Research Article: Emergency obstetric care in a rural district of Burundi: What are the surgical needs?

Date Published: February 7, 2017

Publisher: Public Library of Science

Author(s): E. De Plecker, R. Zachariah, A. M. V. Kumar, M. Trelles, S. Caluwaerts, W. van den Boogaard, J. Manirampa, K. Tayler-Smith, M. Manzi, K. Nanan-N’zeth, B. Duchenne, B. Ndelema, W. Etienne, P. Alders, R. Veerman, R. Van den Bergh, Iratxe Puebla.


In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.

A retrospective analysis of EmOC data (2011 and 2012).

A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).

Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.

Partial Text

The Maternal Mortality Ratio (MMR) is an important measure of the status of maternal health within a given population and is defined as the number of maternal deaths per 100,000 live births over a specified time period [1]. This is an important measure as improving maternal health was one of eight Millennium Development Goals (MDGs) adopted by the international community in 2000. The fifth MDG aimed to reduce the MMR by 75% from the 1990 level by 2015 [2]. Although the number of maternal deaths dropped by 43% since 1990, it remains far from the desired target. Efforts to reduce maternal mortality thus need to be continued. In September 2015, more than 150 world leaders gathered to embrace 17 new and ambitious Sustainable Development Goals targets (SDG). The SDG 3 includes reduction of global maternal mortality ratio to less than 70 per 100,000 live births by 2030 [3].

This is one of the first studies from a rural district hospital setting in Africa that has quantified the type of emergency obstetric conditions for which surgical interventions were required. About four in ten women transferred for EmOC required major surgery which was performed by trained general practitioners and nurse anaesthetists (non-specialists) and hospital exit outcomes were very good with only two reported maternal deaths.




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