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De Plecker E, Zachariah R, Kumar AMV, 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. Emergency obstetric care in a rural district of Burundi: What are the surgical needs? PLoS One 2017; 12:e0170882. [PMID: 28170398 PMCID: PMC5295715 DOI: 10.1371/journal.pone.0170882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 01/13/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES 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. METHODS A retrospective analysis of EmOC data (2011 and 2012). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- E. De Plecker
- Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium
- * E-mail:
| | - R. Zachariah
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - A. M. V. Kumar
- International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi India
| | - M. Trelles
- Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium
| | - S. Caluwaerts
- Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium
| | | | | | - K. Tayler-Smith
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - M. Manzi
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | | | - B. Duchenne
- Medecins sans Frontieres, Bujumbura, Burundi
| | - B. Ndelema
- Medecins sans Frontieres, Bujumbura, Burundi
| | - W. Etienne
- Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium
| | - P. Alders
- Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium
| | - R. Veerman
- Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium
| | - R. Van den Bergh
- Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
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Khogali M, Zachariah R, Reid AJ, Alipon SC, Zimble S, Gbane M, Etienne W, Veerman R, Hassan A, Harries AD. Do non-monetary incentives for pregnant women increase antenatal attendance among Ethiopian pastoralists? Public Health Action 2015; 4:12-4. [PMID: 26423755 DOI: 10.5588/pha.13.0092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022] Open
Abstract
In a pastoralist setting in Ethiopia, we assessed changes in attendance between the first and subsequent antenatal care (ANC) visits following the implementation of non-monetary incentives in a primary health care centre over a 3-year period from October 2009 to September 2012. Incentives included the provision of a bar of soap, a bucket, a mosquito net, sugar, cooking oil, a jerrycan and a delivery kit. The first ANC visits increased by 48% in the first year to 60% in the second. Subsequent visits did not show a similar pattern due to ruptures in incentive stocks. Incentives appear to increase ANC attendance; however, ruptures in stock should be avoided to sustain the effect.
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Affiliation(s)
- M Khogali
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R Zachariah
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - A J Reid
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - S C Alipon
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - S Zimble
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - M Gbane
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - W Etienne
- Operational Centre Brussels, MSF Brussels, Belgium
| | - R Veerman
- Operational Centre Brussels, MSF Brussels, Belgium
| | - A Hassan
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Zachariah R, De Smet M, Etienne W, Khogali M, van Den Bergh R, Veerman R, Harries AD. Non-monetary incentives for pregnant women and antenatal attendance among Ethiopian pastoralists. Public Health Action 2014; 4:133. [PMID: 26393077 DOI: 10.5588/pha.14.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Zachariah
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - M De Smet
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - W Etienne
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - M Khogali
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R van Den Bergh
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R Veerman
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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