Health and sustainable development; strengthening peri-operative care in low income countries to improve maternal and neonatal outcomes

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Health and sustainable development; strengthening peri-operative care in low income countries to improve maternal and neonatal outcomes


JournalReproductive health
Publication date – Oct – 2018
Authors – Isabella Epiu, Josaphat Byamugisha, Andrew Kwikiriza, Meg Amy Autry
Keywordsglobal surgery, health financing, health policy, health systems, maternal health, patient safety, safe anaesthesia, SDGs, universal health care
Open access – Yes
SpecialityObstetrics and Gynaecology, Other
World region Eastern Africa
Country: Uganda
Language – English
Submitted to the One Surgery Index on October 11, 2018 at 9:12 pm
Abstract:

Background
Uganda is far from meeting the sustainable development goals on maternal and neonatal mortality with a maternal mortality ratio of 383/100,000 live births, and 33% of the women gave birth by 18 years. The neonatal mortality ratio was 29/1000 live births and 96 stillbirths occur every day due to placental abruption, and/or eclampsia – preeclampsia and other unkown causes. These deaths could be reduced with access to timely safe surgery and safe anaesthesia if the Comprehensive Emergency Obstetric and Newborn Care services (CEmONC), and appropriate intensive care post operatively were implemented. A 2013 multi-national survey by Epiu et al. showed that, the Safe Surgical Checklist was not available for use at main referral hospitals in East Africa. We, therefore, set out to further assess 64 government and private hospitals in Uganda for the availability and usage of the WHO Checklists, and investigate the post-operative care of paturients; to advocate for CEmONC implementation in similarly burdened low income countries.

Methods
The cross-sectional survey was conducted at 64 government and private hospitals in Uganda using preset questionnaires.

Results
We surveyed 41% of all hospitals in Uganda: 100% of the government regional referral hospitals, 16% of government district hospitals and 33% of all private hospitals. Only 22/64 (34.38%: 95% CI = 23.56–47.09) used the WHO Safe Surgical Checklist. Additionally, only 6% of the government hospitals and 14% not-for profit hospitals had access to Intensive Care Unit (ICU) services for postoperative care compared to 57% of the private hospitals.

Conclusions
There is urgent need to make WHO checklists available and operationalized. Strengthening peri-operative care in obstetrics would decrease maternal and neonatal morbidity and move closer to the goal of safe motherhood working towards Universal Health Care.

OSI Number – 20253
PMID – 30290812

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