Rates of caesarean section and total volume of surgery in Sierra Leone: a retrospective survey

Bolkan, Håkon Angell; Schreeb, Johan von; Samai, Mohamed; Bash-Taqi, Donald; Kamara, Thaim B.; Salvesen, Øyvind; Ystgaard, Brynjulf; Wibe, Arne

doi:10.1016/s0140-6736(15)60814-5

Cited by 3 publications

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“…The number of caesarean sections needed was calculated by multiplying the estimated number of deliveries—live births (as above)15 16 and stillbirths (from a global analysis)17—with the expected need for caesarean section on maternal indication as a percentage of all deliveries (5.4%, from a previous study in West Africa by Dumont and colleagues in 2001) 18. The 2012 caesarean section rate from Bolkan et al , collected and calculated using the same methodology, was used for comparison over time 9 19…”

Section: Methodsmentioning

confidence: 99%

The rate and perioperative mortality of caesarean section in Sierra Leone

et al. 2019

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IntroductionSierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.MethodsWe conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality.ResultsIn 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed.ConclusionsThe caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.

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Section: Methodsmentioning

confidence: 99%

The rate and perioperative mortality of caesarean section in Sierra Leone

et al. 2019

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“…Before the EVD outbreak, CS was the most common major surgery performed in Sierra Leone 14 15. In 2012, the CS rate was 2.1% 16. The high unmet need can be attributed to a number of barriers, such as lack of finances, staff, equipment and healthcare infrastructure 14 17–21…”

Section: Introductionmentioning

confidence: 99%

”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

et al. 2019

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IntroductionRoutine health service provision decreased during the 2014–2016 Ebola virus disease (EVD) outbreak in Sierra Leone, while caesarean section (CS) rates at public hospitals did not. It is unknown what made staff provide CS despite the risks of contracting EVD. This study explores Sierra Leonean health worker perspectives of why they continued to provide CS.MethodsThis qualitative study documents the experiences of 15 CS providers who worked during the EVD outbreak. We interviewed surgical and non-surgical CS providers who worked at public hospitals that either increased or decreased CS volumes during the outbreak. Hospitals in all four administrative areas of Sierra Leone were included. Semistructured interviews averaged 97 min and healthcare experience 21 years. Transcripts were analysed by modified framework analysis in the NVivo V.11.4.1 software.ResultsWe identified two themes that may explain why providers performed CS despite EVD risks: (1) clinical adaptability and (2) overcoming the moral dilemmas. CS providers reported being overworked and exposed to infection hazards. However, they developed clinical workarounds to the lack of surgical materials, protective equipment and standard operating procedures until the broader international response introduced formal personal protective equipment and infection prevention and control practices. CS providers reported that dutifulness and sense of responsibility for one’s community increased during EVD, which helped them justify taking the risk of being infected. Although most surgical activities were reduced to minimise staff exposure to EVD, staff at public hospitals tended to prioritise performing CS surgery for women with acute obstetric complications.ConclusionThis study found that CS surgery during EVD in Sierra Leone may be explained by remarkable decisions by individual CS providers at public hospitals. They adapted practically to material limitations exacerbated by the outbreak and overcame the moral dilemmas of performing CS despite the risk of being infected with EVD.

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Évolution du taux et de la place des accouchements par césarienne au Burkina Faso

Sombié¹,

Mèda²,

Savadogo³

et al. 2017

Santé Publique

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Objective: The objective of this study was to evaluate the trends, mortality rates and places of caesarean section by level of care in Burkina Faso.Method: A retrospective study was conducted using data from Burkina Faso Ministry of Health annual health statistics and public hospital reports from 2000 to 2014. Linear regression was used to analyse caesarean section trends and mortality rates in District Hospitals (HD), Regional Hospitals (CHR) and University Hospitals (CHU).Results: From 2000 to 2014, the number of caesarean sections performed in Burkina Faso public hospitals increased almost tenfold from approximately 2,365 to 19,081, corresponding to a growth of the caesarean section rate from 0.5 to 2 per 100 deliveries. This growth was linear. Between 2000 and 2006, University Hospitals performed most of these caesarean sections. Starting from 2007, the majority of caesarean sections were performed by HD. The proportion of caesarean sections performed in Regional Hospitals remained almost constant, although the number of caesarean sections increased threefold. In 2014, HD performed 52% of caesarean sections, followed by University Hospitals (25%) and Regional Hospitals (23%). Analysis of mortality rates following caesarean section showed upward and downward trends, oscillating between 1 to 2% before 2008 and 0.15% in 2014. This same mortality trend was observed in each type of hospital.Conclusion: The results show an increase of better quality caesarean section rates, performed closer to the woman’s home in Burkina Faso. The health care services decentralization policy and quality of care approaches have helped to achieve these results.

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Rates of caesarean section and total volume of surgery in Sierra Leone: a retrospective survey

Cited by 3 publications

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The rate and perioperative mortality of caesarean section in Sierra Leone

The rate and perioperative mortality of caesarean section in Sierra Leone

”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

Évolution du taux et de la place des accouchements par césarienne au Burkina Faso

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