IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
INTRODUCTION: Ethnic minorities particularly immigrants, tend to be at increased risk for poor birth outcomes. Rochester New York is home to many Nepali immigrants with a 56% increase in 2014. These immigrants face many barriers which includes communication, health literacy and accessibility to health services. The purpose of this study was to evaluate the obstetric outcomes of Nepali patients within the Rochester Regional Health System. METHODS: Nepali women who delivered between January 1, 2011 and December 31, 2016 were matched with Non-Nepali women who delivered during the same time period. Demographic and obstetric information was extracted from the electronic medical records. Obstetric outcomes between the 2 study groups were then analyzed. Data analysis was done using the SPSS, version 24. RESULTS: The final analysis was performed on 194 patients (86 Nepali and 108 Non-Nepali). Nepali patients had prolonged second stage of labor (P<.05) and a higher cesarean section rate (33.7% vs 26.9%) compared to Non-Nepali patients. Nepali patients also had significantly higher rates of chorioamnionitis/endometritis (P<.05) as well as third degree vaginal lacerations (P<.05). More postpartum hemorrhage was seen in the Nepali group of patients, 17.4% vs 12.0%. Babies born to Nepali mothers were more likely to be admitted to the Neonatal Intensive Care unit (P<.05). CONCLUSION: Nepali mothers had higher obstetric complications than Non-Nepali mothers. Further ongoing analysis of health outcomes within this particular migrant population is warranted. This will certainly help to inform better reproductive health care practices for these patients, and ultimately minimize disparities in their obstetric care and outcomes.
We review the case of an unstable gynaecological patient in the USA who presented with profuse vaginal bleeding after spontaneous miscarriage and was ultimately diagnosed with a uterine arteriovenous malformation managed with interventional radiology embolisation of her uterine artery. Her case was complicated by the presence of an ankle monitoring device which had been placed by US Immigration and Customs Enforcement as part of the Alternatives to Detention programme in which she was enrolled during her immigration proceedings. The device prompted important considerations regarding the potential use of cautery, MRI compatibility and device-related trauma, in addition to causing significant anxiety for the patient, who was concerned about how the team’s actions could affect her immigration case. Discussion of her course and shared perspective highlights the unique clinical and medicolegal considerations presented by the expanded use of ankle monitoring devices for electronic surveillance (or ‘e-carceration’) of non-violent immigrants and others.
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