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

In 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 p...

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Veröffentlicht in:	PloS one 2017-02, Vol.12 (2), p.e0170882-e0170882
Hauptverfasser:	De Plecker, E, Zachariah, R, Kumar, A M V, Trelles, M, Caluwaerts, S, van den Boogaard, W, Manirampa, J, Tayler-Smith, K, Manzi, M, Nanan-N'zeth, K, Duchenne, B, Ndelema, B, Etienne, W, Alders, P, Veerman, R, Van den Bergh, R
Format:	Artikel
Sprache:	eng
Schlagworte:	Adolescent Adult Anesthesia Births Burundi - epidemiology Data processing Delivery, Obstetric Emergency medical services Emergency Medical Services - methods Emergency Medical Services - statistics & numerical data Evaluation Female Health Facilities Health Services Accessibility Health Services Needs and Demand Hospital emergency services Hospitals Human performance Humans Maternal & child health Maternal Health Services Maternal mortality Medical care quality Medical personnel Medicine and Health Sciences Middle Aged Obstetric Labor Complications - epidemiology Obstetric Surgical Procedures Obstetrics Outcome Assessment (Health Care) Physicians Pregnancy Quality of Health Care Retrospective Studies Rupture Rural Population Surgery Sustainable development Uterus Womens health Young Adult
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creator	De Plecker, E Zachariah, R Kumar, A M V Trelles, M Caluwaerts, S van den Boogaard, W Manirampa, J Tayler-Smith, K Manzi, M Nanan-N'zeth, K Duchenne, B Ndelema, B Etienne, W Alders, P Veerman, R Van den Bergh, R
description	In 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. A retrospective analysis of EmOC data (2011 and 2012). A 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. Overall, 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.
doi_str_mv	10.1371/journal.pone.0170882
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A retrospective analysis of EmOC data (2011 and 2012). A 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. Overall, 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0170882</identifier><identifier>PMID: 28170398</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Anesthesia ; Births ; Burundi - epidemiology ; Data processing ; Delivery, Obstetric ; Emergency medical services ; Emergency Medical Services - methods ; Emergency Medical Services - statistics & numerical data ; Evaluation ; Female ; Health Facilities ; Health Services Accessibility ; Health Services Needs and Demand ; Hospital emergency services ; Hospitals ; Human performance ; Humans ; Maternal & child health ; Maternal Health Services ; Maternal mortality ; Medical care quality ; Medical personnel ; Medicine and Health Sciences ; Middle Aged ; Obstetric Labor Complications - epidemiology ; Obstetric Surgical Procedures ; Obstetrics ; Outcome Assessment (Health Care) ; Physicians ; Pregnancy ; Quality of Health Care ; Retrospective Studies ; Rupture ; Rural Population ; Surgery ; Sustainable development ; Uterus ; Womens health ; Young Adult</subject><ispartof>PloS one, 2017-02, Vol.12 (2), p.e0170882-e0170882</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 De Plecker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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A retrospective analysis of EmOC data (2011 and 2012). A 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. 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The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anesthesia</subject><subject>Births</subject><subject>Burundi - epidemiology</subject><subject>Data processing</subject><subject>Delivery, Obstetric</subject><subject>Emergency medical services</subject><subject>Emergency Medical Services - methods</subject><subject>Emergency Medical Services - statistics & numerical data</subject><subject>Evaluation</subject><subject>Female</subject><subject>Health Facilities</subject><subject>Health Services Accessibility</subject><subject>Health Services Needs and Demand</subject><subject>Hospital emergency services</subject><subject>Hospitals</subject><subject>Human performance</subject><subject>Humans</subject><subject>Maternal & child health</subject><subject>Maternal Health Services</subject><subject>Maternal 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P</au><au>Veerman, R</au><au>Van den Bergh, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency obstetric care in a rural district of Burundi: What are the surgical needs?</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-02-07</date><risdate>2017</risdate><volume>12</volume><issue>2</issue><spage>e0170882</spage><epage>e0170882</epage><pages>e0170882-e0170882</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In 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. A retrospective analysis of EmOC data (2011 and 2012). A 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. Overall, 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28170398</pmid><doi>10.1371/journal.pone.0170882</doi><tpages>e0170882</tpages><orcidid>https://orcid.org/0000-0003-4266-8159</orcidid><oa>free_for_read</oa></addata></record>
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subjects	Adolescent Adult Anesthesia Births Burundi - epidemiology Data processing Delivery, Obstetric Emergency medical services Emergency Medical Services - methods Emergency Medical Services - statistics & numerical data Evaluation Female Health Facilities Health Services Accessibility Health Services Needs and Demand Hospital emergency services Hospitals Human performance Humans Maternal & child health Maternal Health Services Maternal mortality Medical care quality Medical personnel Medicine and Health Sciences Middle Aged Obstetric Labor Complications - epidemiology Obstetric Surgical Procedures Obstetrics Outcome Assessment (Health Care) Physicians Pregnancy Quality of Health Care Retrospective Studies Rupture Rural Population Surgery Sustainable development Uterus Womens health Young Adult
title	Emergency obstetric care in a rural district of Burundi: What are the surgical needs?
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