Postpartum Tubal Ligation by Nurse-Midwives in Thailand: A Field Trial

Satyapan, Suwannee; Varakamin, Somsak; Suwannus, Prasert; Chalapati, Sopon; Onthuam, Yupha; Dusitsin, Nikorn

doi:10.2307/1966065

Cited by 14 publications

(19 citation statements)

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“…Although some may assume that sharing jobs in clinics with lower-level providers will compromise quality, studies show that less-credentialed health personnel, such as clinical officers and nurse-midwives, can provide clinical methods, including tubal ligation, vasectomy, implants, and IUDs, with quality of care matching that of higher-level providers. For example, in the Thailand study referred to above, nurse-midwives provided tubal ligation of quality equal to that of physicians (Satyapan et al 1983). Similar results were obtained in a study in Bangladesh (Chowdhury and Chowdhury 1975).…”

Section: Task Sharing Within Clinics Frees Up Time For Higher-level Hsupporting

confidence: 66%

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Task Sharing in Family Planning

Janowitz

Stanback

Boyer

2012

Studies in Family Planning

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Section: Task Sharing Within Clinics Frees Up Time For Higher-level Hsupporting

confidence: 66%

“…In the 1980s, physicians in Thailand could not adequately meet the demand for female sterilization. Nurse-midwives were trained to perform sterilizations, thereby freeing up the doctors' time to perform higher-level tasks (Satyapan et al 1983;Kanchanasinith et al 1990).…”

mentioning

confidence: 99%

Task Sharing in Family Planning

Janowitz

Stanback

Boyer

2012

Studies in Family Planning

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“…The average operation time for postpartum sterilization in Thailand was 11 -15 minutes. 17,18 In the present study, the operation time for intra-umbilicus incision was significantly shorter than for infra-umbilicus incision. The present study may be among the earliest to compare the two skin incision sites for postpartum sterilization, in which aesthetic satisfaction was assessed from both surgeons and patients.…”

Section: Operation Timesmentioning

confidence: 44%

Aesthetic Outcomes of Intra-Umbilical Incision vs Infra-Umbilical Incision in Postpartum Tubal Sterilization: A Randomized Controlled Trial

Chirdchim¹,

Wanichsetakul²,

Patumanond³

2019

Rama Med J

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Background: An incision inside the umbilicus is popular used in single port surgery intra-umbilical skin incision surgeries have been proven efficient and safe. When compared to infra-umbilical skin incisions, an incision wound was invisible after the operation. Why not use intra-umbilical skin incision in postpartum tubal sterilization. Objective: To compare aesthetic scores of an incision wound, surgical time and complications in postpartum sterilization under infra-umbilical and intra-umbilical skin incision. Methods: This was a randomized controlled trial conducted in Prapokkhlo Hospital, Chanthaburi, Thailand. Patients (n = 58) with informed consents were randomly assigned to one of the two skin incision techniques for postpartum sterilization (n = 29 for each arm). Surgical times were recorded. Both the patients and an independent physician made wound aesthetic assessments one week after the operation using the Patient and Observer Scar Assessment Scores (POSAS), which compares the wound to the nearby skin. T tests and exact probability statistical tests were used for statistical analysis. Results: The surgeon’s POSAS scores in intra-umbilical incisions were significantly closer to normal skin than those in infra-umbilical incisions (6.8 ± 1.5 vs 12.5 ± 5.0; P < .001). A similar finding was observed for patient POSAS scores (6.5 ± 1.2 vs 15.4 ± 5.0; P < .001). The operation times were also shorter (9.1 ± 2.8 vs 11.8 ± 4.7 minutes; P = .009). Neither intra-abdominal injuries nor wound infections were observed. Conclusions: Postpartum sterilization using intra-umbilical skin incision was more efficient in regard to aesthetic concerns and operation time.

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“…Others have discussed the benefit to VMMC programs of training other clinical providers (not medical doctors) as a means of lowering costs to the program while retaining quality with similar findings [22], [23]. Research on task-shifting to other clinical providers has yielded comparable results to doctors for other types of procedures: post-partum tubal ligation [24], [25], IUD insertion [26], [27], and emergency obstetric surgery [28]. The few studies that have related quality of the operation to efficiency in terms of time-savings had mixed results.…”

Section: Discussionmentioning

confidence: 99%

Surgical Efficiencies and Quality in the Performance of Voluntary Medical Male Circumcision (VMMC) Procedures in Kenya, South Africa, Tanzania, and Zimbabwe

Rech

Bertrand²,

Thomas³

et al. 2014

PLoS ONE

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IntroductionThis analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC), quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider’s time with the client (PPTC) and total elapsed operating time (TEOT).MethodsTwo serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed quality of surgical technique and timed 9 steps in the VMMC procedure. Four elements of efficiency (task-shifting, task-sharing [of suturing], rotation among multiple surgical beds, and use of electrocautery) and quality of surgical technique were assessed as explanatory variables. Mann Whitney and Kruskal Wallis tests were used in the bivariate analysis and linear regression models for the multivariate analyses to test the relationship between these five explanatory variables and two outcomes: PPTC and TEOT. The VMMC procedure TEOT and PPTC averaged 23–25 minutes and 6–15 minutes, respectively, across the four countries and two years. The data showed time savings from task-sharing in suturing and use of electrocautery in South Africa and Zimbabwe (where task-shifting is not authorized). After adjusting for confounders, results demonstrated that having a secondary provider complete suturing and use of electrocautery reduced PPTC. Factors related to TEOT varied by country and year, but task-sharing of suturing and/or electrocautery were significant in two countries. Quality of surgical technique was not significantly related to PPTC or TEOT, except for South Africa in 2012 where higher quality was associated with lower TEOT.ConclusionsSYMMACS data confirm the efficiency benefits of task-sharing of suturing and use of electrocautery for decreasing TEOT. Reduced TEOT and PPTC in high volume setting did not result in decreased quality of surgical care.

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Postpartum Tubal Ligation by Nurse-Midwives in Thailand: A Field Trial

Cited by 14 publications

References 1 publication

Task Sharing in Family Planning

Task Sharing in Family Planning

Aesthetic Outcomes of Intra-Umbilical Incision vs Infra-Umbilical Incision in Postpartum Tubal Sterilization: A Randomized Controlled Trial

Surgical Efficiencies and Quality in the Performance of Voluntary Medical Male Circumcision (VMMC) Procedures in Kenya, South Africa, Tanzania, and Zimbabwe

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