveries < 25% took place in the district hospital. The place of confinement for the other deliveries was not determined. As compared to the total number of expected conditions within the study district < 25% of the breech and < 45% twin deliveries took part in the district hospital and < 10% of pregnancies complicated by placental abruptions and < 5% of the pregnancies complicated by placenta praevia were managed in the district hospital. Comparing the number of serious pregnancy complications which were managed in the hospital to the total expected number for a particular region allows a simple assessment of the accessibility of obstetric care. This ratio might be more useful when evaluating obstetric care than traditional parameters as it stresses the importance of accessibility of care for the whole community.