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Caesarean section p...
Caesarean section performed by medical doctors and associate clinicians in Sierra Leone.
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- van Duinen, A. J. (author)
- Masanga Hospital,St. Olav’s University Hospital,Norwegian University of Science and Technology
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- Kamara, M M (author)
- Port Loko Governmental Hospital,University of Sierra Leone,Ministry of Health and Sanitation, Sierra Leone
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- Hagander, L. (author)
- Lund University,Lunds universitet,Kirurgi och folkhälsa,Forskargrupper vid Lunds universitet,Surgery and public health,Lund University Research Groups,Skåne University Hospital
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- Ashley, T (author)
- Kamakwie Wesleyan Hospital,Ministry of Health and Sanitation, Sierra Leone
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- Koroma, A P (author)
- University of Sierra Leone,Princess Christian Maternity Hospital,Ministry of Health and Sanitation, Sierra Leone
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- Leather, A (author)
- King's College London
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- Elhassein, M (author)
- United Nations Population Fund (UNFPA)
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- Darj, E (author)
- Norwegian University of Science and Technology
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- Salvesen, Ø (author)
- Norwegian University of Science and Technology
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- Wibe, A (author)
- St. Olav’s University Hospital,Norwegian University of Science and Technology
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- Bolkan, H A (author)
- Norwegian University of Science and Technology,St. Olav’s University Hospital,Masanga Hospital
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Masanga Hospital St Olav’s University Hospital (creator_code:org_t)
- 2019-01-08
- 2019
- English.
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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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http://dx.doi.org/10... (free)
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https://urn.kb.se/re...
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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van Duinen, A. J ...
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Kamara, M M
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Hagander, L.
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Ashley, T
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Koroma, A P
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Leather, A
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Elhassein, M
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Darj, E
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Salvesen, Ø
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Wibe, A
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Bolkan, H A
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
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and Public Health Gl ...
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Obstetrics Gynae ...
- Articles in the publication
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British Journal ...
- By the university
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Uppsala University
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Lund University