Emergency obstetric care in a rural district of Burundi: What are the surgical needs?

Abstract

ObjectivesIn a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.MethodsA retrospective analysis of EmOC data (2011 and 2012).ResultsA total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.ConclusionOverall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

“…The recognition that the humanitarian sector is not immune from the need to demonstrate safe surgical care has led to calls for more robust outcome data and clearer accountability 7–9. Only few studies, limited by small study size and limited external validity, have addressed the composition of the surgical workforce employed by humanitarian organisations 10 11. Therefore, there is inadequate published data on whether different anaesthesia providers (eg, physician, nurse or other healthcare provider) are employed in different settings, and to what extent there is a physician expatriate presence within the team.…”

Web-Based Partograph on Early Detection of Emergency Cases and Referral Processes

“…In this case, the umbilical cord winding causes the fetus to experience hypoxemia which resulting in fetal distress. Furthermore, fetal distress can inhibit the decline of fetal presentation to the lowest part of the fetus so that the risk of cesarean section is carried out (Yisma et al, 2013b, Kuppens, Smailbegovic, Houterman, De Leeuw, & Hasaart, 2017Wang, Kuromaki, Ochi, Kikugawa, Matsunaga, & Takagi, 2016;De Plecker et al, 2017;Markos & Bogale, 2016;Dalal & Purandare, 2018). WHO in 2003 reported that an estimation of the maternal mortality rate is around 289,000.…”