| 1. |
- van Duinen, A. J., et al.
(author)
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Caesarean section performed by medical doctors and associate clinicians in Sierra Leone.
- 2019
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 106:2, s. e129-e137
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Journal article (peer-reviewed)abstract
- BACKGROUND: Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task-sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors.METHODS: All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non-inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity.RESULTS: Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42).CONCLUSION: Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task-sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.
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| 2. |
- Baroffio, C. A., et al.
(author)
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Combining plant volatiles and pheromones to catch two insect pests in the same trap : Examples from two berry crops
- 2018
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In: Crop Protection. - : ELSEVIER SCI LTD. - 0261-2194 .- 1873-6904. ; 109, s. 1-8
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Journal article (peer-reviewed)abstract
- Most horticultural crops are attacked by more than one insect pest. As broad-spectrum chemical control options are becoming increasingly restricted, there is a need to develop novel control methods. Semiochemical attractants are available for three important horticultural pests, strawberry blossom weevil, Anthonomus rubi Herbst (Coleoptera: Curculionidae), European tarnished plant bug, Lygus rugulipennis Poppius (Hemiptera: Miridae) and raspberry beetle, Byturus tomentostts deGeer (Coleoptera: Byturidae). Traps targeting more than one pest species would be more practical and economical for both monitoring and mass trapping than traps for single-species. In this study we aimed to (1) improve the effectiveness of existing traps for insect pests in strawberry and raspberry crops by increasing catches of each species, and (2) test if attractants for two unrelated pest species could be combined to capture both in the same trap without decreasing the total catches. Field tests were carried out in four European countries and different combinations of semiochemicals were compared. A volatile from strawberry flowers, 1,4 dimethoxybenzene (DMB), increased the attractiveness of the aggregation pheromone to both sexes of A. rubi. The host-plant volatile, phenylacetaldehyde (PAA), increased the attraction of female L. rugulipennis to the sex pheromone, and, in strawberry, there was some evidence that adding DMB increased catches further. Traps baited with the aggregation pheromone of A. rubi, DMB, the sex pheromone of L rugulipennis and PAA attracted both target species to the same trap with no significant difference in catches compared to those single-species traps. In raspberry, catches in traps baited with a combination of A. rubi aggregation pheromone, DMB and the commercially available lure for B. tomentosus, based on raspberry flower volatiles, were similar to those in single-species traps. In both crops the efficiency of the traps still needs improvement, but the multi species traps are adequate for monitoring and should not lead to confusion for the user as the target species are easy to distinguish from each other.
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| 3. |
- Baroffio, C. A., et al.
(author)
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Management of insect pests using semiochemical traps
- 2016
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In: Acta Horticulturae. - 9789462611221 ; , s. 121-127
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Conference paper (peer-reviewed)abstract
- In the absence of effective control measures, the strawberry blossom weevil (Anthonomus rubi) (SBW) and the raspberry beetle (Byturus tomentosus) (RB) cause large (10 - >80%) losses in yield and quality in organically grown raspberry. Attractive lures for both pests were combined into a single multitrap for the economical management of both of these pests at the same time. This is one of the first approaches to pest management of non-lepidopteran insect pests of horticultural crops using semiochemicals in the EU, and probably the first to target multiple species from different insect orders. The aim is to develop optimized lures and cost-effective trap designs for mass trapping and to determine the optimum density and spatial and temporal patterns of deployment of the traps for controlling these pests by mass trapping. The combination between an aggregation pheromone that attracts Anthonomus rubi and a raspberry flower volatile that attracts Byturus tomentosus seems to be the best combination.
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| 4. |
- Claassen, Yvette H. M., et al.
(author)
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Treatment and survival of rectal cancer patients over the age of 80 years : a EURECCA international comparison
- 2018
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In: British Journal of Cancer. - : Nature Publishing Group. - 0007-0920 .- 1532-1827. ; 119:4, s. 517-522
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Journal article (peer-reviewed)abstract
- BACKGROUND: The optimal treatment strategy for older rectal cancer patients remains unclear. The current study aimed to compare treatment and survival of rectal cancer patients aged 80+.METHODS: Patients of >= 80 years diagnosed with rectal cancer between 2001 and 2010 were included. Population-based cohorts from Belgium (BE), Denmark (DK), the Netherlands (NL), Norway (NO) and Sweden (SE) were compared side by side for neighbouring countries on treatment strategy and 5-year relative survival (RS), adjusted for sex and age. Analyses were performed separately for stage I-III patients and stage IV patients.RESULTS: Overall, 19 634 rectal cancer patients were included. For stage I-III patients, 5-year RS varied from 61.7% in BE to 72.3% in SE. Proportion of preoperative radiotherapy ranged between 7.9% in NO and 28.9% in SE. For stage IV patients, 5-year RS differed from 2.8% in NL to 5.6% in BE. Rate of patients undergoing surgery varied from 22.2% in DK to 40.8% in NO.CONCLUSIONS: Substantial variation was observed in the 5-year relative survival between European countries for rectal cancer patients aged 80+, next to a wide variation in treatment, especially in the use of preoperative radiotherapy in stage I-III patients and in the rate of patients undergoing surgery in stage IV patients.
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| 5. |
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| 6. |
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| 7. |
- Seternes, A., et al.
(author)
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Open Abdomen Treated with Negative Pressure Wound Therapy : Indications, Management and Survival
- 2017
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In: World Journal of Surgery. - : SPRINGER. - 0364-2313 .- 1432-2323. ; 41:1, s. 152-161
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Journal article (peer-reviewed)abstract
- Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications. Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway. The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived. Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.
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| 8. |
- van de Velde, Cornelis J H, et al.
(author)
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EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum.
- 2014
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In: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 50:1
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Journal article (peer-reviewed)abstract
- Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.
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| 9. |
- van de Velde, C. J. H., et al.
(author)
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Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012 : Science, opinions and experiences from the experts of surgery
- 2014
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In: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 40:4, s. 454-468
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Journal article (peer-reviewed)abstract
- The first multidisciplinary consensus conference on colon and rectal cancer was held in December 2012, achieving a majority of consensus for diagnostic and treatment decisions using the Delphi Method. This article will give a critical appraisal of the topics discussed during the meeting and in the consensus document by well-known leaders in surgery that were involved in this multidisciplinary consensus process. Scientific evidence, experience and opinions are collected to support multidisciplinary teams (MDT) with arguments for medical decision-making in diagnosis, staging and treatment strategies for patients with colon or rectal cancer. Surgery is the cornerstone curative treatment for colon and rectal cancer. Standardizing treatment is an effective instrument to improve outcome of multidisciplinary cancer care for patients with colon and rectal cancer. In this article, a review of the following focuses; Perioperative care, age and colorectal surgery, obstructive colorectal cancer, stenting, surgical anatomical considerations, total mesorectal excision (TME) surgery and training, surgical considerations for locally advanced rectal cancer (LARC) and local recurrent rectal cancer (LRRC), surgery in stage IV colorectal cancer, definitions of quality of surgery, transanal endoscopic microsurgery (TEM), laparoscopic colon and rectal surgery, preoperative radiotherapy and chemoradiotherapy, and how about functional outcome after surgery?
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| 10. |
- Van den Broek, C. B. M., et al.
(author)
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Differences in pre-operative treatment for rectal cancer between Norway, Sweden, Denmark, Belgium and the Netherlands
- 2014
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In: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 40:12, s. 1789-1796
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Journal article (peer-reviewed)abstract
- Several studies have shown remarkable differences in colorectal cancer survival across Europe. Most of these studies lacked information about stage and treatment. In this study we compared short-term survival as well as differences in tumour stage and treatment strategies between five European countries: Norway, Sweden, Denmark, Belgium, and the Netherlands. For this retrospective cohort study all patients aged 18 years or older and operated on adenocarcinoma of the rectum without distant metastases and diagnosed in 2008 and 2009 were selected in national audit registries from Norway, Sweden, Denmark, Belgium, and the Netherlands. Differences in pre-operative treatment between the countries were compared using univariable and multivariable logistic regression. One year relative survival and one year relative excess risk of death (RER) were compared between the five countries. Large variation in the use of preoperative radiotherapy and chemoradiation was found between the countries. Even though, there was little variation in relative survival between the countries, except Sweden, which had a significant better one year RER of death among the elderly patients after adjustment. The differences in survival are expected to be caused by differences in pen-operative care, selection of patients, and especially management of elderly patients. The effects of preoperative treatment are expected to be seen on long term follow-up.
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| 11. |
- Van Duinen, Alex J., et al.
(author)
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Travel time and perinatal mortality after emergency caesarean sections : An evaluation of the 2-hour proximity indicator in Sierra Leone
- 2020
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In: BMJ Global Health. - : BMJ. - 2059-7908. ; 5:12
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Journal article (peer-reviewed)abstract
- Introduction Longer travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance. Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma et al; model II Munoz et al). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed. Results The median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001). Conclusion The standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.
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| 12. |
- van Gijn, W., et al.
(author)
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The EURECCA project : Data items scored by European colorectal cancer audit registries
- 2012
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In: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 38:6, s. 467-471
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Journal article (peer-reviewed)abstract
- Aims: The EURECCA (European Registration of Cancer Care) consortium is currently formed by nine independently founded national colorectal audit registrations, of which most already run for many years. The cumulative experience of EURECCA's participants could be used to identify a 'core dataset' that covers all important aspects needed for high quality auditing and at the same time lacking needless data items that only consumes administrative effort. The aim of this study is to compare the data items used by the nine registries participating in EURECCA to identify a core dataset and explore options for future research. Methods: All colorectal outcome registrations participating in the EURECCA project were asked to supply a list with all the data items they score. Items were scored 'present' if they appeared literally in a registration or in case they could he calculated using other items in the same registration. The definition of a 'shared data item' was that at least eight of the nine participating registries scored the item. Results: The number of registered data items varied between 254 (Belgium) and 83 (Norway). Among the 45 variables were patient data, data about preoperative staging, surgical treatment, pre- or postoperative radio- and/or chemotherapy, and follow-up. Items about tumour recurrence or quality of life were scored too little to become shared data items. Conclusions: A total of 45 items were collected by 8 or more of the participating registries and subsequently met the criteria for a shared data item.
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| 13. |
- Vermeer, Nina C. A., et al.
(author)
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Treatment and Survival of Patients with Colon Cancer Aged 80 Years and Older : A EURECCA International Comparison
- 2018
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In: The Oncologist. - : Wiley-Blackwell. - 1083-7159 .- 1549-490X. ; 23:8, s. 982-990
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Journal article (peer-reviewed)abstract
- Background. Colon cancer in older patients represents a major public health issue. As older patients are hardly included in clinical trials, the optimal treatment of these patients remains unclear. The present international EURECCA comparison explores possible associations between treatment and survival outcomes in elderly colon cancer patients.Subjects, Materials, and Methods. National data from Belgium, Denmark, The Netherlands, Norway, and Sweden were obtained, as well as a multicenter surgery cohort from Germany. Patients aged 80 years and older, diagnosed with colon cancer between 2001 and 2010, were included. The study interval was divided into two periods: 2001–2006 and 2007–2010. The proportion of surgical treatment and chemotherapy within a country and its relation to relative survival were calculated for each time frame.Results. Overall, 50,761 patients were included. At least 94% of patients with stage II and III colon cancer underwent surgical removal of the tumor. For stage II–IV, the proportion of chemotherapy after surgery was highest in Belgium and lowest in The Netherlands and Norway. For stage III, it varied from 24.8% in Belgium and 3.9% in Norway. For stage III, a better adjusted relative survival between 2007 and 2010 was observed in Sweden (adjusted relative excess risk [RER] 0.64, 95% confidence interval [CI]: 0.54–0.76) and Norway (adjusted RER 0.81, 95% CI: 0.69–0.96) compared with Belgium.Conclusion. There is substantial variation in the rate of treatment and survival between countries for patients with colon cancer aged 80 years or older. Despite higher prescription of adjuvant chemotherapy, poorer survival outcomes were observed in Belgium. No clear linear pattern between the proportion of chemotherapy and better adjusted relative survival was observed.
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| 14. |
- Bichao, H., et al.
(author)
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Molecular receptive ranges of olfactory receptor neurones responding selectively to terpenoids, aliphatic green leaf volatiles and aromatic compounds, in the strawberry blossom weevil Anthonomus rubi
- 2005
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In: Chemoecology. - : Springer Science and Business Media LLC. - 0937-7409 .- 1423-0445. ; 15:4, s. 211-226
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Journal article (peer-reviewed)abstract
- An important question in insect-plant interactions is which of the numerous plant compounds contribute to the perception of odour qualities in herbivorous insects and are likely to be used as cues in host-searching behaviour. In order to identify which plant-produced volatiles the strawberry blossom weevil Anthonomus rubi detects, we have used electrophysiological recordings from single olfactory neurones linked to gas chromatography and mass spectrometry. We here present 15 receptor neurone types specialised for naturally produced compounds present in the host and nonhost plants and two types for two aggregation pheromone components. The active compounds were terpenoids, aromatic and aliphatic esters, alcohols and aldehydes, some of which are induced by feeding activity of the weevils. The neurones were characterised by a strong response to one or two primary odorants and weaker responses to a few others having similar chemical structure. With one exception, the molecular receptive range of each neurone type was within one chemical group. Enantiomers of linalool separated on a chiral column activated two neurone types with different enantioselectivity. Inhibition by linalool of another neurone type, excited by alpha-pinene, indicated an additional mechanism for coding the information about this compound. Altogether, detection of 54 compounds by olfactory receptor neurones is shown, of which 40 have been chemically identified in this study. Thus A. rubi has the ability to detect a large number of odorants that may be used in host selection behaviour.
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| 15. |
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| 16. |
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| 17. |
- Bolkan, Håkon A, et al.
(author)
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The Surgical Workforce and Surgical Provider Productivity in Sierra Leone: A Countrywide Inventory.
- 2016
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 40:6, s. 1344-1351
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Journal article (peer-reviewed)abstract
- Limited data exist on surgical providers and their scope of practice in low-income countries (LICs). The aim of this study was to assess the distribution and productivity of all surgical providers in an LIC, and to evaluate correlations between the surgical workforce availability, productivity, rates, and volume of surgery at the district and hospital levels.
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| 18. |
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| 19. |
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| 20. |
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| 21. |
- de Jong, Wibe A, et al.
(author)
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Utilizing high performance computing for chemistry : parallel computational chemistry
- 2010
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In: Physical Chemistry, Chemical Physics - PCCP. - : Royal Society of Chemistry (RSC). - 1463-9076 .- 1463-9084. ; 12:26, s. 6896-6920
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Journal article (peer-reviewed)abstract
- Parallel hardware has become readily available to the computational chemistry research community. This perspective will review the current state of parallel computational chemistry software utilizing high-performance parallel computing platforms. Hardware and software trends and their effect on quantum chemistry methodologies, algorithms, and software development will also be discussed.
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| 22. |
- Fountain, M. T., et al.
(author)
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Design and deployment of semiochemical traps for capturing Anthonomus rubi Herbst (Coleoptera : Curculionidae) and Lygus rugulipennis Poppius (Hetereoptera: Miridae) in soft fruit crops
- 2017
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In: Crop Protection. - : Elsevier. - 0261-2194 .- 1873-6904. ; 99, s. 1-9
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Journal article (peer-reviewed)abstract
- Strawberry blossom weevil (SBW), Anthonomus rubi Herbst (Coleoptera: Curculionidae) and European tarnished plant bug (ETB), Lygus rugulipennis Poppius (Hetereoptera: Miridae), cause significant damage to strawberry and raspberry crops. Using the SBW aggregation pheromone and ETB sex pheromone we optimized and tested a single trap for both species. A series of field experiments in crops and semi-natural habitats in five European countries tested capture of the target pests and the ability to avoid captures of beneficial arthropods. A Unitrap containing a trapping agent of water and detergent and with a cross vane was more efficient at capturing both species compared to traps which incorporated glue as a trapping agent. Adding a green cross vane deterred attraction of non-pest species such as bees, but did not compromise catches of the target pests. The trap caught higher numbers of ETB and SBW if deployed at ground level and although a cross vane was not important for catches of ETB it was needed for significant captures of SBW. The potential for mass trapping SBW and ETB simultaneously in soft fruit crops is discussed including potential improvements to make this more effective and economic to deploy.
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| 23. |
- van de Velde, Cornelis J. H., et al.
(author)
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EURECCA colorectal : Multidisciplinary Mission statement on better care for patients with colon and rectal cancer in Europe
- 2013
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In: European Journal of Cancer. - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 49:13, s. 2784-2790
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Journal article (peer-reviewed)abstract
- Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.Methods: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method.Results: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members.Conclusions: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.
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| 24. |
- van Duinen, Alex J., et al.
(author)
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Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone : An evaluation of the free health care initiative
- 2021
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:10 October
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Journal article (peer-reviewed)abstract
- Background Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. Methods Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed. Results For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p<0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure. Conclusion Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone's poorest patients.
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| 25. |
- van Duinen, Alex J., et al.
(author)
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Perinatal outcomes of cesarean deliveries in Sierra Leone : A prospective multicenter observational study
- 2020
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In: International Journal of Gynecology and Obstetrics. - : Wiley. - 0020-7292 .- 1879-3479. ; 150:2, s. 213-221
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Journal article (peer-reviewed)abstract
- Objective: To analyze the indications for cesarean deliveries and factors associated with adverse perinatal outcomes in Sierra Leone. Methods: Between October 2016 and May 2017, patients undergoing cesarean delivery performed by medical doctors and associate clinicians in nine hospitals were included in a prospective observational study. Data were collected perioperatively, at discharge, and during home visits after 30 days. Results: In total, 1274 cesarean deliveries were included of which 1099 (86.3%) were performed as emergency surgery. Of the 1376 babies, 261 (19.0%) were perinatal deaths (53 antepartum stillbirths, 155 intrapartum stillbirths, and 53 early neonatal deaths). Indications with the highest perinatal mortality were uterine rupture (45 of 55 [81.8%]), abruptio placentae (61 of 85 [71.8%]), and antepartum hemorrhage (8 of 15 [53.3%]). In the group with cesarean deliveries performed for obstructed and prolonged labor, a partograph was filled out for 212 of 425 (49.9%). However, when completed, babies had 1.81-fold reduced odds for perinatal death (95% confidence interval 1.03–3.18, P-value 0.041). Conclusion: Cesarean deliveries in Sierra Leone are associated with an exceptionally high perinatal mortality rate of 190 per 1000 births. Late presentation in the facilities and lack of adequate fetal monitoring may be contributing factors.
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