Caesarean section in Malawi: prospective study of early maternal and perinatal mortality

Fenton, Paul M.; Whitty, Christopher J M; Reynolds, F.

doi:10.1136/bmj.327.7415.587

Cited by 120 publications

(115 citation statements)

References 8 publications

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“…Lawn et al note that appropriate cesarean section should prevent many of the fetuses with these characteristics from dying during labor, and further suggest that many of these deaths could be avoided with improved obstetric care and more rapid response to obstetric complications [2]. Thus, the findings from this study suggest that despite giving birth in a health facility and having cesarean section rates even higher than recommended for many developing countries, women may not have received appropriate obstetric care [16]. Our study reinforces findings from other recently published studies that report a failure of Pakistani health facilities to offer essential and comprehensive obstetric care; deficiencies in staff competence have also been reported [17,18].…”

Section: Commentmentioning

confidence: 54%

Stillbirths in an urban community in Pakistan

Jehan

McClure

Salat

et al. 2007

American Journal of Obstetrics and Gynecology

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Objective-To determine stillbirth risk factors and gestational age at delivery in a prospective developing country birth cohort.Study Design-1369 Pakistani women were prospectively enrolled at 20 -26 weeks, the gestational age determined by ultrasound, and risk factors and pregnancy outcomes assessed.Results-The stillbirth rate was 33.6/1000 births despite 96% of women receiving prenatal care, 83% attended by skilled providers in hospital and a 20% cesarean section rate. 51% of stillbirths occurred ≥ 37 weeks and 19% from 34-36 weeks. Only 4% had congenital anomalies. Hemoglobin < 8 g/dL, vaginal bleeding and preeclampsia were associated with increased stillbirth risk.Conclusions-In this developing country with reasonable technical resources defined by hospital delivery and a high cesarean section rate, stillbirth rates were much higher than US rates. That most of the stillbirths were term, did not have congenital anomalies and the demise appeared to be recent, suggests that many Pakistani stillbirths may be preventable with higher quality obstetric care.

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Section: Commentmentioning

confidence: 54%

Stillbirths in an urban community in Pakistan

Jehan

McClure

Salat

et al. 2007

American Journal of Obstetrics and Gynecology

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“…Interestingly, the strongest correlation with job satisfaction on the distributive justice scale occurred with "satisfaction with current work assignments". The fact that mid-level providers who were satisfied with their job assignments were also reporting high levels of job satisfaction provides some evidence that task shifting is not only working in terms of maintaining quality of service, 3,4 but is also having a positive effect on health worker motivation.…”

Section: Discussionmentioning

confidence: 99%

“…2 In the process, much of the obstetric work traditionally carried out by doctors has been shifted to clinical officers, who perform as much as 93% of major emergency obstetric operations in government hospitals and 78% in mission facilities, with comparable post-operative outcomes. 3,4 Despite these successes, most of the attention in addressing the human resource crisis has focused on increasing the capacity of training institutions to produce more doctors and registered nurses to fill vacancies. In addition there is an assumption that cadres such as enrolled nurses, clinical officers and medical assistants are somehow non-poachable, because they lack internationally recognised qualifications.…”

mentioning

confidence: 99%

Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice

McAuliffe

Manafa

Maseko

et al. 2009

Reproductive Health Matters

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“…There is strong evidence to support the assertion that caesarean section is a proxy indicator of severe obstetric complication in resource-poor settings. 3,14 It is reasonable to suppose that the pathological and psychological trauma of a long and difficult labour ending in an emergency operation, together with any adverse effects of the operation itself, would lengthen the time before next pregnancy. However, before we can assert that reduced fertility associated with caesarean section is unique to such settings, we must compare our findings with evidence from settings where caesarean section is not such a strong indicator of severe obstetric problems.…”

Section: Discussionmentioning

confidence: 99%

Caesarean section and subsequent fertility in sub‐Saharan Africa

Collin¹,

Marshall²,

Filippi³

2006

BJOG

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Objective To determine the impact of caesarean section on fertility among women in sub-Saharan Africa.Design Analysis of standardised cross-sectional surveys (Demographic and Health Surveys).Setting Twenty-two countries in sub-Saharan Africa, 1993Africa, -2003 Sample A total of 35 398 women of childbearing age (15-49 years).Methods Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models.Main outcome measures Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery.Results The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P < 0.01; controlling for age, parity, level of education, urban/rural residence and young age at first intercourse).Caesarean section was also associated with prior fertility and desire for further children: among multiparous women, an interval ‡3 versus <3 years between the index birth and the previous birth was associated with higher odds of caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P = 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P < 0.001). Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth.Conclusions Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in subSaharan Africa are emergency procedures for maternal indication.

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Caesarean section in Malawi: prospective study of early maternal and perinatal mortality

Abstract: Objective To examine potentially modifiable factors that may influence the high maternal and perinatal mortality associated with caesarean section in Malawi.

Cited by 120 publications

References 8 publications

Stillbirths in an urban community in Pakistan

Stillbirths in an urban community in Pakistan

Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice

Caesarean section and subsequent fertility in sub‐Saharan Africa

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