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01-12-2020 | Sectio Ceasarea | Research

Impact of Medical Doctors Global Health and Tropical Medicine on decision-making in caesarean section: a pre- and post-implementation study in a rural hospital in Malawi

Authors: Wouter Bakker, Emma Bakker, Christiaan Huigens, Emily Kaunda, Timothy Phiri, Jogchum Beltman, Jos van Roosmalen, Thomas van den Akker

Published in: Human Resources for Health | Issue 1/2020

Abstract

Background

Medical doctors with postgraduate training in Global Health and Tropical Medicine (MDGHTM) from the Netherlands, a high-income country with a relatively low caesarean section rate, assist associate clinicians in low-income countries regarding decision-making during labour. Objective of this study was to assess impact of the presence of MDGHTMs in a rural Malawian hospital on caesarean section rate and indications.

Methods

This retrospective pre- and post-implementation study was conducted in a rural hospital in Malawi, where MDGHTMs were employed from April 2015. Indications for caesarean section were audited against national protocols and defined as supported or unsupported by these protocols. Caesarean section rates and numbers of unsupported indications for the years 2015 and 2016 per quarter for different staff cadres were assessed by linear regression.

Results

Six hundred forty-five women gave birth by caesarean section in the study period. The caesarean rate dropped from 20.1 to 12.8% (p < 0.05, R² = 0.53, y = − 0.0086x + 0.2295). Overall 132 of 501 (26.3%) auditable indications were not supported by documentation in medical records. The proportion of unsupported indications dropped significantly over time from 47.0 to 4.4% (p < 0.01, R² = 0.71, y = − 0.0481x + 0.4759). Stratified analysis for associate clinicians only (excluding caesarean sections performed by medical doctors) showed a similar decrease from 48.3 to 6.5% (p < 0.05, R² = 0.55, y = − 0.0442x + 0.4805).

Conclusions

Our results indicate that presence of MDGHTMs was accompanied by considerable decreases in caesarean section rate and proportion of unsupported indications for caesarean section in this facility. Their presence is likely to have influenced decision-making by associate clinicians.

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Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016;11(2):1–12.CrossRef

Harrison MS, Goldenberg RL. Cesarean section in sub-Saharan Africa. Matern Health Neonatol Perinatol. 2016;2:1–10.CrossRef

Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth. 2013;13(107):1–10.

Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016;123(5):745–53.CrossRefPubMed

Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:1–10.CrossRef

WHO. WHO Statement on Caesarean Section Rates. 2015;1–8. Available from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/.

Souza JP, Gülmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO global survey on maternal and perinatal health. BMC Med. 2010;8(1):71.CrossRefPubMedPubMedCentral

Kessous R, Danor D, Weintraub YA, Wiznitzer A, Sergienko R, Ohel I, et al. Risk factors for relaparotomy after cesarean section. J Matern Neonatal Med. 2012;25(11):2167–70.CrossRef

Levin I, Rapaport A, Satzer L, Maslovitz S, Lessing J, Almog B. Risk factors for relaparotomy after cesarean delivery. Int J Gynecol Obstet. 2012;119:163–5.CrossRef

10.

Esike C, Aluka C, Okali U, Twomey D. Contribution of scarred uterus to ruptured uterus in rural Nigeria. Int J Reprod Contraception, Obstet Gynecol. 2016;5(6):1790–5.

11.

Lannon S, Guthrie K, Vanderhoeven J, Gammill H. Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol. 2015;125(5):1095–100.CrossRefPubMedPubMedCentral

12.

Kalisa R, Rulisa S, Van Roosmalen J, Van Den Akker T. Maternal and perinatal outcome after previous caesarean section in rural Rwanda. BMC Pregnancy Childbirth. 2017;17(1):1–8.CrossRef

13.

Kaboré C, Chaillet N, Kouanda S, Bujold E, Traoré M, Dumont A. Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries. BJOG. 2015;123(13):2147–55.CrossRefPubMed

14.

Van Den Akker T, Mwagomba B, Irlam J, Van Roosmalen J. Using audits to reduce the incidence of uterine rupture in a Malawian district hospital. Int J Gynecol Obstet. 2009;107:289–94.CrossRef

15.

Van Den Hombergh P, De Wit NJ, Van Balen FAM. Clinical and organisational performance in general practice? BMC Fam Pract. 2009;10:1–7.CrossRef

16.

Mooij R, Jurgens EMJ, Van Dillen J, Stekelenburg J. The contribution of Dutch doctors in Global Health and tropical medicine to research in global health in low- and middle-income countries: an exploration of the evidence. Trop Dr. 2019;50(1):43–9.CrossRef

17.

OIGT. Short description of the medical training program in the Netherlands [Internet]. [cited 2018 Jul 5]. Available from: https://www.oigt.nl/?opleidersbuitenland&p = opleidingbuitenland.

18.

Training Institute IGT. Training Component Abroad Content [Internet]. p. 1–10. Available from: https://www.oigt.nl/files/1513619460_OIGT-General-information-Training-Component-Abroad.pdf.

19.

Vas Nunes J, Gordinou de Gouberville M, Prins M. Where do Dutch medical doctors global health and tropical medicine work? MT Bull NVTG. 2017;55(2):16–7.

20.

Highlands Health Services of Anglican Diocese of Upper Shire. Annual Report July 2014 to June 2015 [Internet]. 2015. Available from: https://www.stlukesmalosa.org/about-us/hospital-reports/.

21.

Highlands Health Services of Anglican Diocese of Upper Shire. Annual Report July 2015 to June 2016 [Internet]. 2016. p. 1–49. Available from: https://www.stlukesmalosa.org/about-us/hospital-reports/.

22.

Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga E, Bergström S. Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Hum Resour Health. 2007;5(17):1–6.

23.

Chu K, Rosseel P, Gielis P, Ford N. Surgical task shifting in sub-Saharan Africa. PLoS Med. 2009;6(5):1–4.CrossRef

24.

Dekker L, Houtzager T, Kilume O, Horogo J, van Roosmalen J, Nyamtema AS. Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania. BMC Pregnancy Childbirth. 2018;18(1):1–7.CrossRef

25.

Heemelaar S, Nelissen E, Mdoe P, Kidanto H, van Roosmalen J, Stekelenburg J. Criteria-based audit of caesarean section in a referral hospital in rural Tanzania. Trop Med Int Heal. 2016;21(4):525–34.CrossRef

26.

Gajewski J, Borgstein E, Bijlmakers L, Mwapasa G, Aljohani Z, Pittalis C, et al. Evaluation of a surgical training programme for clinical officers in Malawi. Br J Surg. 2019;106(2):e156–65.CrossRefPubMed

27.

van Duinen AJ, Kamara MM, Hagander L, Ashley T, Koroma AP, Leather A, et al. Caesarean section performed by medical doctors and associate clinicians in Sierra Leone. Br J Surg. 2019;106(2):e129–37.CrossRefPubMedPubMedCentral

Title: Impact of Medical Doctors Global Health and Tropical Medicine on decision-making in caesarean section: a pre- and post-implementation study in a rural hospital in Malawi
Authors: Wouter Bakker
Emma Bakker
Christiaan Huigens
Emily Kaunda
Timothy Phiri
Jogchum Beltman
Jos van Roosmalen
Thomas van den Akker
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Sectio Ceasarea
Sectio Caesarea
Published in: Human Resources for Health / Issue 1/2020
Electronic ISSN: 1478-4491
DOI: https://doi.org/10.1186/s12960-020-00516-5

Keynote webinar | Spotlight on medication adherence

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Impact of Medical Doctors Global Health and Tropical Medicine on decision-making in caesarean section: a pre- and post-implementation study in a rural hospital in Malawi

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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