Objective To evaluate the outcome of caesarean delivery performed by assistant medical officers and specialists in obstetrics and gynaecology with particular attention to post‐operative complications. Design We performed a nonrandomised analysis of 2071 consecutive caesarean deliveries at Maputo Central Hospital. Of these, 958 (46.3%) were performed by assistant medical officers (medical assistants trained for surgery) and the rest (53.7%) by specialists in obstetrics and gynaecology. The age and parity distributions of women in the two groups were almost identical. Setting University Hospital in Maputo, covering all emergency obstetrics with about 48,000 deliveries per year. Population Two thousand and seventy‐one consecutive caesarean deliveries. Main outcome measures Post‐operative complications and the duration of post‐operative hospital stay. Results There were no differences in the indications for caesarean delivery. The surgical interventions associated with caesarean delivery did not differ in the two groups. The only significant difference was in the group of superficial wound separation due to haematoma, which was slightly more common (0.35%vs 0.05%) in the group operated on by assistant medical officers (Odds Ratio 2.2; 95% Confidence Interval 1.3–3.9) Conclusion Training selected medical assistants to perform caesarean delivery, even on women in poor general condition, is justified in settings in which doctors are scarce.

SummaryMalarial infection during pregnancy increases the risks of severe sequelae for the pregnant woman and the risk of delivering a low birthweight baby. The aim of this intervention study was to reduce significantly the prevalence of malaria parasitaemia in adolescent parturients in Matola and Boane in Mozambique. The study was focused upon the most malaria-vulnerable group, adolescent nulliparous and primiparous women. After completing the usual antenatal clinic and giving informed consent, 600 pregnant women were randomly chosen in a double blind manner to one of two regimens comparing the prevailing routine (placebo) for malaria prevention with a two dose regimen of sulphadoxinepyrimethamine (SP). The first dose was given at enrolment with a second dose at the beginning of the third trimester. At delivery maternal and placental malaria parasitaemia as well as birthweight and gestational duration were analysed. At booking the prevalence of malaria parasitaemia was 35.3% in the placebo group and 30.6% in the SP group. At the second dose, the prevalence of malaria parasitaemia in the placebo group and SP group was 19.7% and 8.7%, respectively. This implies a relative risk (RR) of 2.24 with 95% CI (1.34, 3.75). The corresponding figures at delivery were 13.6% and 6.3% with an RR of 2.22 (1.07, 4.60) and in placenta 13.3% and 2.4% with an RR of 4.87 (1.58, 15.0). Newborns with malaria within 7 days were significantly more frequent in the placebo group, 6.4% and 0.7% respectively, with an RR of 6.55 (1.20, 35.7). Almost all (approximately 98%) of the women studied had Plasmodium falciparum, the remainder had P. malariae and P. ovale. The mean birthweight in the SP group was 3077 g and in the placebo group 2926 g. The estimated mean difference between the two groups was 151 g with 95% CI (51, 252). The mean placental weight in the placebo group was 596 and 645 g in the SP group, implying a difference of 49 g with a 95% CI (11, 88). The mean gestational duration was 6.1 days longer in the SP group, 95% CI (1.5, 10.6). In the placebo group there were two cases of urticaria and one case of nausea; in the SP group there was one case of vomiting. No newborn showed any sign of serious SP side-effect. Two doses of SP were enough to significantly reduce the prevalence of peripheral and placental malaria parasitaemia among young nulliparous and primiparous pregnant women in Matola and Boane.

A prospective cohort of 908 consecutively enrolled pregnant women with biparietal diameter (DBP) compatible with gestational age equal to or below 21 weeks were followed up regularly at 2-4 weeks intervals. Normal antenatal care routine was applied. The newborns were followed until 7 days postpartum. The setting was two suburban antenatal clinics in Maputo and the delivery ward at the Maputo Central Hospital. The main outcome variables were low birth weight (LBW), preterm delivery, intrauterine fetal death, perinatal death and small for gestational age (SGA). For each of these variables the odds ratio for maternal risk factors was estimated with 95 per cent confidence interval and multiple logistic regression analysis was used. LBW occurred in 16.2 per cent and low maternal weight, low weight gain during pregnancy and not having a living child were risk factors. Prevalence of preterm birth was 15.4 per cent and low weight gain during pregnancy and malaria in the perinatal period were risk factors. Four per cent of mothers delivered stillborns and syphilis serology (positive VDRL test) was a risk factor. Perinatal death occurred in 4.7 per cent. These deaths were associated with being SGA, LBW or preterm at birth. Of the cohort women, 9.7 per cent delivered SGA newborns. It was concluded that maternal constitutional factors, particularly maternal weight gain, maternal height and maternal weight as well as syphilis and malaria during pregnancy, need to be given attention concerning the adverse outcomes addressed. The establishment of an obstetric cohort, followed prospectively, was possible in a low-income setting with limited numbers lost to follow-up at delivery.

A sample of 908 Mozambican pregnant women with gestational age < or = 21 weeks (as measured by ultrasound) were followed fortnightly from their first antenatal clinic visit until the end of the perinatal period. All women attended two suburban/semirural antenatal clinics in Maputo. Only 9% were lost to follow-up. Pre-term delivery occurred in 15.4% of women and low birthweight (LBW) in 16.2%. Mean birthweight was 2.91 kg. Perinatal death occurred in 4.7%. This obstetric cohort provides valuable baseline data to be used as reference. With substantial efforts, the non-compliance with follow-up at birth could be kept at a low level.