{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:22:39Z","timestamp":1791091359413,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2006,1,26]],"date-time":"2006-01-26T00:00:00Z","timestamp":1138233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2006,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This paper describes the package of interventions undertaken by the CARE\/AMDD program collaboration to increase the availability and quality of emergency obstetric care for 3 high maternal mortality countries in Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Project implementation over 4 years focused on enhancing the capacity of 10 district hospitals in 3 countries \u2014 Tanzania, Rwanda and Ethiopia. Interventions were designed to create functional health facilities with trained and competent staff, working in an enabling environment supporting EmOC service delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By keeping a clear focus on EmOC, the project achieved modest improvements in services, even in the face of the considerable constraints of rural district hospitals. Availability and utilization of EmOC increased in Tanzania; the met need for EmOC increased slightly from 14% in year 1 to 19% in year 4, while in Rwanda it increased from 16% to 25% over 4 years. Case fatality rates (CFR) declined by 30\u201350% in all 3 countries. While still well below UN recommendations, in all 3 countries there was also a progressive increase in the cesarean section rates, a life saving obstetric intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The increases in met need and decreases in case fatality suggest that project interventions improved the quality and use of EmOC, a critical component for saving women's lives.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.ijgo.2005.12.003","type":"journal-article","created":{"date-parts":[[2006,1,27]],"date-time":"2006-01-27T16:35:07Z","timestamp":1138379707000},"page":"308-319","source":"Crossref","is-referenced-by-count":58,"title":["Making EmOC a reality\u2014CARE's experiences in areas of high maternal mortality in Africa"],"prefix":"10.1002","volume":"92","author":[{"given":"M.","family":"Kayongo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Rubardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Butera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Mboninyibuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Madili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,1,26]]},"reference":[{"key":"e_1_2_9_2_2","volume-title":"Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA","author":"World Health Organization","year":"2003"},{"key":"e_1_2_9_3_2","volume-title":"Charting a new course: evolution of CARE's maternal and newborn health programming approach","author":"Ross S.R.","year":"2003"},{"key":"e_1_2_9_4_2","volume-title":"Ethiopia demographic and health survey 2000","author":"Demographic and Health Survey (DHS)","year":"2001"},{"key":"e_1_2_9_5_2","volume-title":"Enqu\u00eate d\u00e9mographique et de Sant\u00e9 EDSR\u2010II Rwanda 2000","author":"Demographic and Health Surveys (DHS)","year":"2001"},{"key":"e_1_2_9_6_2","volume-title":"Tanzania reproductive and child health survey 1999","author":"Demographic Health and Surveys (DHS)","year":"2000"},{"key":"e_1_2_9_7_2","volume-title":"World development report 1993: investing in health","year":"1993"},{"key":"e_1_2_9_8_2","unstructured":"UNFPA Country profiles for population and reproductive health Ethiopia.http:\/\/www.unfpa.org\/profile\/ethiopia.cfm."},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-8080(04)24135-0"},{"key":"e_1_2_9_10_2","unstructured":"CARE FEMME Project\u2014baseline surveys reports.Tanzania.2000"},{"key":"e_1_2_9_11_2","unstructured":"CARE FEMME Project\u2014baseline surveys reports.Ethiopia.2000"},{"key":"e_1_2_9_12_2","volume-title":"Implementation stages of EmOC services, a tool for project monitoring","author":"Gill Z.","year":"2002"},{"key":"e_1_2_9_13_2","unstructured":"UNICEF WHO UNFPA.Guidelines for monitoring the availability and use of obstetric services.1997"},{"key":"e_1_2_9_14_2","volume-title":"Using the UN process indicators of emergency obstetric services: questions and answers","author":"Paxton A.","year":"2003"},{"key":"e_1_2_9_15_2","volume-title":"Managing complications in pregnancy and childbirth: a guide for midwives and doctors","author":"World Health Organization","year":"2000"},{"key":"e_1_2_9_16_2","volume-title":"AMDD. Emergency obstetric care: leadership manual and tool book for improving the quality of EmOC services","author":"Engender Health","year":"2002"},{"key":"e_1_2_9_17_2","volume-title":"Improving emergency obstetric care through criterion\u2010based audit","author":"Averting Maternal Death and Disability (AMDD)","year":"2002"},{"key":"e_1_2_9_18_2","volume-title":"Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer","author":"World Health Organization","year":"2004"},{"key":"e_1_2_9_19_2","unstructured":"CARE\u2010USA.Foundations to Enhance Management of Maternal Emergencies (FEMME) final evaluation reports.2003"},{"key":"e_1_2_9_20_2","unstructured":"Kayongo M Butera J Mboninyibuka D Nyiransabimana B Ntezimana A Mukangamuje V. Improving availability of emergency obstetric care services in Rwanda\u2014CARE's experiences and lessons learned at Kabgayi referral hospital."}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S0020729205006302?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S0020729205006302?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.ijgo.2005.12.003","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.ijgo.2005.12.003","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.ijgo.2005.12.003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T20:30:09Z","timestamp":1696537809000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1016\/j.ijgo.2005.12.003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,1,26]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2006,3]]}},"alternative-id":["10.1016\/j.ijgo.2005.12.003"],"URL":"https:\/\/doi.org\/10.1016\/j.ijgo.2005.12.003","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,1,26]]}}}