Emergency obstetric care in the southernmost provinces of Thailand*

Objective. To assess the accessibility, utilization and quality of emergency obstetric care in the five southernmost provinces of Thailand. Methods. A descriptive study was conducted in the five southernmost provinces of Thailand including fifty-six government hospitals and the admitted obstetric women. The accessibility of hospitals that provided emergency obstetric care was assessed over a 3-month period. The utilization and quality of emergency obstetric care were reviewed using the data of obstetric women admitted in a 6-month period. The admitted women with major obstetric complications were identified by the hospital reports. The accuracy of the hospital reports was checked using Lot Quality Assurance Sampling. The accessibility, utilization and quality of emergency obstetric care services, as defined by the United Nations (UN) indicators. Results. There were 8.4 basic and 1.8 comprehensive emergency obstetric care hospitals per 500 000 population. The pro-portion of births in hospitals was 89.5%, and the adjusted percentage of women with major obstetric conditions treated in the hospitals was 95.5%. The caesarean section rate was 17.8%, and the case fatality rate caused by postpartum haemorrhage was 0.7%. Delays in seeking, reaching and receiving good care were detected in the causes of maternal deaths. Over-reporting due to double-counting and under-reporting of complications were found in the hospital reports. Conclusions. Emergency obstetric care in Southern Thailand met UN guidelines; however, there was a problem of delays in seeking treatment in some maternal deaths. Improvement of over- and under-reporting of obstetric conditions in the hospitals is needed