Current Status of Obstetric Anaesthesia Services (Oasis): A Cross- Sectional Survey of Public Hospitals in Khartoum State, Sudan (original) (raw)
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BMC Pregnancy and Childbirth, 2022
Background: Medically unjustifiable caesarean section (CS) deliveries have been rising rapidly in many developed countries over the last three decades. While many developing countries show rates beyond optimal levels, few poorer countries appear to have sub-optimal obstetric care in relation to essential surgeries. The objective of this study is to document the rates of CS delivery, its time trend, and geographic and sociodemographic variability in Sudan. Methods: We utilized a number of Multiple Indicator Cluster Surveys (MICS) conducted in 2014, 2010, and 2006 to quantify CS rates per 1000 live births. We also documented absolute changes in rates over three-time points and variation in CS rates across geographic regions and areas of residence. Results: Over a decade, CS rates in Sudan increased steadily from 4.3% in 2006 to 6.7% in 2010 and 9.1% in 2014. During this period, CS rates varied considerably across regions showing higher rates in the Northern region (7-25%) and lower rates in Darfur (2-3%). Urban areas experienced rapidly increasing rates (6-14%), while rural areas showed negligible changes to absolute CS rates over time (5-7%). We also found geographic regions, maternal age, maternal education, receiving antenatal care, and birth order of the child were important determinants of CS in Sudan. Conclusion: Sudan may be facing a double burden of problems associated with surgical interventions for childbirth. While the wealthier parts of Sudan are experiencing a rapid surge in CS, some poor parts of rural Sudan may not be getting the essential surgical intervention for birth when mandated. Urgent improvement to obstetric care and the development of appropriate public health interventions that focus on regional disparities are warranted.
BMC Health Services Research, 2015
Background: Every day, globally approximately a thousand women and girls needlessly die as a result of complications during pregnancy, childbirth or the 6 weeks following delivery. The majority of maternal deaths are avoidable and could be prevented with proven interventions to prevent or manage complications during pregnancy and child birth. The aim of this study was to examine factors associated with underutilization of maternal health services in Sudan. Methods: Data was obtained from the Sudan Household Health Survey 2010(SHHS). The SHHS collected data from 5730 women, aged 15-49 years and who were pregnant in the last 2 years preceding the survey. The selection of the respondents was through a multi-stage cluster sampling technique. Interviews were conducted with respondents to collect data about their demographic characteristics, reproductive history, pregnancy and child delivery. Univariate analysis and logistic regression were used to analyze the data. Results: The factors associated with receiving antenatal care were, higher educational level (odds ratio (OR) = 3.428, 95 % CI 2.473-4.751-p value 0.001), higher household wealth (OR 1.656, 95 % CI: 1.484-1.855-p value 0.001) and low parity (OR =1.214, 95 % CI: 1.035-1.423-p value 0.017). The factors associated with institutional delivery were higher educational level (OR = 1.929, 95 % CI: 1.380-2.697-p value 0.001), high household wealth (OR = 2.293, 95 % CI: 1.988-2.644 p value 0.001), urban residence (OR = 1.364, 95 % CI: 1.081-1.721 p value 0.009), low parity (OR = 2.222, 95 % CI: 1/786-2.765 p value 0.001), receiving ANC (OR = 3.342, 95 % CI: 2.306-4.844 p value 0.001) and complications during pregnancy (OR = 1.606, 95 % CI: 1.319-1.957 p value 0.001). Conclusions: The factors associated with both antenatal care use and institutional delivery are similar and interventions to target these include expanding female education and improving coverage and affordability of health services.
Southern African Journal of Anaesthesia and Analgesia, 2013
Objectives: Suboptimal treatment as a result of lack of basic skills in anaesthesia and resuscitation contributes significantly to the continuing increase in anaesthetic-related maternal deaths in South Africa. This study aimed to determine the number of doctors providing obstetric anaesthesia at district and regional hospitals in KwaZulu-Natal, their level of experience and caseload, and to identify specific groups that could be targeted for support and training. Design: This was a prospective open cohort observational study of obstetric anaesthetic services in KwaZulu-Natal, which considered the human resources, caseloads and the experience of doctors. Setting and subjects: Two separate questionnaires, directed independently to medical managers and doctors providing operative obstetric services, were sent to 48 district and regional hospitals in KwaZulu-Natal. One third of the hospitals, selected by stratified randomisation, were visited to improve response rates. Outcome measures: Medical managers were asked for caseload and staffing data. Doctors were asked for details of their qualifications, experience and their current workload. Results: Thirty-eight (a 79% response rate) medical managers and 266 doctors (an estimated response rate of 65%) completed questionnaires. Community service medical officers (CSMOs) at rural district hospitals constituted 27% of fulltime staff. CSMOs at all responding district hospitals were expected to provide obstetric anaesthesia independently. Foreign medical graduates provided obstetric anaesthesia in 71% (27/38) of hospitals and constituted 27% of full-time staff at rural district hospitals. Twenty-four doctors (all foreign-trained) reported no anaesthesia training during their internship. District hospitals were more reliant on part-time (sessional) appointments. Fifty-eight per cent of all (22/38) hospitals reported that a number of sessional appointments provided obstetric anaesthesia. In October 2010, 58% (22/38 active during the month) of sessional appointments at district-level hospitals administered only one obstetric anaesthetic, whereas all 15 sessional appointments who were active at regional level administered two or more. Only 24% of responding doctors had more than five years' experience in their current employment. Only 3% of responding doctors working in rural hospitals had a Diploma in Anaesthesia, compared to 26% in urban hospitals. Only one doctor with more than five years of employment history and a Diploma in Anaesthesia worked at district level. Conclusion: This study highlights the lack of training and experience of doctors in obstetric anaesthesia and documents workload patterns at district hospitals. It also identifies specific target groups for future support and training.
A hospital-centered approach to improve emergency obstetric care in South Sudan
International Journal of Gynecology & Obstetrics, 2015
Objective: To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system. Methods: In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge. Results: The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital. Conclusion: A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings.
BMJ open, 2018
To determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication. This was a retrospective cross-sectional study. Four primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan. All admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications. The primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes. Two hundred and fifty four major obstetric complications were admitted in 2015 o...
Anaesthesia services in developing countries: defining the problems
Anaesthesia, 2007
We describe the use of a questionnaire to define the difficulties in providing anaesthesia in Uganda. The results show that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to deliver safe anaesthesia to a child and 6% to deliver safe anaesthesia for a Caesarean section. The questionnaire identified shortages of personnel, drugs, equipment and training that have not been quantified or accurately described before. The method used provides an easy and effective way to gain essential data for any country or national anaesthesia society wishing to investigate anaesthesia services in its hospitals. Solutions require improvements in local management, finance and logistics, and action to ensure that the importance of anaesthesia within acute sector healthcare is fully recognised. Major investment in terms of personnel and equipment is required to modernise and improve the safety of anaesthesia for patients in Uganda.
Comparison of Obstetric Anesthesia Practices in Different Level of Hospitals Across Pakistan
2019
Objective: To compare the current practices in obstetric anesthesia in different level of hospitals across Pakistan and their adherence to guidelines and standards. Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Okara for two months, from Dec 2018 to Feb 2019. Material and Methods: Five hundred questionnaire were sent to Department of Anesthesiology of 100 different hospitals. The proforma was a self-administered 22-questions that asked about the various aspects of the conduct of obstetric anesthesia. The data were analyzed using SPSS version 20. The qualitative variables were presented as frequency and percentage. Chi square used to calculate significance; p-value ≤0.05 taken as significant. Results: We received 311 questionnaires (62.2%) from various institutes. At the tertiary care hospital, most of respondents were aged less than 35 years and had an experience of 11-20 years as compared to 35-...