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The rate and perioperative mortality of caesarean section in Sierra Leone

Holmer, Hampus LU ; Kamara, Michael M. ; Bolkan, Håkon Angell ; Van Duinen, Alex LU ; Conteh, Sulaiman ; Forna, Fatu ; Hailu, Binyam ; Hansson, Stefan R. LU orcid ; Koroma, Alimamy P. and Koroma, Michael M. , et al. (2019) In BMJ Global Health 4(5).
Abstract

Introduction Sierra Leone has the world's highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country. Methods We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality. Results In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population... (More)

Introduction Sierra Leone has the world's highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country. Methods We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality. Results In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0-2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed. Conclusions The caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
maternal health, obstetrics, surgery
in
BMJ Global Health
volume
4
issue
5
article number
e001605
publisher
BMJ Publishing Group
external identifiers
  • scopus:85072177123
  • pmid:31565407
ISSN
2059-7908
DOI
10.1136/bmjgh-2019-001605
project
Measuring global surgery, obstetrics and anaesthesia – from health systems to patients
language
English
LU publication?
yes
id
c11c2fb7-dd87-4c68-b8cf-4033ab5b7d7c
date added to LUP
2019-10-01 12:44:48
date last changed
2024-05-29 01:16:40
@article{c11c2fb7-dd87-4c68-b8cf-4033ab5b7d7c,
  abstract     = {{<p>Introduction Sierra Leone has the world's highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country. Methods We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality. Results In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0-2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed. Conclusions The caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.</p>}},
  author       = {{Holmer, Hampus and Kamara, Michael M. and Bolkan, Håkon Angell and Van Duinen, Alex and Conteh, Sulaiman and Forna, Fatu and Hailu, Binyam and Hansson, Stefan R. and Koroma, Alimamy P. and Koroma, Michael M. and Liljestrand, Jerker and Lonnee, Herman and Sesay, Santigie and Hagander, Lars}},
  issn         = {{2059-7908}},
  keywords     = {{maternal health; obstetrics; surgery}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Global Health}},
  title        = {{The rate and perioperative mortality of caesarean section in Sierra Leone}},
  url          = {{http://dx.doi.org/10.1136/bmjgh-2019-001605}},
  doi          = {{10.1136/bmjgh-2019-001605}},
  volume       = {{4}},
  year         = {{2019}},
}