1
|
Byamugisha J, Justus B, Kakaire O, Haddy N, Susan O, Korn A, Mukasa DC, Haruna M, Godfrey A, Alison EA. Characteristics and outcomes of patients with pelvic organ prolapse: an analysis of data from Mulago National Referral Hospital from 2007-2016. Afr Health Sci 2023; 23:410-416. [PMID: 37545968 PMCID: PMC10398439 DOI: 10.4314/ahs.v23i1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is associated with negative physical, social, psychological, and sexual experiences. There is paucity of data in low and middle income countries like Uganda. The purpose of this study was to describe clinical characteristics and outcomes of patients undergoing surgery for POP from 2007 to 2016. METHODS The study was conducted at Mulago National Referral Hospital from 2014 to 2016. We conducted a retrospective review of the urogynecology surgical records using a standardized medical record abstraction form. Data of 222 POP patients were abstracted and managed using REDCap. Analysis was performed using Stata statistical software, v14. RESULTS The mean participant age and parity was 57 years and 7 respectively. Ninety four percent of participants presented with a mass protruding from the vagina, 38% with uterine prolapse and 32% with cystocoele. Anaemia and hypertension were common comorbidities. Women underwent a variety of surgery types, and 35% experienced persistent pain post-operatively. At hospital discharge, 83% had achieved either complete resolution or improvement in their condition. CONCLUSIONS Measures encouraging presentation for care as soon as symptoms are experienced and reduction of total fertility rate will be beneficial. Patients with POP should be routinely screened for anaemia and hypertension.
Collapse
Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barageine Justus
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nalubwama Haddy
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Obore Susan
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco
| | | | - Mwanje Haruna
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Alia Godfrey
- Directorate of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - El Ayadi Alison
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF, San Francisco
| |
Collapse
|
2
|
Torloni MR, Opiyo N, Altieri E, Sobhy S, Thangaratinam S, Nolens B, Geelhoed D, Betran AP. Interventions to reintroduce or increase assisted vaginal births: a systematic review of the literature. BMJ Open 2023; 13:e070640. [PMID: 36787978 PMCID: PMC9930566 DOI: 10.1136/bmjopen-2022-070640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To synthesise the evidence from studies that implemented interventions to increase/reintroduce the use of assisted vaginal births (AVB). DESIGN Systematic review. ELIGIBILITY CRITERIA We included experimental, semi-experimental and observational studies that reported any intervention to reintroduce/increase AVB use. DATA SOURCES We searched PubMed, EMBASE, CINAHL, LILACS, Scopus, Cochrane, WHO Library, Web of Science, ClinicalTrials.gov and WHO.int/ictrp through September 2021. RISK OF BIAS For trials, we used the Cochrane Effective Practice and Organisation of Care tool; for other designs we used Risk of Bias for Non-Randomised Studies of Interventions. DATA EXTRACTION AND SYNTHESIS Due to heterogeneity in interventions, we did not conduct meta-analyses. We present data descriptively, grouping studies according to settings: high-income countries (HICs) or low/middle-income countries (LMICs). We classified direction of intervention effects as (a) statistically significant increase or decrease, (b) no statistically significant change or (c) statistical significance not reported in primary study. We provide qualitative syntheses of the main barriers and enablers for success of the intervention. RESULTS We included 16 studies (10 from LMICs), mostly of low or moderate methodological quality, which described interventions with various components (eg, didactic sessions, simulation, hands-on training, guidelines, audit/feedback). All HICs studies described isolated initiatives to increase AVB use; 9/10 LMIC studies tested initiatives to increase AVB use as part of larger multicomponent interventions to improve maternal/perinatal healthcare. No study assessed women's views or designed interventions using behavioural theories. Overall, interventions were less successful in LMICs than in HICs. Increase in AVB use was not associated with significant increase in adverse maternal or perinatal outcomes. The main barriers to the successful implementation of the initiatives were related to staff and hospital environment. CONCLUSIONS There is insufficient evidence to indicate which intervention, or combination of interventions, is more effective to safely increase AVB use. More research is needed, especially in LMICs, including studies that design interventions taking into account theories of behaviour change. PROSPERO REGISTRATION NUMBER CRD42020215224.
Collapse
Affiliation(s)
- Maria Regina Torloni
- Department of Medicine, Evidence Based Healthcare Post-Graduate Program, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Newton Opiyo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elena Altieri
- Behavioral Insights Unit, World Health Organization, Geneva, Switzerland
| | - Soha Sobhy
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Barbara Nolens
- Department of Obstetrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Diederike Geelhoed
- Provincial Directorate of Health, Tete Provincial Hospital, Cidade de Tete, Mozambique
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
3
|
Bakke E, Øseth EH, Fofanah T, Sesay I, van Duinen A, Bolkan HA, Westendorp J, Lonnee-Hoffmann R. Vacuum births and barriers to its use: An observational study in governmental hospitals in Sierra Leone. BMJ Open 2022; 12:e060773. [PMID: 36414288 PMCID: PMC9685198 DOI: 10.1136/bmjopen-2022-060773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Assisted vaginal births (AVD) can prevent unnecessary caesarean sections (CS). The number of CS is increasing rapidly in sub-Saharan Africa; these are still associated with high perioperative mortality rates. The aim of this study is to define the proportion of AVD in governmental hospitals in Sierra Leone and examine barriers to its use. DESIGN Retrospective observational study of AVD between September 2016 and August 2017. SETTING A representative selection of Sierra Leonean governmental hospitals (n=11). PARTICIPANT AND INTERVENTION: (a) Data were collected from labour ward records. (b) Health workers involved in labour management were questioned. PRIMARY AND SECONDARY OUTCOME MEASURES (a) Number of spontaneous, assisted vaginal and caesarean births. (b) Potential barriers to use vacuum-assisted births. RESULTS (a) Total annual numbers of registered births, AVD and CS were 16 833, 631 (3.7%) and 4642 (27.6%). The proportion of vacuum births ranged from 0.0% to 5.1% across facilities. The proportion of CS ranged from 6.5% to 33.4%. (b) The most frequently reported reasons for limited vacuum use were lack of equipment (25/72; 35%) and insufficient training (18/72; 25%). CONCLUSIONS The proportion of AVD was particularly low in district facilities, and according to healthcare workers this was mostly due to lack of equipment and insufficient training. Implementing relevant training programmes on the use of vacuum devices and increasing the availability of working devices may increase the proportion of vacuum births in government hospitals in Sierra Leone. This could reduce the number of unnecessary CS.
Collapse
Affiliation(s)
- Eirik Bakke
- Medical Battalion, Norwegian Armed Forces, Rena, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eirik Hammer Øseth
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Substance Use and Addiction Medicine, Vestre Viken HF, Drammen, Norway
| | - Tairu Fofanah
- CapaCare, Masanga Hospital, Tonkolili district, Sierra Leone
- Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ibrahim Sesay
- CapaCare, Masanga Hospital, Tonkolili district, Sierra Leone
- Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Alex van Duinen
- CapaCare, Masanga Hospital, Tonkolili district, Sierra Leone
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon Angell Bolkan
- CapaCare, Masanga Hospital, Tonkolili district, Sierra Leone
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Josien Westendorp
- CapaCare, Masanga Hospital, Tonkolili district, Sierra Leone
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Obstetrics and Gynaecology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Risa Lonnee-Hoffmann
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
4
|
Dominico S, Kasanga M, Mwakatundu N, Chaote P, Lobis S, Bailey PE. Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania. BMC Pregnancy Childbirth 2021; 21:302. [PMID: 33853540 PMCID: PMC8048302 DOI: 10.1186/s12884-021-03738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors. Methods A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, but only 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive association with recent practice was observed; the single most promising factor was hands-on solo practice during in-service training (66% of providers with this experience had conducted vacuum extraction in the last 3 months). The logistic regression model showed that providers exposed to 7–9 training modalities were 7.8 times more likely to have performed vacuum extraction than those exposed to fewer training opportunities (AOR = 7.78, 95% CI: 4.169–14.524). Providers who worked in administrative councils other than Kigoma Municipality were 2.7 times more likely to have conducted vacuum extraction than their colleagues in Kigoma Municipality (AOR = 2.67, 95% CI: 1.023–6.976). Similarly, providers posted in a health center compared to those in a hospital were twice as likely to have conducted a recent vacuum extraction (AOR = 2.11, 95% CI: 1.153–3.850), and finally, male providers were twice as likely as their female colleagues to have performed this procedure recently (AOR = 1.95, 95% CI: 1.072–3.55). Conclusions Training and location of posting were associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03738-0.
Collapse
Affiliation(s)
| | | | | | - Paul Chaote
- President's Office-Regional Administration and Local Government, Dodoma, Tanzania
| | | | | |
Collapse
|
5
|
Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021; 26:101199. [PMID: 33546999 PMCID: PMC8026747 DOI: 10.1016/j.siny.2021.101199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.
Collapse
|
6
|
Nolens B, Capelle M, van Roosmalen J, Mola G, Byamugisha J, Lule J, Faye A, van den Akker T. Use of assisted vaginal birth to reduce unnecessary caesarean sections and improve maternal and perinatal outcomes. LANCET GLOBAL HEALTH 2020; 7:e408-e409. [PMID: 30879501 DOI: 10.1016/s2214-109x(19)30043-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/31/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Barbara Nolens
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda; Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands; Athena Institute, Vrije Universiteit, Amsterdam, Netherlands.
| | - Manuela Capelle
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, Netherlands
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Glen Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Obstetrics and Gynaecology, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Lule
- Department of Obstetrics and Gynaecology, Kabale University, Kabale, Uganda
| | - Arfang Faye
- Fajikunda Major Health Centre, Serekunda, The Gambia
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
7
|
Makokha-Sandell H, Mgaya A, Belachew J, Litorp H, Hussein K, Essén B. Low use of vacuum extraction: Health care Professionals' Perspective in a University Hospital, Dar es Salaam. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 25:100533. [PMID: 32505920 DOI: 10.1016/j.srhc.2020.100533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Use of vacuum extraction (VE) has been declining in low and middle income countries. At the highest referral hospital Tanzania, 54% of deliveries are performed by caesarean section (CS) and only 0.8% by VE. Use of VE has the potential to reduce CS rates and improve maternal and neonatal outcomes but causes for its low use is not fully explored. METHOD During November and December of 2017 participatory observations, semi-structured in-depth interviews (n = 29) and focus group discussions (n = 2) were held with midwives, residents and specialists working at the highest referral hospital in Tanzania. Thematic analysis was used to identify rationales for low VE use. FINDINGS Unstructured and inconsistent clinical teaching structure, interdependent on a fear and blame culture, as well as financial incentives and a lack of structured, adhered to and updated guidelines were identified as rationales for CS instead of VE use. Although all informants showed positivity towards clinical teaching of VE, a subpar communication between clinics and academia was stated as resulting in absent clinical teachers and unaccountable students. CONCLUSION This study draws connections between the low use of VE and the inconsistent and unstructured clinical training of VE expressed through the health care providers' points of view. However, clinical teaching in VE was highly welcomed by the informers which may serve as a good starting point for future interventions.
Collapse
Affiliation(s)
- Henrik Makokha-Sandell
- International Maternal and Child Health (IMCH), Department of women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden.
| | - Andrew Mgaya
- International Maternal and Child Health (IMCH), Department of women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden; Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Johanna Belachew
- International Maternal and Child Health (IMCH), Department of women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden.
| | - Helena Litorp
- International Maternal and Child Health (IMCH), Department of women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden.
| | - Kidanto Hussein
- International Maternal and Child Health (IMCH), Department of women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden; Medical College, East Africa, Aga Khan University, P.O. Box 38129, Dar es Salaam, Tanzania; Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Birgitta Essén
- International Maternal and Child Health (IMCH), Department of women's and Children's Health, Uppsala University, 75185 Uppsala, Sweden.
| |
Collapse
|
8
|
Eze P, Lawani LO, Chikezie RU, Ukaegbe CI, Iyoke CA. Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria - a retrospective analysis. BMC Pregnancy Childbirth 2020; 20:298. [PMID: 32410592 PMCID: PMC7227301 DOI: 10.1186/s12884-020-02995-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To evaluate the perinatal status of neonates delivered by assisted vaginal delivery (AVD) versus second-stage caesarean birth (CS). METHODS A 5-year retrospective study was conducted in a tertiary hospital. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics. RESULTS A total of 559 births met the inclusion criteria; AVD (211; 37.7%) and second-stage CS (348; 62.3%). Over 80% of the women were aged 20-34 years: 185 (87.7%) for the AVD group, and 301 (86.5%) for the second-stage CS group. More than half of the women were parous: 106 (50.2%) for the AVD group, and 184 (52.9%) for the second-stage CS group. The commonest indication for intervention in both groups is delayed second stage: 178 (84.4%) in the AVD group, and 239 (68.9%) in the second-stage CS group. There was a statistically significant difference in decision to delivery interval (DDI) between both groups: 197 (93.4%) women in the AVD group had DDI of less than 30 min and 21 women (6.0%) in the CS group had a DDI of less than 30 min (p < 0.001). During the DDI, there were 3 (1.4%) intra-uterine foetal deaths (IUFD) in the AVD and 19 (5.5%) in the CS group (p = 0.023). After adjusting for co-variates, there were statistically significant differences between the AVD and CS groups in the foetal death during DDI (p = 0.029) and perinatal deaths (p = 0.040); but no statistically significant differences in severe perinatal outcomes (p = 0.811), APGAR scores at 5th minutes (p = 0.355), and admission into the NICU (p = 0.946). After adjusting for co-variates, use of AVD was significantly associated with the level of experience of the care provider, with resident (junior) doctors less likely to opt for AVD than CS (aOR = 0.45, 95% CI: 0.29-0.70). CONCLUSION Second-stage CS when compared with AVD was not associated with improved perinatal outcomes. AVD is a practical option for reducing the rising Caesarean delivery rates without compromising the clinical status of the newborn.
Collapse
Affiliation(s)
- Paul Eze
- Medecins Sans Frontieres OCBA, Barcelona, Spain
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lucky Osaheni Lawani
- Department of Obstetrics & Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | | | | | | |
Collapse
|
9
|
Reed CR, Commander SJ, Sekabira J, Kisa P, Kakembo N, Wesonga A, Langer M, Villanova GA, Ozgediz D, Fitzgerald TN. Comparison of Ugandan and North American Pediatric Surgery Fellows' Operative Experience: Opportunities for Global Training Exchange. JOURNAL OF SURGICAL EDUCATION 2020; 77:606-614. [PMID: 31862316 DOI: 10.1016/j.jsurg.2019.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE North American pediatric surgery training programs vary in exposure to index cases, while controversy exists regarding fellow participation in global surgery rotations. We aimed to compare the case logs of graduating North American pediatric surgery fellows with graduating Ugandan pediatric surgery fellows. DESIGN The pediatric surgery training program at a regional Ugandan hospital hosts a collaboration between Ugandan and North American attending pediatric surgeons. Fellow case logs were compared to the Accreditation Council for Graduate Medical Education Pediatric Surgery Case Log 2018 to 19 National Data Report. SETTING Mulago National Referral Hospital in Kampala, Uganda; and pediatric surgery training programs in the United States and Canada. RESULTS Three Ugandan fellows completed training and submitted case logs between 2011 and 2019 with a mean of 782.3 index cases, compared to the mean 753 cases in North America. Ugandan fellows performed more procedures for biliary atresia (6.7 versus 4), Wilm's tumor (23.7 versus 5.7), anorectal malformation (45 versus 15.7), and inguinal hernia (158.7 versus 76.8). North American fellows performed more central line procedures (73.7 versus 30.7), cholecystectomies (27.3 versus 3), extracorporeal membrane oxygenation cannulations (16 versus 1), and congenital diaphragmatic hernia repairs (16.5 versus 5.3). All cases in Uganda were performed without laparoscopy. CONCLUSIONS Ugandan fellows have access to many index cases. In contrast, North American trainees have more training in laparoscopy and cases requiring critical care. Properly orchestrated exchange rotations may improve education for all trainees, and subsequently improve patient care.
Collapse
Affiliation(s)
- Christopher R Reed
- Duke University Medical Center, Department of Surgery, Durham, North Carolina.
| | - Sarah J Commander
- Duke University Medical Center, Department of Surgery, Durham, North Carolina
| | | | | | | | | | | | | | | | - Tamara N Fitzgerald
- Duke University Medical Center, Department of Surgery, Durham, North Carolina
| |
Collapse
|
10
|
Nolens B, van den Akker T, Lule J, Twinomuhangi S, van Roosmalen J, Byamugisha J. Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda. Trop Med Int Health 2019; 24:553-562. [PMID: 30803113 PMCID: PMC6850599 DOI: 10.1111/tmi.13222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objectives To investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth. Results The first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail. Conclusions Most women would recommend vacuum extraction over CS in case of prolonged second stage of labour.
Collapse
Affiliation(s)
- Barbara Nolens
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda.,Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - John Lule
- Department of Obstetrics and Gynaecology, Kabale University, Kabale, Uganda
| | - Sulphine Twinomuhangi
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda.,School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
11
|
O’Brien S, Hotton EJ, Lenguerrand E, Wade J, Winter C, Draycott TJ, Crofts JF. The ASSIST Study - The BD Odon Device for assisted vaginal birth: a safety and feasibility study. Trials 2019; 20:159. [PMID: 30836979 PMCID: PMC6402154 DOI: 10.1186/s13063-019-3249-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Assisted vaginal birth is a vital health intervention that can result in better outcomes for mothers and their babies when complications arise in the second stage of labour. Unfortunately, instruments for assisted vaginal birth (forceps and ventouse) are often not utilised in settings where there is most clinical need, resulting in maternal and neonatal morbidity and mortality which could have been prevented. The BD Odon Device is a new device for assisted vaginal birth that may be able to address this unmet need. However, before dissemination, the device requires evaluation in robust clinical trials. A feasibility study to investigate the clinical impact, safety, and acceptability of the BD Odon Device for assisted vaginal birth is therefore planned. This will provide further information on acceptability, recruitment, and the outcome data required to design a future randomised controlled trial of the BD Odon Device versus Kiwi ventouse. METHODS Forty women who require an assisted vaginal birth for a recognised clinical indication will have the birth assisted with the BD Odon Device. The primary outcome is successful vaginal birth completed with the BD Odon Device. Secondary clinical outcomes include maternal and neonatal outcomes, and maternal and practitioner satisfaction. Safety data will be reviewed following every birth. DISCUSSION A future randomised controlled trial of the BD Odon Device versus the current standard instrument (the Kiwi ventouse) is planned. The findings of the ASSIST Study will inform the randomised controlled trial design. TRIAL REGISTRATION ISRCTN, ISRCTN10203171 . Prospectively registered on 27 July 2018.
Collapse
Affiliation(s)
- Stephen O’Brien
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Emily J. Hotton
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Erik Lenguerrand
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cathy Winter
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Tim J. Draycott
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Joanna F. Crofts
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| |
Collapse
|
12
|
Mukisa J, Grant I, Magala J, Ssemata AS, Lumala PZ, Byamugisha J. Level of Partograph completion and healthcare workers' perspectives on its use in Mulago National Referral and teaching hospital, Kampala, Uganda. BMC Health Serv Res 2019; 19:107. [PMID: 30732600 PMCID: PMC6367740 DOI: 10.1186/s12913-019-3934-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background The appropriate use of the Partograph allows early identification of labour related complications and prevents deaths. We, therefore, sought to determine the level of Partograph completion and healthcare worker perspectives towards its utilization. Methods This study had two components; a hospital-based cross-sectional descriptive chart review at the Mulago National Referral Hospital, Kampala, Uganda and a qualitative study involving four Focus Group Discussions (FGDs) with ward nurses, midwives and postgraduate residents. Data from the FGDs were analyzed using thematic -content analysis in Open Code software. The quantitative data were summarized using descriptive statistical analysis, means and proportions. Results Among the 355 Partographs reviewed, 79.1% had incomplete documentation of age, 52.7% gravidity, and 3.2% parity. In about 61%, the specific parameters for fetal monitoring, maternal monitoring and labour progress were incomplete. From the FGDs, the healthcare workers reported being unable to complete the Partographs due to the overwhelming numbers of expectant mothers and other staff responsibilities. Congestion in the maternity ward reduced the Partograph completion rates. The availability of other monitoring tools, limitation in skills, inadequate equipment and supplies, and the state of the mother at the presentation to the hospital all made Partograph use and completion challenging. Conclusions The majority of Partographs started by health workers were incomplete. The time required to document, health system challenges, status of mother at presentation, and the high workload undermined completion of the Partograph at this high volume facility.
Collapse
Affiliation(s)
- John Mukisa
- Uganda CWRU Research Collaboration, Kampala, Uganda.
| | - Isha Grant
- Department of Child Health, Ministry of Health, Kampala, Uganda
| | - Jonathan Magala
- Department of Obstetrics and Gynecology, Life link hospital, Kampala, Uganda
| | - Andrew S Ssemata
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patrick Z Lumala
- Research and Planning Division, Uganda Revenue Authority, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
13
|
Delafield R, Pirkle CM, Dumont A. Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data. BMC Pregnancy Childbirth 2018; 18:432. [PMID: 30382820 PMCID: PMC6211600 DOI: 10.1186/s12884-018-2064-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/18/2018] [Indexed: 01/27/2023] Open
Abstract
Background The purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly. Methods Cross-sectional data analysis from the pre-intervention period (Oct. 1, 2007- Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital. Results Five hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as > 5 live births (aOR = 7.57, 95%CI; 5.19–11.03), prior cesarean (aOR = 2.02, 95%CI; 1.61–2.54), resides outside hospital region (aOR = 1.90, 95%CI: 1.28–2.81), no prenatal care visits (aOR = 1.80, 95%CI; 1.44–2.25), and birth weight of > 3600 g (aOR = 1.61, 95%CI; 1.30–1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90–65.02). Conclusions The results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture. Electronic supplementary material The online version of this article (10.1186/s12884-018-2064-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd., Suite 1015, Honolulu, HI, 96813-5401, USA.
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, BioMed T102, Honolulu, HI, 96822-2319, USA
| | - Alexandre Dumont
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, Research Unit 196 (CEPED), Paris, France
| |
Collapse
|
14
|
Augusto O, Keyes EE, Madede T, Abacassamo F, de la Corte P, Chilundo B, Bailey PE. Progress in Mozambique: Changes in the availability, use, and quality of emergency obstetric and newborn care between 2007 and 2012. PLoS One 2018; 13:e0199883. [PMID: 30020958 PMCID: PMC6051588 DOI: 10.1371/journal.pone.0199883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal mortality in Mozambique has not declined significantly in the last 10-15 years, plateauing around 480 maternal deaths per 100,000 live births. Good quality antenatal care and routine and emergency intrapartum care are critical to reducing preventable maternal and newborn deaths. MATERIALS AND METHODS We compare the findings from two national cross-sectional facility-based assessments conducted in 2007 and 2012. Both were designed to measure the availability, use and quality of emergency obstetric and neonatal care. Indicators for monitoring emergency obstetric care were used as were descriptive statistics. RESULTS The availability of facilities providing the full range of obstetric life-saving procedures (signal functions) decreased. However, an expansion in the provision of individual signal functions was highly visible in health centers and health posts, but in hospitals, performance was less satisfactory, with proportionally fewer hospitals providing assisted vaginal delivery, obstetric surgery and blood transfusions. All other key indicators showed signs of improvements: the institutional delivery rate, the cesarean delivery rate, met need for emergency obstetric care (EmOC), institutional stillbirth and early neonatal death rates, and cause-specific case fatality rates (CFRs). CFRs for most major obstetric complications declined between 17% and 69%. The contribution of direct causes to maternal deaths decreased while the proportion of indirect causes doubled during the five-year interval. CONCLUSIONS The indicator of EmOC service availability, often used for planning and developing EmONC networks, requires close examination. The standard definition can mask programmatic weaknesses and thus, fails to inform decision makers of what to target. In this case, the decline in the use of assisted vaginal delivery explained much of the difference in this indicator between the two surveys, as did faltering hospital performance. Despite this backsliding, many signs of improvement were also observed in this 5-year period, but indicator levels continue below recommended thresholds. The quality of intrapartum care and the adverse consequences from infectious diseases during pregnancy point to priority areas for programmatic improvement.
Collapse
Affiliation(s)
- Orvalho Augusto
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
- * E-mail:
| | - Emily E. Keyes
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
| | - Tavares Madede
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Fátima Abacassamo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | | | - Baltazar Chilundo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Patricia E. Bailey
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
| |
Collapse
|
15
|
Nolens B, van den Akker T, Lule J, Twinomuhangi S, van Roosmalen J, Byamugisha J. Birthing experience and quality of life after vacuum delivery and second-stage caesarean section: a prospective cohort study in Uganda. Trop Med Int Health 2018; 23:914-922. [PMID: 29873887 DOI: 10.1111/tmi.13089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess perceptions of women undergoing vacuum extraction or second-stage caesarean section (SSCS) in a tertiary referral hospital in sub-Saharan Africa. METHODS Prospective cohort study, with six-month follow-up, of women who gave birth to a term singleton in cephalic presentation by vacuum extraction (n = 289) or SSCS (n = 357) between 25 November 2014, to 8 July 2015, in Mulago Hospital, Uganda. Excluded were women who had failed vacuum extraction, severe birth complications and those whose babies had died. Outcome measures were birthing experience satisfaction, physical component summary (PCS) and mental component summary (MCS) of the SF-12 quality-of-life questionnaire, pain scores and dyspareunia. RESULTS One day after vacuum extraction, 63.7% (181/284) of women were feeling well vs. 48.1% (167/347) after SSCS (OR 1.89; 95%CI 1.37-2.61) and mean pain sores were 2.70 vs. 3.87 (P < 0.001). In both groups, >90% of women were satisfied with their birthing experience. At six weeks, in vacuum extraction vs. SSCS, mean pain sores were 0.40 vs. 0.89 (P < 0.001); mean PCS was 48.67 vs. 44.03 (P < 0.001); mean MCS was 52.80 vs. 51.23 (P = 0.203); 40% (70/175) vs. 28.3% (70/247) of women had resumed sexual intercourse (OR 1.69; 95%CI 1.12-2.54) and 21.4% (15/70) vs. 28.6% (20/70) had dyspareunia (OR 0.68; 95%CI 0.32-1.47). No differences were found at six months after birth. CONCLUSION One day and six weeks after birth, outcomes were better in women who had vacuum extraction. At six months, outcomes were similar. To promote quick recovery, vacuum extraction should be the first intervention considered in the second stage of labour.
Collapse
Affiliation(s)
- Barbara Nolens
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda.,Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - John Lule
- Department of Obsterics and Gynaecology, Kabale University, Kabale, Uganda
| | - Sulphine Twinomuhangi
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda.,School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
16
|
Geelhoed D, de Deus V, Sitoe M, Matsinhe O, Lampião Cardoso MI, Manjate CV, Pinto Matsena PI, Mosse Lazaro C. Improving emergency obstetric care and reversing the underutilisation of vacuum extraction: a qualitative study of implementation in Tete Province, Mozambique. BMC Pregnancy Childbirth 2018; 18:266. [PMID: 29945551 PMCID: PMC6020342 DOI: 10.1186/s12884-018-1901-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/17/2018] [Indexed: 01/29/2023] Open
Abstract
Background Maternal and perinatal mortality in Mozambique were declining at a slow pace, despite progress in coverage of institutional childbirth. Implementation of quality emergency obstetric care including vacuum extraction remained inadequate. In 2015–2017, Tete Province achieved remarkable progress in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, with encouraging results for maternal and perinatal outcomes, despite severe resource constraints. This paper presents the experience of Tete Province, generating a rich, contextualised understanding, which might provide generalizable insights and lessons. Methods This qualitative study design is used to present Tete’s experience in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, drawing on principles from implementation science and applying a systems thinking approach. Sources include routine data, documents, social media messages, and the lived experience of the authors, all intimately involved in the implementation process during 2014–2017. Iterative learning and analysis, involving all authors, led to the final interpretations. Results Within a context of severe resource constraints, Tete applied 4 interventions (training, accreditation, audit, monitoring and evaluation with feedback) to improve the implementation of emergency obstetric care. Considerable progress was achieved in vacuum extraction and other signal functions of emergency obstetric care and in the decision-making process for caesarean sections, contributing to important reductions in the provincial institutional maternal mortality and stillbirth rates. Facilitating factors include attributes of the vacuum extraction itself, of the structural and organisational environments in which it was introduced, of the people involved in implementation, and of the process through which the implementation was rolled-out. Conclusions The lessons from implementation science and systems thinking can contribute to surprising results in the improvement of emergency obstetric care including the use of vacuum extraction, even in a severely resource-constrained setting. The creation of conditions for real change, with empowerment of the staff and managers at the front-line of day-to-day practice in Tete may inspire others in similar conditions and circumstances. The underutilisation of vacuum extraction in middle- and low-income countries is indeed a missed opportunity. Its reversion is possible and provides a good chance to make considerable difference in maternal and perinatal outcomes.
Collapse
Affiliation(s)
- D Geelhoed
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique.
| | - V de Deus
- Tete Provincial Hospital, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M Sitoe
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - O Matsinhe
- Rural Hospital of Mutarara, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M I Lampião Cardoso
- Rural Hospital of Ulongue, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C V Manjate
- District Services of Health, Women and Social Action of Chifunde, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - P I Pinto Matsena
- District Services of Health, Women and Social Action of Cidade de Tete, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C Mosse Lazaro
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| |
Collapse
|
17
|
Dominico S, Bailey PE, Mwakatundu N, Kasanga M, van Roosmalen J. Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania. BMC Pregnancy Childbirth 2018; 18:248. [PMID: 29914412 PMCID: PMC6006733 DOI: 10.1186/s12884-018-1888-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/07/2018] [Indexed: 11/15/2022] Open
Abstract
Background In rural Tanzania access to emergency obstetric and newborn care is threatened by poor roads and understaffed facilities among other challenges. Districts in Kigoma, Pwani and Morogoro regions were targeted by a local non-governmental organization to assist local government to build capacity and improve access to clinical management of severe obstetric and newborn complications. The program upgraded ten primary health care centres to provide comprehensive emergency obstetric and newborn care. This paper describes the process of reintroducing vacuum extraction into ten health centres and five hospitals, highlighting patterns in uptake, mode of delivery and lessons learned. Methods This observational study uses facility-based trend data collected between 2011 and 2016.Descriptive outcomes include institutional caesarean delivery rates, vacuum extraction rates, and the ratio of caesareans to vacuum-assisted deliveries. Results Institutional caesarean delivery rates remained stable at about 10–11% and the vacuum extraction rate rose from virtually no procedures in 2011 to about 2% in 2016. The increase was more visible in upgraded health centres than in hospitals. In 2016 vacuum extraction rates in newly upgraded health centres ranged from 0.5 to 7.8%. Between 2011 and 2016, the ratio of caesareans to vacuum extractions in hospitals changed from 304 caesareans to 1 vacuum extraction to 10:1, while in health centres the ratio changed from 22: 1 to 3: 1. Conclusions Reintroduction of vacuum extraction into clinical practice in primary health care facilities with task-shifting is feasible. Reintroduction of this procedure was more successful when part of an integrated upgrading of health centres to provide comprehensive emergency obstetric care than when reintroduced into busy hospital environments. Turnover of trained staff in hospitals contributed to the uneven uptake of vacuum extraction. Lessons learned are applicable to further national scale up and to other countries.
Collapse
Affiliation(s)
| | | | | | | | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center and Athena Institute, VU University, de Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Nolens B, Namiiro F, Lule J, van den Akker T, van Roosmalen J, Byamugisha J. Prospective cohort study comparing outcomes between vacuum extraction and second-stage cesarean delivery at a Ugandan tertiary referral hospital. Int J Gynaecol Obstet 2018; 142:28-36. [PMID: 29630724 DOI: 10.1002/ijgo.12500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/23/2018] [Accepted: 04/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare maternal and perinatal outcomes between vacuum extraction and second-stage cesarean delivery (SSCD). METHODS The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent vacuum extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. RESULTS Among 13 152 deliveries, 358 women who underwent vacuum extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after vacuum extraction versus five deaths from complications of SSCD. Vacuum extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07-0.84). Fetal death during the decision-to-delivery interval was also less common in the vacuum extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07-0.84); however, the perinatal mortality rate did not differ between the vacuum extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49-1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. CONCLUSION Vacuum extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of vacuum extraction.
Collapse
Affiliation(s)
- Barbara Nolens
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda.,Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Flavia Namiiro
- Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda
| | - John Lule
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda.,School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda.,School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
19
|
In Reply. Obstet Gynecol 2017; 129:205-206. [DOI: 10.1097/aog.0000000000001830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Simulation Training for Forceps-Assisted Vaginal Delivery and Rates of Maternal Perineal Trauma. Obstet Gynecol 2016; 129:205. [PMID: 28002293 DOI: 10.1097/aog.0000000000001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|