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

  • Reproductive Health, Volume 15, No. 1, Year 2018

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Study Justification:
– Uganda has high maternal and neonatal mortality rates, far from meeting sustainable development goals.
– Access to timely safe surgery and safe anesthesia can reduce these deaths.
– The availability and usage of WHO Safe Surgical Checklist in hospitals in Uganda needs to be assessed.
– Post-operative care for paturients needs to be investigated.
– Advocating for the implementation of Comprehensive Emergency Obstetric and Newborn Care (CEmONC) in low-income countries.
Study Highlights:
– Cross-sectional survey conducted at 64 government and private hospitals in Uganda.
– Only 34.38% of hospitals used the WHO Safe Surgical Checklist.
– Limited access to Intensive Care Unit (ICU) services for postoperative care in government and not-for-profit hospitals compared to private hospitals.
– Urgent need to make WHO checklists available and operationalized.
– Strengthening peri-operative care in obstetrics can decrease maternal and neonatal morbidity.
Study Recommendations:
– Make WHO Safe Surgical Checklist available and operationalized in hospitals.
– Improve access to Intensive Care Unit (ICU) services for postoperative care in government and not-for-profit hospitals.
– Strengthen peri-operative care in obstetrics to improve maternal and neonatal outcomes.
Key Role Players:
– Ministry of Health
– Hospital administrators
– Obstetricians and gynecologists
– Anesthesiologists
– Nurses and midwives
– Policy makers
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare professionals
– Procurement of WHO Safe Surgical Checklist materials
– Infrastructure improvement for Intensive Care Units
– Equipment and supplies for peri-operative care
– Monitoring and evaluation of implementation progress

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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.

The cross-sectional survey was conducted in Uganda from September 2014 to August 2015. A total of 64 hospitals across Uganda were selected based on the criteria that they provided obstetric anaesthesia At least 15 hospitals from each region; East, West, North and Central were included:- 13 regional referral, 21 general (district), 7 private for profit and 7 private not for profit hospitals across the country. Our study represents 41% of all the hospitals in the country and 100% of the government regional referral hospitals, 15% of government general (district) hospitals and 33% of all private hospitals in Uganda. This included 26% of private for profit and 37% of the private non-for profit hospitals. As published in by Epiu et al.** survey tool to evaluate compliance to the World Federation of Societies’ of Anaesthesiologists (WFSA) international guidelines for safe anaesthesia was developed [19]. These included quantitative and qualitative data on pre-operative assessment of patients, staffing and continuous monitoring intra-operatively and post-operatively. In this report we have included the peri-operative components on the use of the WHO Safe surgical Checklist, and documented the postoperative care of the parturient. I.E and trained research assistants interviewed on anaesthetist at each hospital, the hospital director and using a checklist assessed the theatre and recovery areas. We purposefully selected all 14 regional referral hospitals as they are tertiary centres and serve as the surgical referral hospitals for lower health centres. We also randomly selected hospitals from other types of hospitals present in Uganda to include general (government district hospitals), private for profit and private not for profit hospitals. With the help of a statistician, data was subsequently cleaned and coded into Epidata version 3.1. Range. Consistency and Validity checks were built in to minimize errors. Data was exported and analyzed using STATA version 14 (Statcorp, College Station, Texas, USA). Ethical approval was obtained from Makerere University School of Medicine Research and Ethics Committee (SOMREC) REC REF No 2014–133, the appropriate participating hospitals, and the Uganda National Council for Science and Technology. Informed consent was obtained from all individuals participating in the study.

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The recommendation to improve access to maternal health in Uganda is to strengthen peri-operative care in low-income countries by implementing Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services and appropriate intensive care post-operatively. This recommendation is based on a cross-sectional survey conducted in Uganda, which found that only 34.38% of the surveyed hospitals used the WHO Safe Surgical Checklist and a low percentage of government and not-for-profit hospitals had access to Intensive Care Unit (ICU) services for postoperative care compared to private hospitals.

By making the WHO checklists available and operationalized in all hospitals, and ensuring access to ICU services for postoperative care, the maternal and neonatal morbidity rates can be decreased, moving closer to the goal of safe motherhood and Universal Health Care. This recommendation is published in the journal Reproductive Health, Volume 15, No. 1, in the year 2018.
AI Innovations Description
The recommendation to improve access to maternal health in Uganda is to strengthen peri-operative care in low-income countries, specifically by implementing Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services and appropriate intensive care post-operatively. This recommendation is based on a cross-sectional survey conducted in Uganda, which found that only 34.38% of the surveyed hospitals used the WHO Safe Surgical Checklist and a low percentage of government and not-for-profit hospitals had access to Intensive Care Unit (ICU) services for postoperative care compared to private hospitals.

By making the WHO checklists available and operationalized in all hospitals, and ensuring access to ICU services for postoperative care, the maternal and neonatal morbidity rates can be decreased, moving closer to the goal of safe motherhood and Universal Health Care. This recommendation is published in the journal Reproductive Health, Volume 15, No. 1, in the year 2018.
AI Innovations Methodology
The methodology used to simulate the impact of the main recommendations in this abstract on improving access to maternal health would involve the following steps:

1. Identify a sample of hospitals in low-income countries similar to Uganda that have similar challenges in peri-operative care and access to maternal health services.

2. Conduct a cross-sectional survey similar to the one conducted in Uganda, using preset questionnaires to assess the availability and usage of the WHO Safe Surgical Checklist and the post-operative care of patients in these hospitals.

3. Calculate the percentage of hospitals that currently use the WHO Safe Surgical Checklist and have access to Intensive Care Unit (ICU) services for postoperative care, similar to the findings in the Uganda survey.

4. Implement interventions to address the identified gaps in peri-operative care, such as making the WHO checklists available and operationalized in all hospitals and ensuring access to ICU services for postoperative care.

5. Monitor and evaluate the impact of these interventions on maternal and neonatal morbidity rates in the selected hospitals. This can be done by comparing the pre-intervention and post-intervention data on maternal and neonatal outcomes, such as maternal mortality ratio, neonatal mortality ratio, and stillbirth rates.

6. Analyze the data using statistical software, such as STATA, to determine the effectiveness of the interventions in improving access to maternal health services.

7. Draw conclusions based on the findings and make recommendations for scaling up these interventions in other low-income countries to improve access to maternal health.

It is important to note that this is a hypothetical methodology based on the information provided in the abstract. The actual implementation of such a study would require careful planning, ethical considerations, and collaboration with relevant stakeholders in the selected countries.


Statistics:
Citations: 4
Identifiers:
DOI: 10.1186/s12978-018-0604-6
Research Areas:
Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants, Technology and Innovations
Study Countries:
Multi-Countries, Uganda
Study Design:
Cross Sectional Study
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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