A sector-wide approach to emergency obstetric care in Uganda.

PURPOSE: To establish a baseline for the availability, utilization, and quality of EmOC, and to help develop an operational strategy based on the findings. METHODS: A needs assessment of emergency obstetric care (EmOC) was carried out in 197 health facilities in 19 out of 56 districts in Uganda, covering 38% of the total population. FINDINGS: There were a large number of missing signal functions at health facilities and an urgent need to improve the availability of EmOC. CONCLUSION: By using the data from the assessment, it was possible to influence national policy through the health sector-wide approach (SWAp) and place EmOC high on the national agenda. A national strategy and roll out plan to strengthen EmOC is now in place.

Vasectomy. The men are willing but facilities are inadequate.

PIP: In order to develop a profile of men who choose vasectomy, case records were reviewed of 45 men who chose to undergo a vasectomy at the Voluntary Surgical Contraception Centre at Old Mulago in Kampala, Uganda, during January 1998-December 1992. During the 58 months, there were 0.8 vasectomies performed per month compared to 37.3 minilaparatomy tubal ligations per month. 48.9% of the vasectomy clients traveled a distance of at least 10 miles to obtain vasectomy services. One client traveled from Mbale district (about 260 miles). 62.2% were between 31 and 40 years old. Mean age was 37 years compared to 23.2 years for their wives. 68.9% of vasectomy clients were in a monogamous stable marriage. Wives gave consent in 71.1% of cases. Both spouses arrived at the decision for vasectomy in 44.4% of cases. 80% of vasectomy acceptors had more than a primary education. 62.2% had 6-10 surviving children at the time of vasectomy (mean, 8.7). Most vasectomy acceptors knew essentially nothing about and did not use other family planning methods. 75.6% of vasectomy procedures were performed within 20 minutes. The no-scalpel technique was the most frequently used vasectomy technique. The few minor complaints/complications were abdominal pain just after the procedure and minor wound sepsis. Most acceptors were satisfied with their vasectomy 3-4 months after the procedure and would recommend it to other men. 60% of acceptors chose vasectomy for economic reasons. Misconceptions about vasectomy (e.g., inability to ejaculate) before the procedure had dissipated within 3-4 months after the procedure. Vasectomy should be made more readily available to Ugandans. For example, male family planning counselors and use of satisfied vasectomy clients could orientate family planning services to men.^ieng