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Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

van Duinen, A. J. LU ; Kamara, M. M.; Hagander, L. LU ; Ashley, T.; Koroma, A. P.; Leather, A.; Elhassein, M.; Darj, E.; Salvesen, and Wibe, A., et al. (2019) In The British journal of surgery 106(2). p.129-137
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... (More)

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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Contribution to journal
publication status
published
subject
in
The British journal of surgery
volume
106
issue
2
pages
129 - 137
publisher
John Wiley & Sons
external identifiers
  • scopus:85059927786
ISSN
1365-2168
DOI
10.1002/bjs.11076
language
English
LU publication?
yes
id
1cc32ec5-afb7-45a0-b116-35125b7dab72
date added to LUP
2019-01-24 13:26:54
date last changed
2019-02-20 11:44:24
@article{1cc32ec5-afb7-45a0-b116-35125b7dab72,
  abstract     = {<p>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.</p>},
  author       = {van Duinen, A. J. and Kamara, M. M. and Hagander, L. and Ashley, T. and Koroma, A. P. and Leather, A. and Elhassein, M. and Darj, E. and Salvesen,  and Wibe, A. and Bolkan, H. A.},
  issn         = {1365-2168},
  language     = {eng},
  month        = {01},
  number       = {2},
  pages        = {129--137},
  publisher    = {John Wiley & Sons},
  series       = {The British journal of surgery},
  title        = {Caesarean section performed by medical doctors and associate clinicians in Sierra Leone},
  url          = {http://dx.doi.org/10.1002/bjs.11076},
  volume       = {106},
  year         = {2019},
}