Impact of Medical Doctors Global Health and Tropical Medicine on decision-making in caesarean section: a pre- and post-implementation study in a rural hospital in Malawi

Bakker, Wouter; Bakker, Emma; Huigens, Christiaan; Kaunda, Emily; Phiri, Timothy; Beltman, Jogchum Jan; Roosmalen, Jos van; Akker, Thomas van den

doi:10.1186/s12960-020-00516-5

Cited by 5 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 133 included studies collectively reported on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and more than 11.4 million participants (median per study, 989 [IQR, 257-6857]) from 63 LMICs . Of all 133 LMICs, we found studies from 15 of all 29 low-income countries (51.7%), 25 of all 50 lower-middle–income countries (50.0%), and 23 of all 55 upper-middle–income countries (41.8%) . Fourteen studies (10.5%) were multinational …”

Section: Resultsmentioning

confidence: 99%

“…Most studies (115 [86.5%]) were published in 2010 or after, with a marked increase in the number of included studies per year. Most articles were written in English (126 [94.7%]) . Health care settings were hospital based or secondary care in 93 studies (69.9%) …”

Section: Resultsmentioning

confidence: 99%

“…Most articles were written in English (126 [94.7%]) . Health care settings were hospital based or secondary care in 93 studies (69.9%) . Of the 133 included studies, 107 (80.5%) were observational…”

Section: Resultsmentioning

confidence: 99%

“…Of the 133 included studies, 107 (80.5%) were observational and 17 (12.8%) were qualitative . Most of the included studies (115 [86.5%]) had a gynecology and obstetrics focus (Table 1 and eTable in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Low-Value Surgical Procedures in Low- and Middle-Income Countries

Albarqouni,

Abukmail,

MohammedAli

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceOveruse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures.ObjectivesTo assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs.Evidence ReviewWe searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions.FindingsOf 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle–income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders.Conclusions and RelevanceThis systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Low-Value Surgical Procedures in Low- and Middle-Income Countries

Albarqouni,

Abukmail,

MohammedAli

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…A dataset with all births occurring during the two-year study period, as used in a previous publication, was adapted for detailed analysis of women with prolonged second stage of labour. 12 St. Luke's hospital is a 150-bed faith-based facility in rural Southern Malawi, providing free Basic and Comprehensive Emergency Obstetric Care for its catchment population.…”

Section: Study Design and Settingmentioning

confidence: 99%

Management of prolonged second stage of labour in a rural setting in Malawi: a retrospective cohort study

Bakker

Dorp

Phiri³

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Objective Prolonged second stage of labour potentially leads to maternal and perinatal complications. Options for clinical management are augmentation with oxytocin, instrumental vaginal birth or second-stage caesarean section. We aimed to describe incidence, management and outcome of prolonged second stage of labour in a low-resource setting in Malawi. Methods Retrospective analysis of medical records and partographs of all women who gave birth in 2015-2016 in a rural mission hospital in Malawi, comparing labour tracings with management protocols. Primary outcomes were incidence of prolonged second stage, instrumental vaginal birth and caesarean section. Furthermore, management and outcomes were assessed. Women arriving in hospital in the second stage of labour were compared to women arriving in an earlier stage of labour. Results Of all 3,426 women giving birth in the study period, 307 (9.0%) were diagnosed with prolonged second stage, based on their partographs. Of these women, 22 (7.2%) had labour augmented with oxytocin, 31 (10.1%) gave birth by vacuum extraction and 64 (20.9%) by caesarean section. Spontaneous vaginal birth occurred in 212 (69.0%). In total, 566/3,426 (16.5%) women were admitted whilst already in the second stage of labour of whom 538/566 (95.1%) had spontaneous vaginal births and 38/566 (6.7%) ended up having prolonged second stage registered in their partographs. Conclusion Prolonged second stage of labour is relatively common in this hospital, although diagnosis may be hampered by a very sizeable proportion of women arriving whilst already in the second stage, although a large majority of these women gave birth spontaneously. Caesarean section occurred twice as often as vacuum extraction, suggesting a role for additional training and decision-making during childbirth to support the use of vacuum extraction.

show abstract