NEEDS ASSESSMENT STUDY FOR EMERGENCY OBSTETRIC CARE SERVICES IN GOALPARA, DHUBRI AND BARPETA DISTRICTS OF ASSA
Item
- Title
-
NEEDS ASSESSMENT STUDY
FOR EMERGENCY OBSTETRIC
CARE SERVICES IN
GOALPARA, DHUBRI AND BARPETA
DISTRICTS OF ASSA - extracted text
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NEEDS ASSESSMENT STUDY
FOR EMERGENCY OBSTETRIC
CARE SERVICES IN
GOALPARA, DHUBRI AND BARPETA
DISTRICTS OF ASSAM
By
Dr. Rupali Baruah
Dr. Gokul Ch. Das
Principal Investigators
Gauhati Medical College
Guwahati, Assam
CONTENTS
Page No.
Acknowledgements
Executive Summary
Background of the study
1
Objectives of the study
4
Methodology
4
Results and Observations
6
Performance of EmOC status of District Hospitals and CHCs
6
Status of Obstetric Admissions, Cesarean Sections,
7
Maternal Deaths, Obstetric Complications and CFR
Assessment of Infrastructure and Manpower Resources
15
Assessment of Furniture and Linen
21
Assessment of EmOC Equipment
25
Assessment of EmOC Drug List
35
Recommendations
40
ACKNOWLEDGEMENTS
Special thanks to Dr. Pankaj Mehta, Health Officer UNICEF and Dr. Kaninika
Mitra, APO, Safe Motherhood and Womens’ Health, HQ Kolkata, India for giving
me this opportunity to conduct this interesting survey in Assam.
I am also indebted to Dr. K N. Baruah, Principal-cum-Chief Superintendent of
Gauhati Medical College, Guwahati, Assam for permitting members from the
Department of Community Medicine and the Department of Obstetric and
Gynaecology to be involved in the survey study.
Highly indebted and special thanks to Dr. Gokul Ch. Das, Associate Professor of
Obstetric and Gynaecology, Gauhati Medical College who is also the Principal
Co-investigator of this study, who observed minutely every detail of the project
and for being the guiding light throughout the survey.
I am also thankful to Dr. Ratna Sharma, Professor and Head of the Department
of Community Medicine; Dr N.N. Sarma, Associate Professor; Dr B. Nath,
Assistant Professor; Mr. Jiten Sarma, Lecturer Statistics; all from the Department
of Community Medicine, Gauhati Medical College.
Thanks also to all the Post Graduates student for sincerely and diligently helping
with data collection in the field areas : Dr. Joydeep Das, Dr. Siddhartha Datta, Dr.
Nagen Sarma, Dr. Himadri Pathak, Dr. Jayanta Bhattacharjee and Dr. Gautam
Sarma.
I have special thanks for Mr. Rafi Ahmed, Media Centre, Guwahati for typing out
the whole draft.timely and preparing the electronic versions of the project report.
Principal Investigator :
Dr. Rupali Baruah
Assistant Professor
Department of Community Medicine
Gauhati Medical College
Guwahati-781 032.
Executive Summary
A survey report on “Needs Assessment of Emergency Obstetric Care in 3
districts of Assam” has been prepared in response to UNICEF’s plan of
monitoring the processes or interventions aimed at reducing maternal mortality.
While the primary responsibility for monitoring progress towards the goal of
reduction of maternal mortality lies with the government of each country, United
Nations Agencies, in co-operation with other national and international
organisations, have a critical role to play in supporting countries in this process.
In 1987 Safe Motherhood Conference in Nairobi first formulated the goal of
reduction of maternal mortality by half between 1990 and the year 2000. This
goal was re-emphasised at the 1994 International Conference on Population and
Development in Cairo and 1995 Fourth World Conference on Women in Beijing.
One of the critical pathways to reduce maternal mortality is improving the
accessibility, utilisation and quality of services for the treatment of complications
during pregnancy and childbirth. Evidence shows that atleast 15% of all pregnant
women develop sudden serious complications and require life saving access to
quality obstetric services.
This report prepared for the period January 2001 to December 2001 in the three
districts of Assam namely Goalpara, Dhubri and Barpeta will give an insight into
the status of emergency obstetric care in selected health institutions of the
districts in Assam.
The main objectives of this study was to assess the functioning of emergency
obstetric care services in three district hospitals and one CHC each of Goalpara,
Dhubri and Barpeta district of Assam. To assess the needs regarding facilities
equipment, drug and human resources. The pattern of obstetric admissions
including complicated cases and maternal deaths in these institutions in the
preceding year.
Of the six health institutions surveyed the three district / civil hospitals were found
to be all having the eight “signal functions” to be categorised as Comprehensive
EmOC. Of the three CHCs, Chapar and Pathsala were by status determination
were only basic EmOC, since there was no caesarean sections and blood
transfusion services. Rongjuli CMC was not even basic EmOC as three signal
functions including C-sections and blood transfusion services were not available.
Among the complicated case admissions fatality was highest in eclampsia / pre
eclampsia cases. CFR was also high in ruptured uterus, haemorrhage and other
obstetric causes. Only in induced / septic abortion, case fatality rate recorded
was less than one percent.
Linen was found in short supply in all the health facilities, so also basic
equipments like sphygmomanometer, stethoscope, ultrasonic fetal monitor,
thermometers and urinary catheters. Residences were not available for all
doctors and staff in / near the hospital premises.
Since record keeping was very poor in all the health institutions it is
recommended that the staff be trained and workshops held for proper and
scientific record maintenance.
Eclampsia room should be done away with as they are usually neglected. Rather
an “Eclampsia Corner” in the general ward be started for proper care and
adequate attention of the eclampsia cases.
Proper waste management training and provision of incinerators in all the
hospitals highly recommended. There is lack of bio-safety measures for lack of
which necessary equipments, linen and bio-safety awareness training should be
given to the hospital staff.
If all the lacunae found in the sample survey study is filled up, the six health
institutions surveyed can be made to provide comprehensive EmOC for
maximum utilisation.
Sharing of this partial survey data at national and international levels will
definitely go a long way to help the governments and international agencies to
plan for future programmes for Safe Motherhood.
NEEDS ASSESSMENT STUDY FOR EMERGENCY
OBSTETRIC CARE SERVICES IN 3 DISTRICTS OF ASSAM
BACKGROUND OF THE STUDY
Almost 600,000 women die every year from complications of pregnancy and
childbirth. For every one of these deaths, between 30 and 100 more women
suffer from acute maternal morbidities that are painful, debilitating and often
permanently disabling.
A women in the developing world is almost 40 times more likely to die from
complications of pregnancy and childbirth than a women living in an industrial
world.
While many other health indicators have dropped sharply over the last two
decades, maternal mortality rates and ratios have remained stagnant. The
causes are rooted in the inappropriateness of many interventions intended to
improve maternal health, as well as in the powerfulness of women (UNICEF :
Programming for Safe Motherhood).
Hence the rationale of this study in Assam on Needs Assessment EmOC as
proposed by UNICEF, Kolkata, Safe Motherhood and Women’s Health Section.
The state of Assam is situated in the North Eastern Region of India covering
78,438 sq. km land area demarcated into 24 districts. It has a population of
2,66,38,407 (2007 census of India).
Barpeta, Dhubri and Goalpara are three border districts of Assam lying on the
western range of the State. Barpeta shares a border with Bhutan, Dhubri with
Bangladesh and Goalpara with the neighbouring State of Meghalaya. Per capita
net domestic product of the State is only Rs. 518.9 (Directorate of Economics &
Statistics, Assam). Infant mortality rate in Assam is estimated at 75/1000 live
births when all India average is 70/1000. Birth rate is 29.3 and death rate is
9.4(Source : Sample Registration Bulletin, R.G.I., Jan 1998).
The total population of Dhubri district is 1,634,589 of which rural population is
1,444,043 and urban population is 190,546.The total population of Goalpara
District is 822,306 of which rural population is 755,017 and urban population is
67,289.The total population of Borpeta District is 1,642,420 of which rural
population is 1,517,280 and urban population is 125,140(Source: Population
census 2001)
One of the important objectives of the National Family Welfare Programme is to
reduce the maternal mortality. The causes of maternal death rate are the same
for women everywhere but the particular vulnerability of the women in the world’s
poorest nations is directly related to the non-fulfilment of several key human
rights and lack of accessible and functioning Emergency Obstetric Care Services
(EmOC).
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Map of Assam showing the districts of
Goalpara, Dhubri and Barpeta
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3
Assam’s high IMR and India’s Maternal Mortality Ratio of 437 deaths / 100000
live births definitely points to deficiencies in availability, accessibility and poor
utilisation of services.
A health centre that provides basic EmOC can prevent many maternal deaths.
Obstetric complications cannot really be predicted but can be managed
effectively, saving many lives if quality EmOC is available. For some conditions
like post partum haemorrhage EmOC services would be sufficient but for other
complications like obstructed labour, more complicated treatment is required
such as Comprehensive EmOC which includes caesarean sections and blood
transfusion services. Even with EmOC, and first aid, lives can be saved because
the woman’s condition can be stabilized before she is referred.
The term Emergency Obstetric Care (EmOC) covers some “signal functions” with
which to measure the care provided for obstetric complications in a given setting.
The short list of services that can save the lives of the majority of women with
obstetric complications are at two levels of care as defined by : (1) Basic EmOC
and (2) Comprehensive EmOC The main difference in these two is the provision
of caesarean sections and blood transfusions in Comprehensive EmOC. A list of
eight “signal functions” have been taken up which is shown below
Were the following services performed at least once during
the last 3 months?
Yes
No
(a) Parenteral antib[otics
(b) Parenteral oxytocics
(c) Parenteral sedatives/anticonvulsants
(d) Manual removal of placenta________
(e) Removal ofRetained products
(f) Assisted vaginal delivery_
(g) Blood transfusion
(h) Cesarean section
Determination of EmOC status :
In the above table, (1) if a-h is yes, then status of health centre
is
Comprehensive EmOC, (2) if a-f is yes and g & h is no then status is Basic
EmOC, (3) If any of a-f is no, then status of health centre is not EmOC.
4
OBJECTIVES OF THE STUDY
1. To assess the functioning of the district hospitals and Rongjuli, Pathsala
and Chapor CHCs of Goalpara, Dhubri and Barpeta districts of Assam
respectively, regarding provision of emergency obstetric care services.
2. To find out the pattern of obstetric admissions including complicated cases
and maternal deaths in these institutions last year.
3. To assess the need regarding infrastructure, facilities, furniture, linen,
equipment, drugs and human resources required for providing obstetric
care in the above mentioned institutions.
4. To suggest specific recommendations to make these institutions functional
for providing comprehensive emergency obstetric care services.
METHODOLOGY
Three border districts of Assam, viz., Goalpara, Dhubri and Barpeta were taken
as a cluster for partial survey initially for Needs Assessment Study for Emergency
Obstetric Care Services (NA-EmOC). These three districts of Assam have been
picked up for the survey as based on Director of Health Services, Assam’s data
on RCH and Safe Motherhood and also UNICEF, Kolkata’s specific proposal.
In each of the three districts of Goalpara, Dhubri and Barpeta two health
institutions namely District Hospital / Civil Hospital and the CHC designated and
approved as FRU by the Government were taken up for the evaluation study.
Hence a total of six health facilities were studied using standardised proforma.
They are
1. Goalpara Civil Hospital
2. Rongjuli CHC
3. Dhubri Civil Hospital
4. Chapor CHC
5. Barpeta Civil Hospital
6. Pathsala CHC
The above six institutions were studied in regard to obstetric and complicated
admissions, infrastructure, manpower, furniture and linen, EmOC equipment,
EmOC drug list, services available so as to determine whether the health facilities
are giving Comprehensive EmOC or Basic EmOC or not having any EmOC
services and facilities.
Collection of Data
Data was collected using pre-designed pre-tested proforma. A set of
standardised Forms 1-6 were supplied by UNICEF, Kolkata to be used per set at
each health institution. Hence a total of 36 forms were filled up with requisite
information at the six health facilities. Computerised analysis of the data was
done.
6
RESULTS AND OBSERVATIONS
PERFORMANCE OF EMOC STATUS OF DISTRICT HOSPITALS AND CHCs
District Hospitals
The three District / Civil Hospitals assessed namely Goalpara Civil Hospital,
Dhubri Civil Hospital and Barpeta Civil Hospital are all (having) Comprehensive
EmOC services performing all the following eight signal functions in three months
preceding the survey
(a) Parenteral antibiotics
(b) Parenteral oxytocics
(c) Parenteral sedatives/anticonvulsants
(d) Manual removal of placenta
(e) Removal of retained products
(f) Assisted vaginal delivery
(g) Blood transfusion
(h) Caesarean section
During the last three months these services were available for 24 hours
(a) Always at Goalpara Civil Hospital
(b) Most of the time at Dhubri Civil Hospital
(c) Most of the time at Barpeta Civil Hospital
The above 8 services were performed at least once during the last three months
in all the three civil hospitals.
In all the above three health institutions data was collected following review of
records and interview of doctors and nursing staff, Superintendents of the
respective hospitals and Joint Director of the district concerned.
Record keeping and maintenance was poor in almost all the civil hospitals and
the CHCs except Dhubri Civil Hospital and Chapar CHC where record
maintenance was fair. Hence most of the data collections were done relying on
verbal discussions and interviews with the doctors, nursing staff, the medical
superintendents of the civil hospitals and Joint Director of the respective district.
Community Health Centres (CHCs)
The EmOC status of the 3 CHCs were assessed and none had Comprehensive
EmOC. Pathsala CHC and Chapar CHC’s status was Basic EmOC whereas
Rongjuli CHC was not EmOC. In Rongjuli CHC there was no Gynaecologist. The
doctors present did not practice manual removal of placenta. Retained placenta
cases were referred out to Goalpara Civil Hospital.
In all the 3 CHCs namely Rongjuli CHC, Chapar CHC and Pathsala CMC there
were no blood transfusion and caesarean section services.
7
Chapar
Rongjuli
Were the following services performed
at least once during the last 3 months?
(a) Parenteral antibiotics
(b) Parenteral Ozxytocics
(c) Parenteral
sedatives/a nticonvulsants______
(d) Manual removal of placenta
(c) Removal of retained products
(f) Assisted vaginal delivery
(g) Blood transfusion
(h) Cesarean section
Yes
No’
No
Yes
Pathsala
No
Yes
Z
STATUS OF OBSTETRIC ADMISSIONS INCLUDING COMPLICATED CASES,
DELIVERIES, C-SECTIONS, MATERNAL DEATHS AND CFR IN LAST ONE
YEAR (JAN 2001 TO DEC 2001)
GOALPARA CIVIL HOSPITAL
Goalpara
Dhubri
Barpeta
TOTAL OBSTETRIC ADMISSIONS
1902
3285
1155
DELIVERIES
788
2359
1113
Emergency
40
142
Elective
11
26
51
168
1
2
C-SECTIONS
TOTAL C-SECTIONS
MATERNAL DEATHS
Haemorrhage (ante- and post-partum)
Obstructed/prolonged labour
Ruptured uterus
2
4
Post-partum sepsis
1
2
Pre-eclampsia/eclampsia
11
Induced/septic/ incomplete abortion
1
20
Ectopic pregnancy
Total maternal deaths due to major obstetric causes
17
27
Other obstetrical maternal deaths
2
18
TOTAL MATERNAL DEATHS
19
45
10
26
OBSTETRIC COMPLICATIONS -ADMISSIONS
Haemorrhage (ante- and post-partum
11
8
Obstructed/prolonged labour
37
22
Ruptured uterus
7
15
Post-partum sepsis
3
2
Pre-eclampsia/eclampsia
44
85
13
Induced/septic /incomplete abortion
151
738
18
Ectopic pregnancy
3
11
1
Total obstetric complications due to major causes
256
899
46
Referrals out due to major obstetric causes
5
Other obstetric complications
5
27
10%
7.69%
CASE FATALITY RATE
3
27
8
(# of deaths/# of cases)
Haemorrhage (ante- and post-partum)
Obstructed/prolonged labour
Ruptured uterus
9.09%
57.14%
Post-partum sepsis
6.67%
100%
Pre-eclampsia/eclampsia
25%
Induced/septic abortion
0.66%
23.53%
Ectopic pregnancy
Case fatality rate due to major obstetric causes
6.64%
3%
Case fatality rate due to other obstetric causes
40%
66.67%
In Goalpara Civil Hospital total obstetric admissions from January 2001 to
December, 2001 was 1902 of which total deliveries was 788.
Total caesarean sections was 51 of which Emergency C.S. totalled 40 and
Elective C.S. was 11. Hence percentage of C.S. was 6.47%.
Goalpara Civil Hospital records showed total maternal deaths for the year 2001
as 19 of which maternal deaths due to (a) Haemorrhage (ante & post partum) - 1
(b) Ruptured uterus - 4 (c) Pre-eclampsia / eclampsia - 11 (d) Induced / septic /
incomplete abortion - 1 (e) Other obstetrical maternal deaths - 2.
Maternal mortality ratio in the institution was 998/lac. MMR shows very high rate
as denominator was only 1902, which is the total obstetric admission. Since it is
not a community based study and catchment area of the health institution is not
known, it is difficult and very unreliable to calculate MMR from this data. It is to be
noted that health facility data are not suitable for calculating maternal mortality
rates or ratios because not all maternal deaths that occur in the population take
place in health facilities. In developing countries like India the proportion of
deaths- that take place outside health facilities is often high, though generally
unknown. Population surveys are more reliable for these calculations. The
population of Goalpara district, according to 2001 census, is 822306 of which
rural population is 755017 and urban population is 67289
9
Regarding admission of obstetric complications due to major causes the total for
the year 2001 was 256. The break-up was as follows
Total Admn. Death
CFR %
10
1
10
(a) Haemorrhage (ante & post partum)
37
(b) Obstructed/prolonged labour
8
4
50
(c) Ruptured uterus
3
(d) Post partum sepsis
44
11
25
(e) Pre-eclampsia / eclampsia
151
1
0.66
(f) Induced / septic / incomplete abortion
3
(g) Ectopic pregnancy
40
5
(h) Other obstetrical maternal deaths
2
CFR in haemorrhage, ruptured uterus, pre-eclampsia / eclampsia is very high per
guidelines assessment where the case fatality rate among women with obstetric
complications in EmOC facilities is less than 1%.
Only in case of induced / septic / incomplete abortion the CFR was 0.66% which
was less than 1 %.
There were no deaths reported from ectopic pregnancy, post partum sepsis and
obstructed / prolonged labour.
Diagram showing causes of maternal deaths in
EJ Haemorrhage (anteGoalpara Civil Hospital
and post-partum)
11%
5%
■ Ruptured uterus
5%
--
□ Pre-eclampsia/
eclampsia
■ Induced/septic/
incomplete abortion
58%
■ Other obstetrical
maternal deaths
There were no reported deaths due to obstructed / prolonged labour, post partum
sepsis and ectopic pregnancy. It is seen from the pie diagram that maximum
number of maternal deaths in Goalpara Civil Hospital is due to eclampsia/preeclampsia. This is mainly due to inadequate attention given to these patients as
they are segregated in dark small rooms away from the general wards and the
nurses station. Next common cause of maternal deaths is ruptured uterus. These
are usually cases who come without ante-natal check-ups at the last moment to
the hospital with severe complications. When immediate intervention is not done,
usually the cases end up with ruptured uterus.
10
' y
h I
i
View of the Labour Room at Barpeta Civil Hospital
■ffe'
Eb
BS'?
■
Dark and dingy Eclampsia Room in
Dhubri Civil Hospital
I
rt]
i
I'
• 'll! W,
i
The Medical Records Room in
Dhubri Civil Hospital
11
DHUBRI CIVIL HOSPITAL
Total obstetric admissions for the year January 2001 to December 2001 was
3285 of which total deliveries for the year was 2359.
Total C-Sections was 168 of which 142 were Emergency C.S. while 26 were
Elective. Hence the percentage of C-Section in the institution for the year 2001
was 7.12%.
Total maternal deaths due to major obstetric causes is 27 and due to other
obstetrical causes is 18. Hence we have total maternal deaths of 45. Other
obstetrical maternal deaths include
- Retained placenta
- Pregnancy with Malaena
- Pregnancy with Anaemia
- Pregnancy with PUO
- Amniotic fluid embolism
- Pregnancy with intestinal obstruction.
In Dhubri Civil Hospital we have 899 total obstetric complications due to major
causes and 27 due to other obstetric complications. The break-up of the major
obstetric complication and the case fatality rate (CFR) are as follows
CFR %
Total Admn. Death
7.69
26
2
(a) Haemorrhage (ante & post partum)
2
9.09
22
(b) Obstructed/prolonged labour
15
1
6.67
(c) Ruptured uterus
100
2
2
(d) Post partum sepsis
23.53
85
20
(e) Pre-eclampsia / eclampsia
738
(f) Induced / septic / incomplete abortion
11
(g) Ectopic pregnancy
18
66.67
27
(h) Other obstetrical maternal deaths
In comparison to Goalpara Civil Hospital and Barpeta Civil Hospital, where record
keeping in very poor, Dhubri Civil Hospital has fair records. CFR is showing very
high percentage in all the categories because only the very serious cases are
brought to the health institution in these rural areas. Hence, compared to total
admission the death rate is very high. Hence, CFR is also high. It is seen from
the above that CFR % for eclampsia / pre-eclampsia is very high being 23.53.
One vital observation made was that the eclampsia / pre-eclampsia cases are
very neglected in most of the health facilities. These cases are segregated in
small dark rooms away from the general ward. Separate Nurses’ Station for these
patients are usually non-existent. Often when eclampsia / pre-eclampsia patients
undergo convulsions it is not noticed by the doctors and staff. Under such
circumstances of negligence CFR in eclampsia / pre-eclampsia is generally very
high.
12
Diagram showing causes of maternal deaths in
Dhubri Civil Hospital
r4%
4% I
2%
4%
9 H aemo rrhage (ante- and
post-partum)
■ 0 bstruc ted/pro Io nged
labour
□ Ruptured uterus
41%1
□ Post-partum sepsis
■ P re-ec la m ps ia/ ec la m ps ia
45%
□Otherobstetrical maternal
deaths
The most common cause of maternal deaths at Dhubri Civil hospital is due to
eclampsia/pre-eclampsia (45%). The cause again is inadequate attention and
segregation of cases in separate eclampsia rooms. Next common cause of
maternal death (41%) is due to other obstetrical causes. Common causes found
in Dhubri Civil Hospital under this heading were retained placenta, pregnancy
with Malaena, pregnancy with anaemia, pregnancy with PUO, amniotic fluid
embolism and pregnancy with intestinal obstruction. There were no deaths due to
induced / septic / incomplete abortion and due to ectopic pregnancy.
BARPETA CIVIL HOSPITAL
Total obstetric admissions from January, 2001 to December 2001 were 1155 of
which total deliveries were 1113.
Total caesarean sections were only 22. Hence the percentage of C.S. was only
1.97%. Infrastructure and manpower was not lacking but there was lack of
motivation on the part of the doctors, mainly the OBGY Specialist and
Anaesthtist. C-sections were done on a regular basis at the private nursing
homes at Barpeta Road which is about 18 km away from the Civil Hospital by
same doctors. Doctors during interview reported that the figures of eclampsia and
septic abortion are much more but proper records are not available. Maternal
deaths reported are few in number but proper records are not available.
Total obstetric complications due to major causes was 46 of which the break up
was as follows
11
(a) Haemorrhage (ante & post partum)
3
(b) Obstructed/prolonged labour
(c) Ruptured uterus
(d) Post partum sepsis
(e) Pre-eclampsia / eclampsia
13
(f) Induced / septic / incomplete abortion
18
(g) Ectopic pregnancy
1
13
No records of maternal deaths in Barpeta Civil Hospital.
RONGJULI / CHAPOR / PATHSALA CHC
Rongjuli
TOTAL OBSTETRIC ADMISSIONS
96
DELIVERIES
96
Chapar
PathsaJa
971
68
915
C-SECTIONS
Emergency
Elective
TOTAL C-SECTIONS
MATERNAL DEATHS
Haemorrhage (ante- and post-partum)
Obstructed/prolonged labour
Ruptured uterus
1
Post-partum sepsis
Pre-eclampsia/eclampsia
Induced/septic/ incomplete abortion
1
Ectopic pregnancy
Total maternal deaths due to major obstetric causes
2
Other obstetrical maternal deaths
TOTAL MATERNAL DEATHS
2
OBSTETRIC COMPLICATIONS -ADMISSIONS
Haemorrhage (ante- and post-partum
7
14
Obstructed/prolonged labour
14
4
Ruptured uterus
1
Post-partum sepsis
6
Pre-eclampsia/eclampsia
12
5
Induced/septic /incomplete abortion
81
13
Total obstetric complications due to major causes
121
36
Referrals out due to major obstetric causes
50
48
Other obstetric complications
17
5
Ectopic pregnancy
CASE FATALITY RATE (# of deaths/# of cases)
Haemorrhage (ante- and post-partum)
Obstructed/prolonged labour
Ruptured uterus
Post-partum sepsis
Pre-eclampsia/eclampsia
100%
14
1.23%
Induced/septic abortion
Ectopic pregnancy
Case fatality rate due to major obstetric causes
1.65%
Case fatality rate due to other obstetric causes
As regards Rongjuli CMC only total number of admissions and total deliveries
were recorded from the centre which is 96 each. There was no records of
maternal deaths.
In Chapor CHC the total deliveries being 68 and the total number of maternal
deaths recorded is 2. Total admissions for Obstetric complications is
(a) Haemorrhage (ante & post partum)
7
(b) Obstructed/prolonged labour
14
(c) Ruptured uterus
1
(d) Post partum sepsis
6
(e) Pre-eclampsia / eclampsia
12
(f) Induced / septic / incomplete abortion
81
(g) Ectopic pregnancy
(h) Other obstetric complications
17
Other obstetric complications include any one or more than one of the following
- IUGR + PROM
- Anaemia
- Retained placenta with Anaemia
- Post partum eclampsia
- IUD with obstructed labour
CFR in Chapor CMC being
(a) Haemorrhage (ante & post partum)
(b) Obstructed/prolonged labour
(c) Ruptured uterus
(d) Post partum sepsis
(e) Pre-eclampsia / eclampsia
(f) Induced / septic / incomplete abortion
(g) Ectopic pregnancy
(h) Other obstetrical maternal deaths
Total Admn.
7
14
1
6
12
81
Death
CFR %
1
100
1
1.23
17
In Pathsala CHC total obstetric admission is 971 and total deliveries is 915. No
records of C-Section and maternal deaths is available. No CFR could be
calculated as no records of maternal deaths. The total admissions recorded of
obstetric complications from January 2001 to December 2001 is as follows
(a) Haemorrhage (ante & post partum)
14
(b) Obstructed/prolonged labour
4
(c) Ruptured uterus
(d) Post partum sepsis
15
(e) Pre-eclampsia / eclampsia
(f) Induced / septic / incomplete abortion
(g) Ectopic pregnancy
(h) Other obstetric complications
5
13
5
ASSESSMENT OF INFRASTRUCTURE & MANPOWER RESOURCES
In District Civil Hospitals
Goalpara Civil Hospital
Biosafety Measures
Ambulance Service BHHHHHBRMHMi
______
ResirHu i.-t: A-:- i.vdab-.-n F"' ' '
Laboratory
:/ • : I
Blood Bank / Blood Storage Unit
Wards ■■
}
Emergency Room f
Utilities
]
Sluice Room
Delivery Room j
1
'
Septic Operatic i '■ heaIre I
S
Operation Theatre
■ Avaiiable/Fucrrtional
Available/Non-fucntionai H Not Available
Dhubri Civil Hospital
Biosafety Measures
...JSi
Ambulance Service
Residential Accommodation
Laboratory
Blood Bank / Blood Storage Unit
Wards
Emergency Room
-
■
...
,
■
■
Utilities
I
Sluice Room
Delivery Room
Septic Operation Theatre
Operation Theatre
■ Available^ucntional DAvailable/Non-fucntional ■ Not Available
16
I'
■
Labour Room, Chapar CMC
I
*
p :: 1
1
..
I
Baby Room, Chapar CMC
17
Barpeta Civil Hospital
Biosafety Measures
__
-
Ambulance Service
Residential Accommodation
i
__
Laboratory
Blood Bank! Blood Storage Unit
f=
Wards ■MMMMMMI
Emeroencv Roon
|
____ ...
siiuce Room
i:rityke.!, :i
» •'.
..r
Sept^ Operation Theatre ta||||||||
Operaton Theatre LmMB
I
■ Avaiiable/Fucntional
AvailaWe/Non-fucntional ■Not Available i
Staffing pattern in the Civil Hospitals in the three district headquarters are as
follows :
Goa para_____
Dhubri______
Barpeta______
Posts
Posts
Posts
Staff
Posts
Posts
Posts
Filled/
Filled/
Filled/
Sanctioned
Sanctioned
Sanctioned
Residence
Residence
Residence
OBGY specialist
5
6
6/ Yes
5/ Yes
3
3/Yes
Surgeon
4
4/ Yes
4
4/ Yes
2
2
General Duty
Doctor (MBBS)
3
3/ Yes
3
3/ Yes
19
19
Anaesthetist
3
3/ Yes
1
1/Yes
1
1
Blood
Technician
2
2/ Yes
4
4/ Yes
2
2
Nurses
25
25/ Yes
60
60/ Yes
32
32/ Yes
Lab Technician
4
4
3
3
OT Sister
4
4
3
3/ Yes
1
1
OT Attendant
4
4
1
1/ Yes
1
1
Ambulance
Driver
1
1/ Yes
2
2/ Yes
2
2
Comments : Staff position is satisfactory except in Dhubri where there is no
sanctioned post of Laboratory Technician. There is no resident Anaesthetist in
Barpeta Civil Hospital. No resident OT Sister and OT Attendant which is
18
necessary for smooth functioning of Comprehensive EmOC in Goalpara and
Barpeta districts. There is no accommodation for Blood Technician in Barpeta
Civil Hospital. In addition to these, a post of Paediatrician may be created in ail
the District Hospitals.
In CHCs
Rongjuli CMC
Biosafety Measures f ‘
Ambulance Service
Residential Accommodation
....... / ; '.' ' '..........
•• ' ......................
Laboratory
Blood Bank / Blood Storage Unit
■ Available/Fucriional
Wards
Avajlable/No n-f ucntional
Emergency Room
■ Nat Available
Utilities
Sluice Room
i""'1". .
I
Delivery Room
'
.
. .
i
~
Septic Operation Theatre iBBHHiMHMi
Operation Theatre
Chapar CHC
Biosafety Measures
Ambulance Service
—„u..u.uu
Residential Accommodation
Laboratory
Blood Bank / Blood Storage Unit
r— --------■ Available/F ucntional
Wards
i
Emergency Room
Utilities
Sluice Room
Delivery Room
Septic Operation Theatre
Operation Theatre
•
Available/No n-f uc ntiona I
--------------------------------------
.................. ■=—
I III.......
Ill IIIIIIIHI llllll llllllll I I
■Not Available
19
rWwl
I
Operation Theatre in Barpeta Civil Hospital
Operation Theatre, Barpeta Civil Hospital
A view of the Operation theatre in
Goaloara Civil Hospital
20
Pathsaia CHC
Biosafety Measures
Ambulance Service
z
Residential Accommodation ■||p|
I
Lduoraluiy ■■
Blood Bank / Blood Storage Unit
wa,ds ■■
Hl
S Available/F ucntional
□ Avaiiable/Non-f ucnlional
EtTiergency Room
■ Not Available
Utilities
Sluice Room
1
Delivery Room
]
Septic Operation Theatre
1
Operation Theatre
in case of the CHCs the staffing pattern is as follows :
Chapor______
Pathsaia_____
Rongjuli______
Posts
Posts
Posts
Posts
Posts
Staff
Posts
Filled/
Filled/
Filled/
Sanctioned
Sanctioned
Sanctioned
Residence
Residence
Residence
't
OBGY specialist
1
1
Surgeon
General Duty
Doctor (MBBS)
5
5/ Yes
6
6
Anaesthetist
Blood
Technician
1
1
6
6
1
1
Nurses
6
5/ Yes
15
15
7
7
Lab lechnician
1
1/Yes
2
2
1
1
OT Sister
1
1
OT Attendant
1
1
1
1
1
1
Ambulance
Driver
1
1/ Yes
Comments : in Rongjuli CHC there is a sanctioned post of OBGY Specialist but
the post is not filled up. There is no sanctioned post of Anaesthetist, Blood
Technician and OT Attendant, in Chapor there is no sanctioned post of OBGY
Specialist and Anaesthetist, in Pathsaia there is no sanctioned post of Blood
21
Technician, OT Sister and OT Attendant. Hence the deficient posts have to be
sanctioned and filled up to make the health institutions a Comprehensive EmOC.
ASSESSMENT OF FURNITURE AND LINEN
in District Hospitals
Assessment for Furniture & Linen in the Civil Hospitals
IS
16
14
12
10
8
6
4
|
t
r
□ Operatio n Theatre
■ Linen for operations
i
HLabor/Deiivery
n
-
i
■ Linen for Labor/Delivery
BWard(si
I
2
0
Quantity
AvailableS
Functional
r
-—t l
Quantity
Available
but not
Functional
GOALPARA
Not Avalable
Quantity
I 11 L I
Avalable
& r-iiKttoneiI
Quantity
Availdjie
but not
Functional
Not Available
DHUBRI
Quantity
Ava'ldblt
& Functional
I
Quantity
A«slcbie
but not
Not Avalable
Fmctional
BARPETA
Comments : Regarding Furniture and Linen Goalpara Civil Hospital had quantity
available and functional of most of the items except leggings under linen for
operations and linen for labour and delivery. Patient gowns were not available, in
the wards food trolley for patients was not available so also pillows with
waterproof covers and patient gowns, towels and cleaning cloths. Ail the rest
items assessed were available and functional.
In Barpeta Civil Hospital under operation theatre all the items were available and
functional except that the Nursing station and doctors room were both very small.
The Barpeta Civil Hospital will soon be shifted to a new complex. Linen for
labour/delivery room were all not available. Linen was always in short supply and
the patients were asked to buy the necessary linen. In the wards the items not
available were benches for relatives, patient gowns, towels, cleaning cloths. The
mattresses and pillows although available were without waterproof covers.
In Dhubri Civil Hospital all items were available and functional in the operation
theatre. Most of the linen for operations were not available. Only items available
were gowns, glove covers and laparotomy / other sponges. Under linen for labour
/ delivery items not available were drapes, half sheets, pack/instrument wrappers,
glove covers, cloth to clean and wrap neonate,. Disposable gloves were
commonly used. There were aprons for doctors but not for nursing staff. Bed
sheets, patient gowns and towels were not available. In the wards, items not
available were wheel chairs, patient gowns, cleaning cloths. Mattresses and bed
sheets although available were in short supply.
22
View of the Minor Operation Theatre at
Dhubri Civil Hosoital
ig ?
: is
■if
fa
A view of the proposed Operation Theatre in
Pathsala CHC
23
Labour Room, Pathsala CMC
I®
Labour / Deliverv Room. Dhubri Civil Hosoital
Labour Room, Goalpara Civil Hospital
24
In CHCs
Assessment of Furniture & Linen in the CHCs
18
16
14 I
O Operation Theatre
12 wtjjiSwpife
■ Labor/Delivery
■ linen for operations
■ Linen for Labor/Delivery
■ Ward(s)
10
!;
1
'.. 'ffll
f
Quantity
Avalableft
Functioned
Quantity
A vailable
but not
Functional
RONGJULI
Not
Available/
Renarks
nlfc
1
Quantity
Available
& Functional
I J
Ll I
Not
Available/
Quantity
Available
Quantity
Available
Remains
& FunctionalI
Finctionai
but not
Functional
CHAPOR
PATHSALA
Quantity
Available
but not
Not
Available/
Remarks
Comments : In the Rongjuli CHC, OT has not been constructed, so all the items
for operation theatre and linen for operations were not available. Under
labour/delivery head items available were delivery table with stirrups, revolving
stool, cloth to clean and wrap neonate, rubber sheets, sterile sanitary pads, bed
sheets, blanket for mother and baby. Standing spotlight was available but not
functional. Rest of the items were not available. In the wards there were 20 beds
and most of the furniture were available except patient food trolley, benches for
relatives, patient trolley, wheel chairs, stretchers, pillow cases, patient gowns and
towels.
In Chapor CHC most of the items under the heading operation theatre were
available but not functional. Only the table and chairs in the nursing station and
doctors room were available and functional. Under heading linen for operations,
no items were available. In the labour / delivery room, only items available and
functional were one delivery table with stirrups, two standing spotlights and two
revolving stools. One brand new delivery table with stirrups was in the store. No
linen for labour / delivery was available. In the ward there were 11 beds. Only
items available and functional were stretchers, table and chairs for nursing station
and doctors room and medicine cupboards. Rest none of the items were
available.
In Pathsala CHC only items available under heading of operation theatre were
instrument trolley and revolving stool. Operating table with stirrups and standing
spotlights were available but not functional. No linen for operations were
available. Under heading of labour / delivery items available were delivery table
with stirrups, standing spotlight, revolving stool. Items available under heading of
linen for labour / delivery were drapes, half sheets, sterile sanitary pads, bed
sheets, blanket for mother. In the wards there were 10 beds and items available
25
were stretchers, table and chairs for doctors and nursing station, medicine
cupboards, mattresses and pillows without waterproof covers, bed sheets and
pillow cases. Patient food trolley and patient trolley were available but not
functional.
ASSESSMENT OF EmOC Equipment
IN DISTRICT HOSPITALS
Goalpara Civil Hospital
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(k)
(l)
(m)
(n)
Available/
Functional
23
Basic Equipment_________________________
Delivery Pack___________________________
Perineal /Vaginal /Cervical Repair Pack_______
Eqpt. for Vacuum Extraction or Forceps Delivery
Obstetric Laparotomy/Caesarean Section Pack
Equipment for Craniotomy_________________
Neonatal Resuscitation Pack_______________
Basic Equipment for Uterine Evacuation_______
Manual vacuum aspiration_________________
Electrical Suction apparatus________________
Anaesthesia Equipment___________________
Ultrasonic fetal monitor____________________
Essential Materials for the Provision
of Donor Blood for Transfusion_____________
Side Laboratory
Available/Non
-functional
Not Available
9
9
3
27
6
11
1
8
3
1
2
14
1____
26
1
21
26
Assessment of EmOC equipment in
Goalpara Civil hospital
■
11 si
(a)
(b)
(c)
(d)
(e)
(f)
I
(g)
(h)
(0
(j)
(k)
(1)
(m)
(n)
Il Available/Functional ■ Available/Non-functional nNot Available
Comments : In Goalpara Civil Hospital under heading Basic Equipment all the
equipments listed are available and functional. Under delivery pack all the
equipments listed are available and functional. Total number of delivery packs
available was two. Under the heading perineal / vaginal / cervical repair pack all
the equipments are available. It is to be noted that vaginal speculum (Hamilton
Bailey) is not used nowadays but Sim’s Vaginal Speculum double bladed is
26
available and functional. Under equipment for vacuum extraction or forceps
delivery, except vacuum extractor all are available. Under heading of obstetric
laparotomy all the equipments are available. All the equipments for craniotomy,
neonatal resusctation pack and basic equipment for uterine evacuation are all
available and functional. Under the heading manual vacuum aspiration silicone
lubricant, metal canula are not available. Under the heading of electrical suction
apparatus all the equipments are available and functional. Ultrasonic fetal monitor
is available and functional. Under essential materials for donor blood for
transfusion all materials are available except 20% bovine albumin for cross
matching. In the side laboratory the available items are microscope, immersion
oil, glass rods, measuring cylinder (50ml), interval time clock and methanol.
Under the subhead thick blood films for malaria parasites both items are
available. Under the subhead total and differential WBC count, all items are
available. Under the subhead Estimation of haemoglobin, hydrochloric acid
solution is not available. Under the subhead Erythrocyte volume fraction
(Haematocrit) except microhaematocrit centrifuge, the other items are not
available. Under the subhead detection of glucose in urine, Benedict solution,
pipette, test tube holder and spirit lamp is available and functional. Under the
subhead detection of ketones in urine, dropping pipette and glacial acetic acid is
available. Under the subheads detection of protein in urine, detection of bile
pigments in urine and detection of urobilinogen in urine, the items listed are not
available.
Dhubri Civil Hospital
Available/
Functional
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
1*1
(l)
(m)
(n)
Basic Equipment_________________________
Delivery Pack___________________________
Perineal /Vaginal /Cervical Repair Pack_______
Eq pt. for Vacuum Extraction or Forceps Delivery
Obstetric Laparotomy/Caesarean Section Pack
Equipment for Craniotomy_________________
Neonatal Resuscitation Pack_______________
Basic Equipment for Uterine Evacuation_______
Manual vacuum aspiration_________________
Electrical Suction apparatus________________
Anaesthesia Equipment___________________
Ultrasonic fetal monitor____________________
Essential Materials for the Provision
of Donor Blood for Transfusion_____________
Side Laboratory
/5~
g Ql
Available/Non
-functional
/
7^/ Pflcit,)
Not Available
7
l
3
---
=3=2
J
__ I______
IO
3
I
16
4-
27
I
Laboratory, Pathsala CHC
[“^1
•S
A view of the Laboratory, Dhubri Civil Hospital
Blood Bank. Dhubri Civil Hospital
28
Assessment of EmOC equipment in Dhubri Civil
Hospital
I
(a) (b) (c) (d) (e) (f) (g) (h) (i)
(j) (k) (I) (m) (n)
B Available/Functionai ■ Available/Non-functional
Not Available
In Dhubri Civil Hospital under heading Basic Equipment the equipments listed
not available are Stethoscope, clinical oral thermometer, low reading
thermometer, surgeon’s hand brush, adult ventilator bag and mask, mouth gag
and sharps disposal containers. The item which is available and not functional is
Instrument sterilizer, rest of the items are available and functional. Under delivery
pack all the equipments listed are available and functional. Total number of
delivery packs available was two. Under the heading perineal / vaginal / cervical
repair pack all the equipments are available. It is to be noted that vaginal
speculum (Hamilton Bailey) is not used nowadays but Sim’s Vaginal Speculum is
available and functional. Under equipment for vacuum extraction or forceps
delivery, except obstetric forceps, outlet all items are unavailable. Under heading
of obstetric laparotomy all the equipments are available. All the equipments for
craniotomy, all items are available and functional except for infant laryngoscope
with spare bulb and batteries, endotracheal tubes 3.5 and 3.0. Under the heading
basic equipment for uterine evacuation al! items are available and functional.
Under the heading manual vacuum aspiration silicone lubricant, adapters and
metal cannulae are not available. Under the heading of electrical suction
apparatus all the equipments are available and functional except the
endotracheal tubes with cuffs (8 and 10mm) and endotracheal tube connectors
15mm plastic. Ultrasonic fetal monitor is not available. Under essential materials
for donor blood for transfusion all materials are available except microscope
illuminator and pipettes of 1, 10 and 20ml. In the side laboratory the available
items are microscope, immersion oil, glass rods, rack for drying slides, Leishman
stain. Under the subhead thick blood films for malaria parasites field stain A and
B is available. Under the subhead total and differential WBC count, all items are
available. Under the subhead estimation of haemoglobin, both items are
available. Under the subhead Erythrocyte volume fraction (Haematocrit) all the
items are not available and investigations not done. Under the subhead detection
of glucose in urine, all items are available and functional except indicator papers
and tablets and beaker 50ml. Under the subhead detection of ketones in urine, all
items are not available. Under the Subheads detection of protein in urine, only
TrKffcatyor papers and tablets are not available. Under the subhead detection of
29
bile pigments in urine and detection of urobilinogen in urine, the items listed are
not available.
Barpeta Civil Hospital
Available/
Functional
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(k)
(l)
(m)
(n)
Basic Equipment_________________________
Delivery Pack___________________________
Perineal /Vaginal /Cervical Repair Pack_______
Eq pt. for Vacuum Extraction or Forceps Delivery
Obstetric Laparotomy/Caesarean Section Pack
Equipment for Craniotomy_________________
Neonatal Resuscitation Pack_______________
Basic Equipment for Uterine Evacuation_______
Manual vacuum aspiration_________________
Electrical Suction apparatus________________
Anaesthesia Equipment___________________
Ultrasonic fetal monitor____________________
Essential Materials for the Provision
of Donor Blood for Transfusion_____________
Side Laboratory
Available/Non
-functional
Not Available
1
I
__8l_____
<2^
A
-L-
1A-
1
AS
18
eg?
Assessment of EmOC equipment in Barpeta Civil
Hospital
(a) (b) (c)
(d) (e)
(f)
(g) (h)
(i)
0)
a Available/Functional ■ Available/Non-functional
(k)
(I) (m) (n)
Not Available
In Barpeta Civil Hospital under heading Basic Equipment the equipments listed
are available except Sphygmomanometer (doctor use their own personal
instruments). Also not available are low reading thermometers, surgeons hand
brush, heat source, syringes and needles, adult ventilator bag and musk, mouth
gag and sharps disposal containers. Under delivery pack all the equipments
listed are available and functional. Total number of delivery packs available was
two. Under the heading perineal / vaginal / cervical repair pack all the equipments
are available. Under equipment for vacuum extraction or forceps delivery, except
vacuum extractor and obstetric forceps mid cavity all items are available and
functional. Under heading of obstetric laparotomy all the equipments are
available except intestinal clamps curved and straight. Equipments for craniotomy
is not available. Under neonatal resuscitation pack suction catheter Ch 12 is
30
available and not functional. Suction catheter Ch 10 , infant laryngoscope and
endotracheal tubes 3.5 and 3.0m is not available. Under the heading basic
equipment for uterine evacuation all items are available and functional. Under the
heading manual vacuum aspiration silicone lubricant, adapters and metal
cannulae are not available. Under the heading of electrical suction apparatus all
the equipments are available and functional. Ultrasonic fetal monitor is not
available. Under essential materials for donor blood for transfusion all materials
are available. In the side laboratory the available items are microscope,
immersion oil, glass rods, rack for drying slides, Leishman stain, methanol and
refrigerator. Under the subhead thick blood films for malaria parasites both items
are available. Under the subhead total and differential WBC count, items are not
available. Under the subhead estimation of haemoglobin, haemoglobinometer is
available. Under the subhead Erythrocyte volume fraction (Haematocrit) only
spirit lamp and ethanol is available. Under the subhead detection of glucose in
urine, the items available and functional are Benedict solution, pipette, test tube
holder and spirit lamp. Under the subhead detection of ketones in urine, all items
are not available except glacial acetic acid. Under the subheads detection of
protein in urine, all items are not available. Under the subhead detection of bile
pigments in urine only measuring cylinder is available. Under the head detection
of urobilinogen in urine, the items listed are not available.
IN CHCs
Rongjuli CMC
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(k)
(l)
(m)
(n)
Basic Equipment_________________________
Delivery Pack___________________________
Perineal /Vaginal /Cervical Repair Pack_______
Eqpt. for Vacuum Extraction or Forceps Delivery
Obstetric Laparotomy/Caesarean Section Pack
Equipment for Craniotomy_________________
Neonatal Resuscitation Pack_______________
Basic Equipment for Uterine Evacuation_______
Manual vacuum aspiration_________________
Electrical Suction apparatus________________
Anaesthesia Equipment___________________
Ultrasonic fetal monitor____________________
Essential Materials for the Provision
of Donor Blood for Transfusion_____________
Side Laboratory
Available/
Functional
Available/Non
-functional
9
I
Not Available
5“
in.
8
J_
I
3
17
31
j
a
I
MM
11
Nurses Station at Pathsala CMC
f;■: • ?
'"-4
'■-^7 .JO
Jr
; . ..Mlhfe JOSS
||K /
A view of the Ante Natal Ward in Pathsala CHC
k‘-'
- 'i’S 'O
>-----
O f A
07/7i
i8<.
32
Assessment of EmOC equipments in Rongjuli CHC
s*1
(j) (k) (I) (m) (n)
(a) (b) (c) (d) (e) (f) (g) (h) (i)
g Available/Functional ■ Avai!able/Non-functional
Not Available
By status determination Rongjuli CHC is not EmOC. Most of the basic
equipments are not available except sphygmomamometer, baby weighing scale,
fetel stethoscope, instrument sterilizer, kidney basins, auto destruct syringes and
needles, suture needles and suture material, IV stand, surgical gloves, scissors,
rubbish bins. Most of these EmOC basic equipments are not available because
they have not been supplied. Delivery is conducted here and only available and
functional equipments are artery forceps, cord ties, gauze swabs and episiotomy
scissors. Disposable delivery kits (DDK) supplied by Assam Area Project are
available and used during normal deliveries. All the equipments for perineal /
vaginal / cervical repair packs are available but not functional but all the items are
still unpacked and kept in the store. All items under Obstetrui laparotomy /
ceasarean section pack are not available as there is no operation theatre in
Rongjuli CHC. Equipments for craniotomy, neonatal recucsitation pack, basic
equipment for uterine evacuation and manual vacuum aspiration are available but
not functional and are lying in the store room unpacked. Electrical suction
apparatus is not available. Under Anaesthesia equipments everything is available
and non functional except the Boyle’s apparatus, oxygen cylinders and
electrically operated suction apparatus is not available. Under the heading
provision of donor blood for transfusion, only available items are test tubes, slides
and the compound microscope, other items are not available. Under the heading
side laboratory no items are available.
Chapor CHC
Available/
Functional
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Basic Equipment_________________________
Delivery Pack___________________________
Perineal /Vagina) /Cervical Repair Pack_______
Eqpt. for Vacuum Extraction or Forceps Delivery
Obstetric Laparotomy/Caesarean Section Pack
Equipment for Craniotomy_________________
Neonatal Resuscitation Pack_______________
Basic Equipment for Uterine Evacuation
Avaiiable/Non
-functional
1^
Not Available
3
________
//
10
J______
3
33
(■)
(j)
(k)
(l)
(m)
(n)
Manual vacuum aspiration_______
Electrical Suction apparatus______
Anaesthesia Equipment_________
Ultrasonic fetal monitor__________
Essential Materials for the Provision
of Donor Blood for Transfusion
Side Laboratory
4
&
J
Si
23
it:
Assessment of EmOC equipments in Chapor CHC
(a)
(b) (c)
(d)
(e)
(f)
(g)
(h)
(i)
0)
(k)
@ Available/Functional HAvaiiable/Non-functionai
(I)
(m)
(n)
Not Available
Chapor CHC is a functioning EmOC. Most of the basic equipments are available
except stethoscope, clinical oral thermometer, surgeons hand brush, urinary
catheters, mouth gag, sharps disposal containers. The doctors use their own
personal stethoscopes. Patients buy the urinary catheters when necessary. The
thermometers were available initially but due to breakage, replacements have to
be made frequently by local purchase. Instruments for two delivery packs are
available except plastic sheeting, cloth and episiotomy scissors. Doctors use their
own personal epi scissors and linen are in short supply due to frequent use. Two
packs of Perineal / vaginal / cervical repair packs are available. Under the head
equipment for vacuum extraction or forceps delivery vacuum extractor and
obstetric forceps, breech is available but not functional. Under obstetric
laparotomy / caesarean section pack stainless steel instrument tray, uterine
haemostasis forceps, pedicle clamps, mosquito forceps, triangular point suture
needles, round bodied needles, abdominal retractor, suction nozzle, suction tube
is not available. Among items available but not functional are intestinal clamps
straight and curved operating scissors, surgical knife handle and blades, straight
artery forceps, sponge forceps and towel clips. Under Equipment for craniotomy,
cranial perforator is available but not functional, other items are not available. The
number of neonatal resuscitation pack available is one. The items available and
functional are mucus extractor, infant face mask, ventilatory bag, suction catheter
and baby warmer with trolley. The basic equipment for uterine evacuation which
are not available are sponge forceps, single tooth tenaculum forceps and long
dressing forceps. Other items are available. Under the head manual vacuum
aspiration all the items are not available. The electrical suction apparatus and the
ultrasonic fetal monitor is also not available. Under the head anaesthesia
equipments the items that are available and not functional are anaesthetic face
34
mask, oropharyngeal airways, laryngoscopes, endotracheal tubes with cuffs,
intubating forceps and Boyle’s apparatus. The other items in this category is not
available. Chapor CHC does not have the provision of blood storage and
transfusion and investigations are done in the side laboratory where most of the
reagents and instruments are available except glass rods, interval timer clock,
Leishman stain, mehanol and refrigerator. Two microscopes are available and
function but four are out of order. Most of the investigations are not done except
detection of glucose in urine and detection of protein in urine for which
instruments and reagents are available. Instead of sulpho salicylic acid, glacial
acetic acid is used.
Pathsala CHC
Basic Equipment_________________________
Delivery Pack___________________________
Perineal /Vaginal /Cervical Repair Pack_______
Eq pt. for Vacuum Extraction or Forceps Delivery
Obstetric Laparotomy/Caesarean Section Pack
Equipment for Craniotomy_________________
Neonatal Resuscitation Pack_______________
Basic Equipment for Uterine Evacuation_______
Manual vacuum aspiration_________________
Electrical Suction apparatus________________
Anaesthesia Equipment___________________
Ultrasonic fetal monitor____________________
Essential Materials for the Provision
of Donor Blood for Transfusion_____________
Side Laboratory
(a)
(b)
(c)
(d)
(f)
(g)
(h)
(■)
(j)
(k)
(l)
(m)
(n)
Available/
Functional
Available/Non
-functional
15-
I
___L
—1&.
1
Not Available
i
i
-8^-
zzl
-1^
J
3
\x
3^
Assessment of EmOC equipment in Pathsala CHC
- . ... . ..
Sil
Plf
~ ..........
.
•
■
■
I
1
.
.......................—■
si
a
In
■ W
ft
■ 1I
II nl
B
(a) Jb)
(O^ (d)(e2
I
F
(f)
(g)
(j)
(1^ (I) jm)
E3 Available/Functional ■ Available/Non-functional
Not Available
(h)
(i)
(n)
Pathsala CHC is a functioning EmOC and most of the basic equipments are
available and functional except surgeons hand brush, heat source, adult
ventilator bag and mask, mouth gag and sharps disposal containers is not
available. Two delivery packs are available with all the instruments except cloth.
All the instruments are available for perineal repair pack except vaginal
speculum, but Cusco’s speculum is available. Vacuum extractor is avail but not
35
functional because the cap is missing. Obstetric forceps, mid cavity and breech is
not available. For obstetric laparotomy all the instruments are available except
stainless steel instrument tray with cover, straight pedicle clamps, triangular point
suture needles, round bodied needles, abdominal retractors, curved and straight
operating scissors and suction nozzle. Equipment for craniotomy are all available
and functional except cranial perforator and embryotomy scissors. For neonatal
resuscitation pack all the equipments are available except baby warmer with
trolley and suction apparatus. Basic equipment for uterine evacuation all
instruments are available and functional. Under manual vacuum aspirator no
instrument is available. The electrical suction apparatus is available and
functional. Since there is no operation theatre, there is no equipment for
anaesthesia. Ultrasonic fetal monitor is not available. Essential materials for
provision of donor blood for transfusion is not there as there is no blood bank.
Only slides, binocular microscope and cotton is available for grouping and cross
matching. Only investigation done in the side laboratory are thick and thin blood
films for malarial parasite, detection of glucose in urine. Reagents and
instruments available are microscope, immersion oil, glass rods, Field stains A &
B, glass containers, spirit lamp, ethanol, Benedict solution, pipette and glacial
acetic acid.
ASSESSMENT OF EmOC DRUG LIST
Antibiotics
25000
!
20000
■
i
15000
| | ■ Antibiotics
10000
5000
4
0
Goalpara
Dhubri
Barpeta
___
■HKJ
Chapor
Rongjuli
Pathsala
As seen in the bar diagram above, commonly available antibiotics are oral and
injectable penicillin, metranidazole (both oral and injectable), co-trimoxazole (both
tablets and suspension), norfloxacin, tinidazole, amoxicillin capsules, injectable
benzly penicillin, injection oxytetracycline and nitrofurantoin oral tablets. The
supply of antibiotics in Rongjuli CMC is very poor.
36
Disinfectants
60
60
40
=
i 30
i
Disinfectants
I( ------------
: 20
3
I
I
10
o [-■
Goalpara
Dhubrt
Barpeta
Rongjuli
Chapar
Rathsala
The common disinfectants available are iodine and surgical spirit. There was no
stock of disinfectants in Rongjuli CHC, and supply was short in Rathsala CHC.
Antifungals
4500 i~
1
k a .....
I
3500 j- j
3000 f
WiBSi t-
2500 i
M
2000 j
1500 ||
S Antifungals
;..... ................ .1.. _
... . ..... ............... -....................
glJBfiSaft
1000 :
500 :
0W
Goalpara
J
... ;...........................
t i-ry..................................
Dhubri
Barpeta
Chapor
Rongjuli
i
Rathsala
Only antifungals available were clotrimazole (vaginal) 4000 in numbers in
Goalpara Civil Hospital. No antifungals were available in the other institutions
surveyed.
37
Steroids
120
100
80 -
60
Steroids
40 -
20
0
Goalpara
. ...................................... .
W
Dhubri
Chapor
Barpeta
i
MMWI 'll
■Mill
Rongjuli
Pathsala
Steroids available in the Civil hospitals and CHCs were injectable betamethasone
and injectable dexamethasone. There were no steroids available in Barpeta Civil
Hospital.
Drugs used in resuscitation
1400
j
1200
1000
■■
I
L
800
600
l
400
“ J
j _L;
............ k
E Drugs used in
resuscitation
sW®
.. ..i
.........:.. '.'i. i
200 H
.....
.....
E3
0
Goalpara
Dhubri
Barpeta
EZU ;
Chapo r
Rongjuli
Paths ala
Drugs used in recsuscitation which were available in the institutions were
injectable adrenaline, injectable aminophylline, injectable atropine sulphate. No
resuscitation drugs were available in Dhubri Civil Hospital.
38
IV fluids
900
800
700
■a*
600
■
500
400
EIV fluids |
300
200
100
0
Goal para
Dhubri
Barpeta
Chapor
Rongjuli
Pathsala
IV fluids available were 5% dextrose, normal saline, Ringer’s lactate solution and
plasma expanders. In Goalpara Civil Hospital and Rongjuli CHC there was no
supply and patients were asked to buy the IV fluids from the market.
Anticonvulsants
120 liUi
100
80 J M
lafi
60 I I...... ■...................
I
J
40
.-y: 'j
h<
20 HHI
............................................................................................................................................................................................................................................................... -...................................................................................................................................................... ...............
0■
Goalpara
H Anticonvulsants
‘
iiiaiMMMi
Dhubri
Barpeta
Chapor
Rongjuli
Paths ala
Anticonvulsants were available only in Goalpara Civil Hospital and Chapor CHC.
The only anticonvulsants available was injectable diazepam. Magnesium
sulphate and phenytoin were not available in any of the institutions surveyed.
Antihypertensives were not available in any of the six institutions surveyed.
Patients had to buy them when necessary.
39
Oxytocics
600
5(X) 1
I
400
300 -j
El Oxytocics
200
100
0
Goalpara
Dhubri
Barpeta
Chapor
Rongjuli Pathsala
Oxytocics were not available in Dhubri Civil Hospital and Chapor CHC. The
commonly available oxytocics were ergometrine (both oral and injectable), methly
ergometrine (injectable) and oxytocin (injectable). Misoprostol, prostagladin F2a
(injectable), prostagladin E2 and vaginal prostaglandins were not available in any
of the six institutions surveyed.
40
RECOMMENDATIONS
GENERAL RECOMMENDATIONS
a. Since record keeping is very poor, doctors and staff should be
trained for proper record keeping. This applies for all the six health
institutions assessed.
b. Proper formats and sheets for data entry not available. Hence
regular supply of registers, data entry, books with correct formats
for different information is recommended.
c. Septic OT may be set-up in the existing infrastructure with
necessary renovations, additions with requisite OT table, focus
light, instrument trolley, linen, drugs, revolving stool, suction
machines and other paraphernalia.
d. There is no incinerator for proper waste disposal and no bio-safety
measures in all the health institutions surveyed. Hence, an
incinerator is highly recommended, which is also mandatory by law.
Provision of adequate autoclaves, needle cutters gloves, masks,
aprons and sharps disposal containers are recommended for bio
safety.
e. Staff should be trained and workshops conducted for scientific
waste management.
f. Linen in the labour room / delivery room and in the operation
theatre are in short supply. So also the instruments necessary for
EmOC which are not available may be supplied along with the
necessary linen and equipment.
g- Sewage system by proper scientific methods may be constructed.
h. Alternate electricity (generator) should be supplied in all the EmOC
health facilities as electricity power supply is very erratic throughout
the State.
i. A post of Paediatrician is recommended along with OBGY
Specialist and Anaesthetists in all the EmOC facilities.
Since
potable drinking water is not available, water filters preferably
Jelectrical filters with gamma radiations may be provided in all the
health institutions. Water borne diseases are very high especially
during the summer and rainy seasons.
SPECIFIC RECOMMENDATIONS
Goalpara Civil Hospital
a. If the half constructed out patient department block is completed,
then all the services of Comprehensive EmOC can be expanded
well.
b. Since there is no separate septic OT and Goalpara Civil Hospital
caters to a very big population with referrals from the peripheral
institutes, setting up of a septic OT is recommended. This can be
set-up within the existing infrastructure or in the new half
constructed complex.
41
For supply of water 24 hours, more overhead storage and water
pumps can be made available.
d. Since there is a separate eclampsia room away from the nurses
station, a section of the obstetric ward can be converted into an
“Eclampsia Corner” with the necessary medicines, beds and
oxygen cylinders and a nurses’ station especially for this section.
e. Besides a telephone which is out of order most of the time, intercom
services need to be set-up as the hospital area is very extensive
being single storied (Assam type).
f. Although both X-ray machine and ultrasonography machines are
available and functional, a Radiologist in the staff position is not
there which is highly recommended.
C.
Dhubri Civil Hospital
a. The construction of the original complex for OBGY Department
should be immediately completed. This will help in expansion of
services.
b. There are six OBGY Specialists but only one Anaesthetist There
should be at least three Anaesthetist in position to take the entire
load of the hospital.
c. Potable drinking water to be made available by supplying electrical
filters.
d. Dhubri Civil Hospital interestingly does not have a sanctioned post
for a Laboratory Technician. Two posts of Lab Technicians are
recommended to cater to the hospital’s needs.
e. Regular supply of adequate linen is recommended along with the
equipments and drugs which are not available as per data
collected.
Barpeta Civil Hospital
a. There are no residents within / near the hospital premises except
for 1 OBGY Specialist. Quarters for doctors, nurses and other
health staff are not near hospital premises which is recommended.
b. There is no Septic OT in the old hospital complex. Setting up of a
Septic OT in the new complex is recommended.
Rongjuli Civil Hospital
Sanctioned post of OBGY specialist to be filled up and 1 post of
Anaesthetist to be sanctioned and filled up to start Basic EmOC or
better still Comprehensive EmOC.
b. A room designated as the OT is there. It needs renovation and
necessary installations to convert it into a full fledged operation
theatre. Then with the necessary manpower in position Rongjuli
CHC can function as a Comprehensive EmOC.
a
42
Entrance to the Blood Bank at Dhubri Civil Hospital.
Also seen the half constructed O&G Complex
The half done out patients department at
Goalpara Civil Hospital
A view of the dilapidated walls and floor of the
Labour Room, Dhubri Civil Hospital
43
Blood transfusion services can be started with the appointment of a
trained Blood Technician and setting up the infrastructure for
storage.
d. Since source of water and overhead tank is already there, a water
pump with back up electricity (generator) will provide 24 hours
running water.
e. Ward space used for storage of beds and other furniture can be
removed and utilised properly.
f. As per discussion with the Joint Director, Health Services, district
Goalpara, one OT table and one Boyle’s apparatus can be provided
from his jurisdiction. With other minor modifications, the operation
theatre can be made functional.
C.
Chapar CHC
a. To convert Chapar CHC which is a Basic EmOC to Comprehensive
EmOC the following have to be included :
Manpower : OBGY Specialist
Anaesthetist
Paediatrician
Operation theatre services can be made functional by construction
of an OT or renovation and addition to the already existing room
and placing requisite furniture, equipments, linen and drugs to start
EmOC.
Pathsala CHC
a. The operation theatre can be made functional by minor repairs,
renovations and installations of basic equipments, furniture, linen
and drugs. Manpower - One OBGY Specialist and one Anaesthetist
are already posted here.
b. Blood transfusion facilities by appointing a Blood Technician and
necessary infrastructure for blood storage will make Pathsala CHC
a Comprehensive EmOC.
c. The laboratory should be upgraded with machines like centrifuge,
binocular and compound microscopes, water bath etc.
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