Page 95 - Contributed Paper Session (CPS) - Volume 5

CPS1108 Collins O. et al.
4. Discussion and Conclusion
This work provides a unified formulation and comprehensive treatment of
the class of count time series following GLM models with application to
maternal complication. An integral part of this model is the dependence on
past values of the conditional mean, which allows for modelling of temporal
correlation. In this work we present the first study on trends of maternal
complications incorporating covariate effects (CeMOnC and BeMonC) within
this framework. Quality care is a major determinant of health outcomes and is
adversely affected when the health care facility is overcrowded with limited
BeMonC interventions. Government programmes are still focusing on
antenatal care, high-risk approach, trained birth attendants neglecting
delivery care and EmOC. With the assumption of Poisson or Negative Binomial
conditional distribution we facilitate model-based prediction and model
assessment. We utilize likelihood-based methods for model fitting and
assessment, prediction and intervention analysis for this model.
PPH was seen in 10% of cases and haemorrhage requiring blood
transfusion occurred in 3%. This is slightly higher than most literature review
which reported a 6-8% rate of PPH and a 1-2% rate of blood transfusion.
Quality care remains a major determinant of health outcomes and is
adversely affected when the health care facility is overcrowded; a situation that
is common in resource-limited setting. Government programmes are still
focusing on antenatal care, high-risk approach, trained birth attendants
neglecting delivery care, basic emergency obstetric and new-born care
(BEmONC) and comprehensive emergency obstetric and new-born care
(CEmONC) services. Lack of facilities to perform a CS, facilities for blood
transfusion or paediatrician, with only one medical officer to look after all kinds
of cases every day and the lack of transport facilities in remote places are some
of the barriers which contribute to high maternal mortality. Provision of
comprehensive emergency obstetric services within the reach of all pregnant
women is one of the strategies employed to reduce the maternal mortality
worldwide. The public is made aware of the availability of such services free of
cost in government institutions.
In this study, we have observed levels, patterns, and trends of the
utilization of maternal complications in the three major cities for the period
Dec 2014 to Jan 2017. From this study, it can be said that the proportion of
women who had eclamsia, APH, PPH and sepsis has increased over that past
2 years. Effects of interventions were significant in BeMOnC compared to
CeMonC. Complication rates did not vary by maternal regions. Providers who
perform obstetrical care should be alert to the high rate of maternal medical
complications associated with APH, PPH and obstructed labour. Introduction
BEmONC package improved performance of providers in reducing maternal
and new-born complications and mortality.

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