Impact of a high dependency unit in a resource limited setting

Introduction The maternity department in Mulago Hospital, Kampala delivers >30 000 women with extremely limited staffing and resources. There is a high maternal mortality, often the result of late detection of critically ill women. Exchange visits between clinicians from Liverpool Women's Hospital and Mulago highlighted the benefit of a dedicated area to manage high risk patients and plans for an high dependency unit (HDU) were initiated. The HDU opened in October 2010 with funding from the Tropical Health Education Trust. Its main advantage is the low patient to staff ratio (maximum six patients to one midwife) which enables the sickest patients to be monitored regularly so that deterioration is recognised before it becomes irreversible. Methods To evaluate the impact of the HDU over the first 7 weeks, observed maternal mortality figures during that time were compared with expected mortality using most recently available data. Results In 2009 there were 186 deaths among 33 000 women delivered. In the first 7 weeks (=0.135 of a year) that the unit has been opened there have been two deaths for an estimated 4442 deliveries (0.135×33 000), expected deaths were 22 (0.135×33 000) (p=0.0001 χ2 test) Conclusions Early indications are that the introduction of an HDU in a low resource setting can have a significant impact on maternal mortality. In this setting the most important factor is the improved staff to patient ratio.