NDLI: Increasing the availability and quality of caesarean section in Tanzania.

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Increasing the availability and quality of caesarean section in Tanzania.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Nyamtema, A. Mwakatundu, N. Dominico, S. Mohamed, H. Shayo, A. Rumanyika, R. Kairuki, C. Nzabuhakwa, C. Issa, O. Lyimo, C. Kasiga, I. Van Roosmalen, J.
Description	Country affiliation: Tanzania Author Affiliation: Nyamtema A ( Tanzanian Training Centre for International Health, Ifakara, Tanzania.); Mwakatundu N ( Saint Francis University College for Health and Allied Sciences, Ifakara, Tanzania.); Dominico S ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); Mohamed H ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); Shayo A ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); Rumanyika R ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); Kairuki C ( Tanzanian Training Centre for International Health, Ifakara, Tanzania.); Nzabuhakwa C ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); Issa O ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); Lyimo C ( Catholic University of Health and Allied Sciences, Mwanza, Tanzania.); Kasiga I ( World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.); van Roosmalen J ( Hubert Kairuki Memorial University, Dar es Salaam, Tanzania.)
Abstract	OBJECTIVE: To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. DESIGN: Before-after intervention study design. SETTINGS: Rural Tanzania. METHODS: Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CEmOC. Mentoring and audit of reasons for caesarean section (CS) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA) statistical tests. MAIN OUTCOME MEASURES: Trends in CS rates, proportion of unjustified CS, use of spinal anaesthesia, and the risk of death from complications related to CS and anaesthesia. RESULTS: During the audit period (2012-2014), 5868 of 58 751 deliveries were by CS (10%). The proportion of CS considered to be unjustified decreased from 30 to 17% in health centres (P = 0.02) and from 37 to 20% in hospitals (P < 0.001). Practice of spinal anaesthesia for CS increased from 10% to 64% in hospitals (P < 0.001). Of 110 maternal deaths, 18 (16.4%) were associated with complications of CS, giving a risk of 3.1 per 1000 CS; three (2.7%) were judged to be anaesthetic-associated deaths with a risk of 0.5 per 1000 caesarean deliveries. CONCLUSIONS: Increasing availability and quality of CS by improving infrastructure, training and audit of reasons for CS is feasible, acceptable and required in low resource settings. TWEETABLE ABSTRACT: Increasing availability and quality of CS in rural Africa is feasible.
File Format	HTM / HTML
ISSN	14700328
e-ISSN	14710528
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Issue Number	10
Volume Number	123
Language	English
Publisher	Wiley
Publisher Date	2016-09-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Obstetrics Gynaecology
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology

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