Background: Maternal mortality is persistently high in Uganda. Access to quality emergency obstetrics care (EmOC)
is fundamental to reducing maternal and newborn deaths and is a possible way of achieving the target of the fifth
millennium development goal. Karamoja region in north-eastern Uganda has consistently demonstrated the nation’s
lowest scores on key development and health indicators and presents a substantial challenge to Uganda’s stability
and poverty eradication ambitions. The objectives of this study were: to establish the availability of maternal and
neonatal healthcare services at different levels of health units; to assess their utilisation; and to determine the quality
of services provided.
Methods: A cross sectional study of all health facilities in Napak and Moroto districts was conducted in 2010. Data
were collected by reviewing clinical records and registers, interviewing staff and women attending antenatal and
postnatal clinics, and by observation. Data were summarized using frequencies and percentages and EmOC indicators
were calculated.
Results: There were gaps in the availability of essential infrastructure, equipment, supplies, drugs and staff for maternal
and neonatal care particularly at health centres (HCs). Utilisation of the available antenatal, intrapartum, and postnatal
care services was low. In addition, there were gaps in the quality of care received across these services. Two hospitals,
each located in the study districts, qualified as comprehensive EmOC facilities. The number of EmOC facilities per
500,000 population was 3.7. None of the HCs met the criteria for basic EmOC. Assisted vaginal delivery and removal of
retained products were the most frequently missing signal functions. Direct obstetric case fatality rate was 3%, the met
need for EmOC was 9.9%, and 1.7% of expected deliveries were carried out by caesarean section.
Conclusions: To reduce maternal and newborn morbidity and mortality in Karamoja region, there is a need to increase
the availability and the accessibility of skilled birth care, address the low utilisation of maternity services and improve
the quality of care rendered. There is also a need to improve the availability and accessibility of EmOC services, with
particular attention to basic EmOC