Background: Maternal mortality in developing countries remains high due to lack of appropriate emergency obstetric care. Major obstetric intervention (MOI) rate can be used as an indicator of unmet obstetric needs and quality of care. Objectives: Identify indications for major obstetric interventions, determine MOI rates and assess 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 7,630 women from the host population delivering in Turkana district between January 1995 and September 1999. Data Sources: Maternity registers, inpatient case notes and theatre registers. Main outcome measures: Maternal mortality, perinatal mortality, major obstetric interventions, unmet obstetric need and length of stay. Results: The subjects from the two study populations were similar with respect to age, parity and indications for surgical intervention. Caesarean section was the only major obstetric intervention. Overall, caesarean section rate was significantly higher among refugees than in the host population (3.1% versus 2.1%, p<0.01; Cl 1.4-2.1 ). Maternal indications were the main reasons for c/s in both populations, with the c/s rate being higher for refugees than for local women (2.5% versus 1.7%). At least 0.8% of parturient women from the host population had unmet obstetric needs: this translates to 61 pregnant women who may have died or experienced birth-related complications over the study period. The mean length of hospital stay was much less for refugee women than for the host population (8.1 days versus 11.3 days). Conclusion: Encamped refugee women in Kakuma have better obstetric care than those from the host population, and the level of unmet obstetric needs in the district is high. This imbalance could be reduced through resource sharing and integration of refugee health care services with that for the host population.

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Needs Assessment refugee pregnancy complication Pregnancy Complications obstetric operation Obstetric Surgical Procedures human Refugees statistics health service Kenya Humans Adolescent female pregnancy Article adult maternal mortality Maternal Health Services mortality cesarean section