Article Text


Estimating the met need for emergency obstetric care (EmOC) services in three payams of Torit County, South Sudan: a facility-based, retrospective cross-sectional study
  1. Pontius Bayo1,2,
  2. Imose Itua3,
  3. Suzie Paul Francis2,
  4. Kofi Boateng4,
  5. Elijo Omoro Tahir5,
  6. Abdulmumini Usman6
  1. 1 Department of Obstetrics and Gynecology, St Mary’s Hospital Lacor, Gulu, Uganda
  2. 2 Department of Maternal and Child Health, WHO, Juba, South Sudan
  3. 3 School of Public Health, University of Liverpool, Liverpool, UK
  4. 4 EPI Department, WHO, Juba, South Sudan
  5. 5 Department of Pharmaceuticals, Torit State Hospital, Torit, South Sudan
  6. 6 Department of Administration, WHO, Juba, South Sudan
  1. Correspondence to Dr Pontius Bayo; pontiusby{at}


Objective To determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication.

Design This was a retrospective cross-sectional study.

Setting Four primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan.

Participants All admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications.

Primary and secondary outcome measures The primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes.

Results Two hundred and fifty four major obstetric complications were admitted in 2015 out of 390 expected from 2602 pregnancies, representing 65.13% met need. The met need was highest (88%) for Nyong Payam, an urban area, compared with the other two rural payams, and 98.8% of the complications were treated from the hospital, while no complications were treated from three PHCCs. The most common obstetric complications were abortions (45.7%), prolonged obstructed labour (23.2%) and haemorrhage (16.5%). Evacuation of the uterus for retained products (42.5%), caesarean sections (32.7%) and administration of oxytocin for treatment of postpartum haemorrhage (13.3%) were the most common interventions.

Conclusion The met need for EmOC in Torit County is low, with 35% of women with major obstetric complications not accessing care, and there is disparity with Nyong Payam having a higher met need. We suggest more support supervision to the PHCCs to increase access for the rural population.

  • major obstetric complications
  • met need
  • torit county
  • South Sudan

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors PB and II designed the study. PB collected the data. PB and II analysed the data and drafted the manuscript. SPF, KB, EOT and AU participated in intellectual content analysis and methodological review, and also reviewed the final version of the manuscript for consistency. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was sought from the University of Liverpool Ethics Committee and South Sudan State Ministry of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.