MAJOR OBSTETRIC INTERVENTIONS AMONG EIQCAMPED REFUGEES AND THE LOCAL POPULATION IN TURKANA DISTRICT, KENYA

Background: Maternal mortality in developing countries remains high due to lack ofappropriate emergency obstetric care. Major obstetric intervention (MOI) rate can be usedas an indicator of unmet obstetric needs and quality of care.Objectives: Identify indications for major obstetric interventions, determine M01 rates andassess extent of unmet obstetric need for women in Turkana district, Kenya.Design: Descriptive bi-directional study.Setting: Turkana district: Kakuma Refugee Camp, Kakuma Catholic Mission and Lodwar -District Hospitals.Subjects: Four thousand two hundred and eighty encamped refugee women and 7,630women from the host population delivering in Turk ma district between January 1995 andSeptember 1999.Data Sources: Maternity registers, inpatient case notes and theatre registers.Main outcome measures: Maternal mortality, perinatal mortality, major obstetricinterventions, unmet obstetric need and length of st ty.Results: The subjects from the two study populations were similar with respect to age, parityand indications for surgical intervention. Caesarea~t section was the only major obstetricintervention. Overall, caesarean section rate was sig iificantly higher among refugees thanin the host population (3.1 % versus 2.1 % , p<O.Ol; CI 1.4-2.1). Maternal indications were themain reasons for CIS in both populations, with the ds rate being higher for refugees than forlocal women (2.5% versus 1.7%). At least 0.8% of parturient women from the hostpopulation had unmet obstetric needs: this translata to 61 pregnant women who may havedied or experienced birth-related complications over the study period. The mean length ofhospital stay was much less for refugee women than fc r the host population (8.1 days versus11.3 days).Conclusion: Encamped refugee women in Kakuma lave better obstetric care than thosefrom the host population, and the level of unmet obst 3tric needs in the district is high. Thisimbalance could be reduced through resource sharing and integration of refugee health careservices with that for the host population