Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study

Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study Hindawi Surgery Research and Practice Volume 2019, Article ID 5367068, 5 pages https://doi.org/10.1155/2019/5367068 Research Article Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study 1 2 3 4 Yihun Tariku , Tadele Gerum , Mareshet Mekonen, and Haddis Takele Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia Departement of Surgery, Arba Minch General Hospital, Arba Minch, Ethiopia Correspondence should be addressed to Yihun Tariku; yihuntariku@gmail.com Received 8 October 2018; Accepted 25 December 2018; Published 3 February 2019 Academic Editor: Eelco de Bree Copyright © 2019 Yihun Tariku et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. To improve access to surgical service and to reduce neonatal mortality Ethiopia implemented surgical task shifting to nonphysician surgeons (NPSs). We aim at assessing surgical outcomes between NPSs and physician surgeons working in two hospitals. Methods. We collected data from two hospitals on 474 maternal medical records. Completed maternal medical records were included in this study. Data were entered into Epi Info version 7 and analyzed by SPSS version 20 software. Both descriptive and inferential statistics were done. If the 95% confidence interval values exclude the null value, the factor was considered as a significant factor. Result. Totally, 3429 mothers delivered in two hospitals. Of them, 840 (24.5%) delivered by caesarian section (CS), but 474 mothers’ records meet the inclusion criteria included in this study. Of 474 CS deliveries, the majority (82%) of them were performed by NPS. Maternal or fetal emergency conditions were the main reasons (92.0%, n � 436) for CS. Task shifting does not affect immediate newborn outcomes (ARR, 1.24 (0.55, 2.78)), but duration of hospitalization (ARR: 4 (2.3, 7.5)), condition of the fetus during admission (ARR: 5.22 (2.9, 9.2)), and type of anesthesia used (ARR: 0.2 (0.1, 0.4)) significantly determine the outcome. Conclusion. Surgical task shifting to NPS does not affect the immediate newborn outcome. But general anesthesia is one of the major factors that affects the outcome. EmONC is best implemented in developing countries 1. Introduction through surgical task shifting. )ere is evidence from Surgical care task shifting to nonphysicians is a common different countries on significant reduction of neonatal practice in most developing countries [1]. Ethiopia imple- mortality due to EmONC implementation [7, 11]. )is is mented task shifting to NPSs, (they are BSc health officers or because surgical intervention of EmONC creates a window BSc nurses plus a 4-year training on integrated emergency to save the life of both mother and fetus due to emergency conditions during pregnancy. An emergency condition is a surgery and obstetrics) to overcome the dire shortage of physicians, to improve access to medical and surgical care major reason for CS [12–18]. service, and to reduce maternal and neonatal mortality Different scholars reveal that there is an improvement on [2–6]. access to CS service and reduction of neonatal mortality after Neonatal mortality is one of the major health problems implementation of surgical task shifting [1, 12–14, 19]. )ere of Ethiopia. Surgical task shifting is an intervention sup- are findings from Ethiopia that assess the quality of CS posed to reduce the rate of neonatal mortality [7–9]. service and its rate; but this research assesses the effect of Emergency Obstetric and Newborn Care (EmONC) is surgical task shifting on neonatal birth outcomes another strategy to reduce neonatal mortality [10]. [12, 15, 16, 20, 21]. 2 Surgery Research and Practice 2. Methods and Materials Total number of deliveries = 3429 A retrospective cohort study design was used to assess the Number of deliveries rate of CS delivery and the relationship between NPS and not by CS = 2589 CS outcomes. Data were collected from July 1 to 30, 2017. )e study was conducted in Arba Minch General Hospital Number of deliveries by and Sawla District Hospital. )ese hospitals were selected CS = 840 because they qualify Comprehensive EmONC standard 366 were excluded [20]. due to incomplete data Mothers who gave birth by CS from July 2015 to June 2016 and all those who meet inclusion criteria (fully 474 were included in the study recorded medical record, mothers who give birth after ar- rival to the hospital, and both the mother and fetus are alive Figure 1: Schematic presentation of sampling procedure at selected at the time of arrival to the hospitals) were included in this health institutions, July 2015–June 2016 (n � 474). study. Data were collected by data abstraction tools adopted from averting maternal death and disability program module [10]. We collected data on the condition of mother 3.1.3. Indications for Cesarean Section. Of the 474 CS de- and fetus during admission, who conducts CS, different tasks liveries, 436 (92%) were performed because of emergency done during the procedure, and status of the newborn until conditions. But 85% of CS were due to cephalopelvic dis- the time of discharge. Experienced midwives and anesthe- proportion (CPD), fetal distress, malpresentation, previous tists were used to collect data after attending one-day CS scar, multiple gestation, and antipartum hemorrhage; 131 training on how to collect the data. Ethical clearance was (28%), 102 (21%), 67 (14%), 43 (9%), 36 (8%), and 25 (5%), obtained from the South Region Health Research Ethics respectively (Figure 2). Review Committee. Often, spinal anesthesia and lower uterine segment Data were entered into Epi Info version 7 and analyzed transverse CS were used in 379 (79.1%) and 464 (96.9%) using SPSS version 20. We did both descriptive and an- mothers, respectively. )e majority (82%) of procedures alytic statistics. Initially, binary logistic regression was were performed by nonphysician surgeons. )e average time performed to assess the association between each expo- of the procedure was 51 (SD 18.62) minutes (Figure 3). sure and outcome variables. During bivariate analysis, For 176 (37%) mothers, labor was managed by parto- variables with P value 0.2 were considered for multivariate graph, but 144 (82%) of them were completely filled. )e binary logistic regression. When 95% confidence interval average length of hospitalization was 5 (SD± 2) days. Es- values exclude null value the factors considered as a timated average blood loss is 495 ml (SD± 156). Of the total significant factor. )e immediate newborn outcome was mothers undergone CS, only 33 (6.9%) mothers were blood categorized into good and bad. )e good outcome means transfused; 31 mothers transfusion were prescribed by NPSs. when the newborn is alive during birth without distress, and bad outcome means when there is a prenatal death or 3.1.4. Complication and Death. )is study revealed 40 lives birth with distress. (8.4%) deaths and 33 (6.7%) complications, totally 73 (15.2%) bad immediate CS outcomes (Table 1). 3. Results and Discussion 3.1. Results 3.1.5. Factors Determining Outcomes of CS Delivery. Other than the type of staff, time of hospitalization (ARR: 2.96, 3.1.1. Participants in the Study. Totally, 3429 deliveries were 95% CI (1.4, 6.26)), condition of the fetus during admission attended in two hospitals, and of them 840 (24.5%) were (ARR: 3.53 95% CI (1.97, 6.31)), and the type of anesthesia delivered by CS. But only 474 mothers who fulfilled the used for surgery (ARR: 4.19, 95% CI (2.26, 7.77)) significantly inclusion criteria were included in this study (Figure 1). determined immediate CS birth outcomes (Table 2). 3.1.2. Characteristics of Mothers. From the total pop- 3.2. Discussion. )is study reveals that the rate of CS, the ulation, the majority (58%) of mothers were in the age group between 15 and 25: 189 (39.5%) mothers were rate of bad CS birth outcome, major indications for CS, the effect of surgical task shifting, and factors determine CS birth nulliparous (not given birth before), and 64 (13.5%) mothers have more than 5 children. Greater than 60% of outcome. Incompleteness of maternal data registration mothers were rural by residence, and 222 (48.2%) mothers imposes gap in the study, but strong association between come to hospital referred from rural health centers. At the factors and CS strengthens our findings. time of admission, 159 (33.5%) mothers and 157 (33.1%) )e rate of CS delivery (24.5%) obtained in this study is fetuses had an unstable vital sign. Only 152 (32.1%) greater than the normal range set by WHO, which is between mothers’ medical registrations have data on the time 5 and 15% and rates reported nationally and abroad interval from decision to perform CS to actual incision [10, 12, 20–23]. Similar to different findings, high emergency time. conditions (92%) are the major reasons for CS delivery Surgery Research and Practice 3 21.4% 24.5% 3.1% 2.0% 19.4% 36.8% 17.4% 43.9% 9.2% 131.28% 102.21% 67.14% Placenta previa Fetal distress Placental abruption Breech with footling/malpresentation Failed induction CPD/prolonged labor Previous scar Multiple gestation Eclampsia/severe preeclampsia Cord prolapse Others Two or more of the above Figure 2: Indications for cesarean section at selected health institutions, July 2015–June 2016 (n  474). OB-GYN GP NPS BSc NPSs with 4-year training Figure 3: Types of sta� members that performed the cesarean section in two hospitals, July 2015–June 2016 (n  474). [13, 15, 22]. is shows that surgical task shifting is playing a Table 1: Immediate newborn outcome of CS delivery from July 2015 up to June 2016. great role in Ethiopia to reduce maternal and fetal mortality because the commonest emergency conditions, such as Factor Number (%) CPD, fetal distress, malpresentation, and antipartum Normal live birth 401 83.7 hemorrhage, similar to �ndings from di�erent countries Live birth with distress 32 6.7 Outcome of newborn [12, 13, 15, 17, 18], can lead to fetal or maternal mortality if Dead 24 5.0 One or more death for twin 16 3.3 they are not managed through surgical interventions. However, in order to reduce risk of surgery, the increasing Stillbirth 15 68.2 Death Early neonatal death 7 31.8 rate of CS delivery needs deep investigation. In Ethiopia and other countries where both surgeons and Asphyxia and trauma 14 70 NPSs are active, NPSs are performing majority (82%) of CS Infection or pneumonia 1 5 Primary cause of Trauma 15 procedures, [17, 19, 24–26]. is means NPSs contribute in stillbirth Other 2 10 saving the lives of mothers and fetuses during emergency Unknown 1 5 conditions. Moreover, they make CS service more accessible No information 1 5 to people in need. However, out of 73 (15%) bad CS birth 4 Surgery Research and Practice Table 2: Factors affecting newborn outcome of cesarean delivery. Death/distress Factor of newborn COR (95% CI) AOR (95% CI) No Yes 15–25 238 37 1 Age 26–35 148 31 1.3 (0.8, 2.26) > � 36 15 5 2.1 (0.7, 6.2) Urban 157 14 1 Residence Rural 231 56 2.9 (1.5, 5.5) Nulliparous 163 24 1 Primiparous 103 13 0.8 (0.4, 1.7) Parity Multiparous 88 19 1.46 (0.76, 2.8) Grand multiparous 47 17 2.31 (1.13, 4.7) No 212 25 1 Mother referred Yes 173 47 2.4 (1.4, 4) Well 289 26 1 1 Condition of fetus Any sign of complication 110 47 4.9 (2.9, 8.4) 3.53 (1.97, 6.31) Stable vital sign 273 42 1 Condition of mother Critical 124 31 1.7 (0.99, 2.8) Normal 239 34 1 Time on labour Prolonged 114 33 2 (1.2, 3.4) Spinal 338 37 1 1 Type of anesthesia General 63 36 5.2 (3, 8.9) 4.19 (2.26, 7.77) Emergency 365 71 1 CS classified Elective 27 1 5.1 (0.69, 38.7) ≤30 minute 80 18 1 Duration of procedure ≥30 minute 321 55 0.68 (0.37, 1.23) ≤3 94 12 1 1 Hospitalized date ≥4 287 57 3.9 (2.2, 6.9) 2.96 (1.40, 6.26) Physician 75 10 1 1 Staff Nonphysician 325 63 1.4 (0.7, 2.9) 1.24 (0.55, 2.78) outcomes, 63 (13%) of them were due to NPSs. But there is no Conflicts of Interest statistically significant birth outcome difference between )e authors declare that there are no conflicts of interest. those performed by physicians and NPSs (AOR 1.24 (95% CI: 0.55, 2.78)). )is is also similar to the finding from another part of Ethiopia [12]. But there are factors affecting CS birth Authors’ Contributions outcome of children, such as using general anesthesia four times likely leads to bad newborn outcome than using spinal YT designed the study, supervised data collection, analyzed anesthesia (AOR 4.19, 95% CI: 2.26, 7.77); this is similar with the data, and drafted the manuscript. TG participated in the findings from Tigray, Ethiopia [12], being hospitalized for design of the study and supervised data collection. MM four or more days is at risk to develop bad CS birth outcome reviewed the manuscript. HT supervised data collection and (AOR 2.96, 95% CI: 1.40, 6.26), and moreover,fetus under the critically reviewed the manuscript. All authors read and distress condition during admission was more at risk for bad approved the final manuscript. CS outcome than fetus under well condition during admis- sion (AOR 3.53, 95% CI: 1.97, 6.31); this finding is similar to a References study finding from Malawi [14]. [1] F. Mullan and S. Frehywot, “Non-physician clinicians in 47 4. Conclusion sub-Saharan African countries,” .e Lancet, vol. 370, no. 9605, pp. 2158–2163, 2007. NPSs are dominant hand for saving the life of children of [2] Y. Berhan, “Medical doctors profile in Ethiopia: pro- Ethiopia. Using spinal anesthesia and short-time hospital- duction, attrition and retention. In memory of 100-years ization will improve CS birth outcomes. Ethiopian modern medicine and the new Ethiopian mil- lennium,” Ethiopian Medical Journal, vol. 46, no. 1, pp. 1– 77, 2008. Data Availability [3] F. Mullan, “)e metrics of the physician brain drain,” New )e data used to support the findings of this study are England Journal of Medicine, vol. 353, no. 17, pp. 1810–1818, available from the corresponding author upon request. 2005. Surgery Research and Practice 5 [4] World Health Organization, Working Together for Health: the reducing maternal mortality in Ethiopia,” BMC Health Ser- World Health Report 2006, World Health Organization, vices Research, vol. 13, no. 1, p. 459, 2013. [21] Y. Ali, “Analysis of caesarean delivery in Jimma Hospital, Geneva, Switzerland, 2006. [5] S. Bergstrom, ¨ “Who will do the caesareans when there is no south-western Ethiopia,” East African Medical Journal, vol. 72, no. 1, p. 4, 1995. doctor? Finding creative solutions to the human resource [22] R. Najam and R. Sharma, “Maternal and fetal outcomes in crisis,” BJOG: An International Journal of Obstetrics and elective and emergency caesarean sections at a teaching Gynaecology, vol. 112, no. 9, pp. 1168-1169, 2005. hospital in North India. A retrospective study,” Journal of [6] Federal Democratic Republic of Ethiopia, Health Sector De- Advance Researches in Biological Sciences, vol. 5, no. 1, pp. 5–9, velopment Program IV 2010/11–2014/15, Ministry of Health, New Delhi, India, 2010. [23] Central Statistical Agency (CSA) and ICF, Ethiopia De- [7] M. C. Hogan, K. J. Foreman, M. Naghavi et al., “Maternal mographic and Health Survey 2016, CSA and ICF, Addis mortality for 181 countries, 1980–2008: a systematic analysis Ababa, Ethiopia, 2016. of progress towards Millennium development Goal 5,” .e [24] C. Kathryn, P. Rosseel, P. Gielis, and N. Ford, “Surgical task Lancet, vol. 375, no. 9726, pp. 1609–1623, 2010. shifting in sub-Saharan Africa,” PLoS Medicine, vol. 6, no. 5, [8] Y. Yaya and B. Lindtjorn, “High maternal mortality in rural article e1000078, 2009. south-west Ethiopia: estimate by using the sisterhood [25] C. McCord, G. Mbaruku, C. Pereira, C. Nzabuhakwa, and method,” BMC Pregnancy and Childbirth, vol. 12, no. 1, p. 136, S. Bergstrom, “)e quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals,” [9] Newborns: Reducing Mortality, 2016, http://www.who.int/ Health Affairs, vol. 28, no. 5, pp. w876–w885, 2009. entity/mediacentre/factsheets/fs333/en/. [26] C. Pereira, A. Cumbi, R. Malalane et al., “Meeting the need for [10] World Health Organization, Monitoring Emergency Obstetric emergency obstetric care in Mozambique: work performance Care: A Handbook, World Health Organization, Geneva, and histories of medical doctors and assistant medical officers Switzerland, 2009. trained for surgery,” BJOG: An International Journal of Ob- [11] World Health Organization, “Children: reducing mortality,” stetrics and Gynaecology, vol. 114, no. 12, pp. 1530–1533, 2007. 2016, http://www.who.int/mediacentre/factsheets/fs178/en/. [12] A. Gessessew, G. A. Barnabas, N. Prata, and K. Weidert, “Task shifting and sharing in Tigray, Ethiopia, to achieve comprehensive emergency obstetric care,” International Journal of Gynecology and Obstetrics, vol. 113, no. 1, pp. 28–31, 2011. [13] Y. M. Kim, H. Tappis, P. Zainullah et al., “Quality of caesarean delivery services and documentation in first-line referral fa- cilities in Afghanistan: a chart review,” BMC Pregnancy and Childbirth, vol. 12, no. 1, p. 14, 2012. [14] P. M. W. Fenton, J. M. Christopher, and F. Reynolds, “Caesarean section in Malawi: prospective study of early maternal and perinatal mortality,” BMJ, vol. 327, no. 7415, p. 587, 2003. [15] N. Fesseha, A. Getachew, M. Hiluf, Y. Gebrehiwot, and P. Bailey, “A national review of cesarean delivery in Ethiopia,” International Journal of Gynecology and Obstetrics, vol. 115, no. 1, pp. 106–111, 2011. [16] Y. Berhan and A. Ahmed, “Emergency obstetric performance with emphasis on operative delivery outcomes does it reflect on the quality of care?,” Ethiopian Journal of Health Devel- opment, vol. 18, no. 2, p. 10, 2004. [17] G. Chilopora, P. Caetano, F. Kamwendo, A. Chimbiri, E. Malunga, and S. Bergstrom, ¨ “Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi,” Human Resources for Health, vol. 15, no. 17, 2007. [18] A. O. D. Kolawole, P. Onwuhuafua, G. Adesiyun, A. Oguntayo, and A. Mohammed-Duro, “Audit of primary caesarean sections in nulliparae seen in ABUTH kaduna,” Australian Journal of Basic and Applied Sciences, vol. 5, no. 6, pp. 1088–1097, 2011. [19] C. Pereira, G. Mbaruku, C. Nzabuhakwa, S. Bergstrom, and C. McCord, “Emergency obstetric surgery by non-physician clinicians in Tanzania,” International Journal of Gynecology and Obstetrics, vol. 114, no. 2, pp. 180–183, 2011. [20] M. Girma, Y. Yaya, E. Gebrehanna, Y. Berhane, and B. Lindtjorn, “Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgery Research and Practice Hindawi Publishing Corporation

Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study

Download PDF
6 pages

Loading next page...
 
/lp/hindawi-publishing-corporation/surgical-task-shifting-helps-reduce-neonatal-mortality-in-ethiopia-a-buiGMGQ49v

References (27)

Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2019 Yihun Tariku et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2356-7759
eISSN
2356-6124
DOI
10.1155/2019/5367068
Publisher site
See Article on Publisher Site

Abstract

Hindawi Surgery Research and Practice Volume 2019, Article ID 5367068, 5 pages https://doi.org/10.1155/2019/5367068 Research Article Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study 1 2 3 4 Yihun Tariku , Tadele Gerum , Mareshet Mekonen, and Haddis Takele Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia Departement of Surgery, Arba Minch General Hospital, Arba Minch, Ethiopia Correspondence should be addressed to Yihun Tariku; yihuntariku@gmail.com Received 8 October 2018; Accepted 25 December 2018; Published 3 February 2019 Academic Editor: Eelco de Bree Copyright © 2019 Yihun Tariku et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. To improve access to surgical service and to reduce neonatal mortality Ethiopia implemented surgical task shifting to nonphysician surgeons (NPSs). We aim at assessing surgical outcomes between NPSs and physician surgeons working in two hospitals. Methods. We collected data from two hospitals on 474 maternal medical records. Completed maternal medical records were included in this study. Data were entered into Epi Info version 7 and analyzed by SPSS version 20 software. Both descriptive and inferential statistics were done. If the 95% confidence interval values exclude the null value, the factor was considered as a significant factor. Result. Totally, 3429 mothers delivered in two hospitals. Of them, 840 (24.5%) delivered by caesarian section (CS), but 474 mothers’ records meet the inclusion criteria included in this study. Of 474 CS deliveries, the majority (82%) of them were performed by NPS. Maternal or fetal emergency conditions were the main reasons (92.0%, n � 436) for CS. Task shifting does not affect immediate newborn outcomes (ARR, 1.24 (0.55, 2.78)), but duration of hospitalization (ARR: 4 (2.3, 7.5)), condition of the fetus during admission (ARR: 5.22 (2.9, 9.2)), and type of anesthesia used (ARR: 0.2 (0.1, 0.4)) significantly determine the outcome. Conclusion. Surgical task shifting to NPS does not affect the immediate newborn outcome. But general anesthesia is one of the major factors that affects the outcome. EmONC is best implemented in developing countries 1. Introduction through surgical task shifting. )ere is evidence from Surgical care task shifting to nonphysicians is a common different countries on significant reduction of neonatal practice in most developing countries [1]. Ethiopia imple- mortality due to EmONC implementation [7, 11]. )is is mented task shifting to NPSs, (they are BSc health officers or because surgical intervention of EmONC creates a window BSc nurses plus a 4-year training on integrated emergency to save the life of both mother and fetus due to emergency conditions during pregnancy. An emergency condition is a surgery and obstetrics) to overcome the dire shortage of physicians, to improve access to medical and surgical care major reason for CS [12–18]. service, and to reduce maternal and neonatal mortality Different scholars reveal that there is an improvement on [2–6]. access to CS service and reduction of neonatal mortality after Neonatal mortality is one of the major health problems implementation of surgical task shifting [1, 12–14, 19]. )ere of Ethiopia. Surgical task shifting is an intervention sup- are findings from Ethiopia that assess the quality of CS posed to reduce the rate of neonatal mortality [7–9]. service and its rate; but this research assesses the effect of Emergency Obstetric and Newborn Care (EmONC) is surgical task shifting on neonatal birth outcomes another strategy to reduce neonatal mortality [10]. [12, 15, 16, 20, 21]. 2 Surgery Research and Practice 2. Methods and Materials Total number of deliveries = 3429 A retrospective cohort study design was used to assess the Number of deliveries rate of CS delivery and the relationship between NPS and not by CS = 2589 CS outcomes. Data were collected from July 1 to 30, 2017. )e study was conducted in Arba Minch General Hospital Number of deliveries by and Sawla District Hospital. )ese hospitals were selected CS = 840 because they qualify Comprehensive EmONC standard 366 were excluded [20]. due to incomplete data Mothers who gave birth by CS from July 2015 to June 2016 and all those who meet inclusion criteria (fully 474 were included in the study recorded medical record, mothers who give birth after ar- rival to the hospital, and both the mother and fetus are alive Figure 1: Schematic presentation of sampling procedure at selected at the time of arrival to the hospitals) were included in this health institutions, July 2015–June 2016 (n � 474). study. Data were collected by data abstraction tools adopted from averting maternal death and disability program module [10]. We collected data on the condition of mother 3.1.3. Indications for Cesarean Section. Of the 474 CS de- and fetus during admission, who conducts CS, different tasks liveries, 436 (92%) were performed because of emergency done during the procedure, and status of the newborn until conditions. But 85% of CS were due to cephalopelvic dis- the time of discharge. Experienced midwives and anesthe- proportion (CPD), fetal distress, malpresentation, previous tists were used to collect data after attending one-day CS scar, multiple gestation, and antipartum hemorrhage; 131 training on how to collect the data. Ethical clearance was (28%), 102 (21%), 67 (14%), 43 (9%), 36 (8%), and 25 (5%), obtained from the South Region Health Research Ethics respectively (Figure 2). Review Committee. Often, spinal anesthesia and lower uterine segment Data were entered into Epi Info version 7 and analyzed transverse CS were used in 379 (79.1%) and 464 (96.9%) using SPSS version 20. We did both descriptive and an- mothers, respectively. )e majority (82%) of procedures alytic statistics. Initially, binary logistic regression was were performed by nonphysician surgeons. )e average time performed to assess the association between each expo- of the procedure was 51 (SD 18.62) minutes (Figure 3). sure and outcome variables. During bivariate analysis, For 176 (37%) mothers, labor was managed by parto- variables with P value 0.2 were considered for multivariate graph, but 144 (82%) of them were completely filled. )e binary logistic regression. When 95% confidence interval average length of hospitalization was 5 (SD± 2) days. Es- values exclude null value the factors considered as a timated average blood loss is 495 ml (SD± 156). Of the total significant factor. )e immediate newborn outcome was mothers undergone CS, only 33 (6.9%) mothers were blood categorized into good and bad. )e good outcome means transfused; 31 mothers transfusion were prescribed by NPSs. when the newborn is alive during birth without distress, and bad outcome means when there is a prenatal death or 3.1.4. Complication and Death. )is study revealed 40 lives birth with distress. (8.4%) deaths and 33 (6.7%) complications, totally 73 (15.2%) bad immediate CS outcomes (Table 1). 3. Results and Discussion 3.1. Results 3.1.5. Factors Determining Outcomes of CS Delivery. Other than the type of staff, time of hospitalization (ARR: 2.96, 3.1.1. Participants in the Study. Totally, 3429 deliveries were 95% CI (1.4, 6.26)), condition of the fetus during admission attended in two hospitals, and of them 840 (24.5%) were (ARR: 3.53 95% CI (1.97, 6.31)), and the type of anesthesia delivered by CS. But only 474 mothers who fulfilled the used for surgery (ARR: 4.19, 95% CI (2.26, 7.77)) significantly inclusion criteria were included in this study (Figure 1). determined immediate CS birth outcomes (Table 2). 3.1.2. Characteristics of Mothers. From the total pop- 3.2. Discussion. )is study reveals that the rate of CS, the ulation, the majority (58%) of mothers were in the age group between 15 and 25: 189 (39.5%) mothers were rate of bad CS birth outcome, major indications for CS, the effect of surgical task shifting, and factors determine CS birth nulliparous (not given birth before), and 64 (13.5%) mothers have more than 5 children. Greater than 60% of outcome. Incompleteness of maternal data registration mothers were rural by residence, and 222 (48.2%) mothers imposes gap in the study, but strong association between come to hospital referred from rural health centers. At the factors and CS strengthens our findings. time of admission, 159 (33.5%) mothers and 157 (33.1%) )e rate of CS delivery (24.5%) obtained in this study is fetuses had an unstable vital sign. Only 152 (32.1%) greater than the normal range set by WHO, which is between mothers’ medical registrations have data on the time 5 and 15% and rates reported nationally and abroad interval from decision to perform CS to actual incision [10, 12, 20–23]. Similar to different findings, high emergency time. conditions (92%) are the major reasons for CS delivery Surgery Research and Practice 3 21.4% 24.5% 3.1% 2.0% 19.4% 36.8% 17.4% 43.9% 9.2% 131.28% 102.21% 67.14% Placenta previa Fetal distress Placental abruption Breech with footling/malpresentation Failed induction CPD/prolonged labor Previous scar Multiple gestation Eclampsia/severe preeclampsia Cord prolapse Others Two or more of the above Figure 2: Indications for cesarean section at selected health institutions, July 2015–June 2016 (n  474). OB-GYN GP NPS BSc NPSs with 4-year training Figure 3: Types of sta� members that performed the cesarean section in two hospitals, July 2015–June 2016 (n  474). [13, 15, 22]. is shows that surgical task shifting is playing a Table 1: Immediate newborn outcome of CS delivery from July 2015 up to June 2016. great role in Ethiopia to reduce maternal and fetal mortality because the commonest emergency conditions, such as Factor Number (%) CPD, fetal distress, malpresentation, and antipartum Normal live birth 401 83.7 hemorrhage, similar to �ndings from di�erent countries Live birth with distress 32 6.7 Outcome of newborn [12, 13, 15, 17, 18], can lead to fetal or maternal mortality if Dead 24 5.0 One or more death for twin 16 3.3 they are not managed through surgical interventions. However, in order to reduce risk of surgery, the increasing Stillbirth 15 68.2 Death Early neonatal death 7 31.8 rate of CS delivery needs deep investigation. In Ethiopia and other countries where both surgeons and Asphyxia and trauma 14 70 NPSs are active, NPSs are performing majority (82%) of CS Infection or pneumonia 1 5 Primary cause of Trauma 15 procedures, [17, 19, 24–26]. is means NPSs contribute in stillbirth Other 2 10 saving the lives of mothers and fetuses during emergency Unknown 1 5 conditions. Moreover, they make CS service more accessible No information 1 5 to people in need. However, out of 73 (15%) bad CS birth 4 Surgery Research and Practice Table 2: Factors affecting newborn outcome of cesarean delivery. Death/distress Factor of newborn COR (95% CI) AOR (95% CI) No Yes 15–25 238 37 1 Age 26–35 148 31 1.3 (0.8, 2.26) > � 36 15 5 2.1 (0.7, 6.2) Urban 157 14 1 Residence Rural 231 56 2.9 (1.5, 5.5) Nulliparous 163 24 1 Primiparous 103 13 0.8 (0.4, 1.7) Parity Multiparous 88 19 1.46 (0.76, 2.8) Grand multiparous 47 17 2.31 (1.13, 4.7) No 212 25 1 Mother referred Yes 173 47 2.4 (1.4, 4) Well 289 26 1 1 Condition of fetus Any sign of complication 110 47 4.9 (2.9, 8.4) 3.53 (1.97, 6.31) Stable vital sign 273 42 1 Condition of mother Critical 124 31 1.7 (0.99, 2.8) Normal 239 34 1 Time on labour Prolonged 114 33 2 (1.2, 3.4) Spinal 338 37 1 1 Type of anesthesia General 63 36 5.2 (3, 8.9) 4.19 (2.26, 7.77) Emergency 365 71 1 CS classified Elective 27 1 5.1 (0.69, 38.7) ≤30 minute 80 18 1 Duration of procedure ≥30 minute 321 55 0.68 (0.37, 1.23) ≤3 94 12 1 1 Hospitalized date ≥4 287 57 3.9 (2.2, 6.9) 2.96 (1.40, 6.26) Physician 75 10 1 1 Staff Nonphysician 325 63 1.4 (0.7, 2.9) 1.24 (0.55, 2.78) outcomes, 63 (13%) of them were due to NPSs. But there is no Conflicts of Interest statistically significant birth outcome difference between )e authors declare that there are no conflicts of interest. those performed by physicians and NPSs (AOR 1.24 (95% CI: 0.55, 2.78)). )is is also similar to the finding from another part of Ethiopia [12]. But there are factors affecting CS birth Authors’ Contributions outcome of children, such as using general anesthesia four times likely leads to bad newborn outcome than using spinal YT designed the study, supervised data collection, analyzed anesthesia (AOR 4.19, 95% CI: 2.26, 7.77); this is similar with the data, and drafted the manuscript. TG participated in the findings from Tigray, Ethiopia [12], being hospitalized for design of the study and supervised data collection. MM four or more days is at risk to develop bad CS birth outcome reviewed the manuscript. HT supervised data collection and (AOR 2.96, 95% CI: 1.40, 6.26), and moreover,fetus under the critically reviewed the manuscript. All authors read and distress condition during admission was more at risk for bad approved the final manuscript. CS outcome than fetus under well condition during admis- sion (AOR 3.53, 95% CI: 1.97, 6.31); this finding is similar to a References study finding from Malawi [14]. [1] F. Mullan and S. Frehywot, “Non-physician clinicians in 47 4. Conclusion sub-Saharan African countries,” .e Lancet, vol. 370, no. 9605, pp. 2158–2163, 2007. NPSs are dominant hand for saving the life of children of [2] Y. Berhan, “Medical doctors profile in Ethiopia: pro- Ethiopia. Using spinal anesthesia and short-time hospital- duction, attrition and retention. In memory of 100-years ization will improve CS birth outcomes. Ethiopian modern medicine and the new Ethiopian mil- lennium,” Ethiopian Medical Journal, vol. 46, no. 1, pp. 1– 77, 2008. Data Availability [3] F. Mullan, “)e metrics of the physician brain drain,” New )e data used to support the findings of this study are England Journal of Medicine, vol. 353, no. 17, pp. 1810–1818, available from the corresponding author upon request. 2005. Surgery Research and Practice 5 [4] World Health Organization, Working Together for Health: the reducing maternal mortality in Ethiopia,” BMC Health Ser- World Health Report 2006, World Health Organization, vices Research, vol. 13, no. 1, p. 459, 2013. [21] Y. Ali, “Analysis of caesarean delivery in Jimma Hospital, Geneva, Switzerland, 2006. [5] S. Bergstrom, ¨ “Who will do the caesareans when there is no south-western Ethiopia,” East African Medical Journal, vol. 72, no. 1, p. 4, 1995. doctor? Finding creative solutions to the human resource [22] R. Najam and R. Sharma, “Maternal and fetal outcomes in crisis,” BJOG: An International Journal of Obstetrics and elective and emergency caesarean sections at a teaching Gynaecology, vol. 112, no. 9, pp. 1168-1169, 2005. hospital in North India. A retrospective study,” Journal of [6] Federal Democratic Republic of Ethiopia, Health Sector De- Advance Researches in Biological Sciences, vol. 5, no. 1, pp. 5–9, velopment Program IV 2010/11–2014/15, Ministry of Health, New Delhi, India, 2010. [23] Central Statistical Agency (CSA) and ICF, Ethiopia De- [7] M. C. Hogan, K. J. Foreman, M. Naghavi et al., “Maternal mographic and Health Survey 2016, CSA and ICF, Addis mortality for 181 countries, 1980–2008: a systematic analysis Ababa, Ethiopia, 2016. of progress towards Millennium development Goal 5,” .e [24] C. Kathryn, P. Rosseel, P. Gielis, and N. Ford, “Surgical task Lancet, vol. 375, no. 9726, pp. 1609–1623, 2010. shifting in sub-Saharan Africa,” PLoS Medicine, vol. 6, no. 5, [8] Y. Yaya and B. Lindtjorn, “High maternal mortality in rural article e1000078, 2009. south-west Ethiopia: estimate by using the sisterhood [25] C. McCord, G. Mbaruku, C. Pereira, C. Nzabuhakwa, and method,” BMC Pregnancy and Childbirth, vol. 12, no. 1, p. 136, S. Bergstrom, “)e quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals,” [9] Newborns: Reducing Mortality, 2016, http://www.who.int/ Health Affairs, vol. 28, no. 5, pp. w876–w885, 2009. entity/mediacentre/factsheets/fs333/en/. [26] C. Pereira, A. Cumbi, R. Malalane et al., “Meeting the need for [10] World Health Organization, Monitoring Emergency Obstetric emergency obstetric care in Mozambique: work performance Care: A Handbook, World Health Organization, Geneva, and histories of medical doctors and assistant medical officers Switzerland, 2009. trained for surgery,” BJOG: An International Journal of Ob- [11] World Health Organization, “Children: reducing mortality,” stetrics and Gynaecology, vol. 114, no. 12, pp. 1530–1533, 2007. 2016, http://www.who.int/mediacentre/factsheets/fs178/en/. [12] A. Gessessew, G. A. Barnabas, N. Prata, and K. Weidert, “Task shifting and sharing in Tigray, Ethiopia, to achieve comprehensive emergency obstetric care,” International Journal of Gynecology and Obstetrics, vol. 113, no. 1, pp. 28–31, 2011. [13] Y. M. Kim, H. Tappis, P. Zainullah et al., “Quality of caesarean delivery services and documentation in first-line referral fa- cilities in Afghanistan: a chart review,” BMC Pregnancy and Childbirth, vol. 12, no. 1, p. 14, 2012. [14] P. M. W. Fenton, J. M. Christopher, and F. Reynolds, “Caesarean section in Malawi: prospective study of early maternal and perinatal mortality,” BMJ, vol. 327, no. 7415, p. 587, 2003. [15] N. Fesseha, A. Getachew, M. Hiluf, Y. Gebrehiwot, and P. Bailey, “A national review of cesarean delivery in Ethiopia,” International Journal of Gynecology and Obstetrics, vol. 115, no. 1, pp. 106–111, 2011. [16] Y. Berhan and A. Ahmed, “Emergency obstetric performance with emphasis on operative delivery outcomes does it reflect on the quality of care?,” Ethiopian Journal of Health Devel- opment, vol. 18, no. 2, p. 10, 2004. [17] G. Chilopora, P. Caetano, F. Kamwendo, A. Chimbiri, E. Malunga, and S. Bergstrom, ¨ “Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi,” Human Resources for Health, vol. 15, no. 17, 2007. [18] A. O. D. Kolawole, P. Onwuhuafua, G. Adesiyun, A. Oguntayo, and A. Mohammed-Duro, “Audit of primary caesarean sections in nulliparae seen in ABUTH kaduna,” Australian Journal of Basic and Applied Sciences, vol. 5, no. 6, pp. 1088–1097, 2011. [19] C. Pereira, G. Mbaruku, C. Nzabuhakwa, S. Bergstrom, and C. McCord, “Emergency obstetric surgery by non-physician clinicians in Tanzania,” International Journal of Gynecology and Obstetrics, vol. 114, no. 2, pp. 180–183, 2011. [20] M. Girma, Y. Yaya, E. Gebrehanna, Y. Berhane, and B. Lindtjorn, “Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Surgery Research and Practice – Hindawi Publishing Corporation

Published: Feb 3, 2019

There are no references for this article.