Caetano Pereira

Meeting the need for emergency obstetric care in Mozambique: work performance and histories of medical doctors and assistant medical officers trained for surgery

Objective  Nonphysicians in Mozambique have been performing major surgery for more than 20 years, with documented outcomes equivalent to those of specialists. The purpose of this study was to make an inventory of all government hospitals so as to document obstetric surgery performed by ‘técnicos de cirurgia’ (TCs) and to elucidate their retention at district level.

Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

BackgroundClinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.MethodsDuring a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers.ResultsDuring the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death.ConclusionClinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.

A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique

Objective To evaluate the outcome of caesarean delivery performed by assistant medical officers and specialists in obstetrics and gynaecology with particular attention to post‐operative complications.

Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique

Objective  To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (técnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Técnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians.

The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

Five countries in sub-Saharan Africa use nonphysicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers provide most of this surgery outside of major cities. Questions about the quality of surgery by nonphysicians have kept most African countries from following this example. We reviewed the records of all patients admitted for complicated deliveries to fourteen district hospitals during four months. Among 1,134 complicated deliveries and 1,072 major obstetrical operations, there were no significant differences between assistant medical officers and medical officers in outcomes, risk indicators, or quality. There were significant differences between mission and government hospitals.

Emergency obstetric surgery by non‐physician clinicians in Tanzania

To calculate the met need for comprehensive emergency obstetric care (CEmOC) in 2 Tanzanian regions (Mwanza and Kigoma) and to document the contribution of non‐physician clinicians (assistant medical officers [AMOs]) and medical officers (MOs) with regard to meeting the need for CEmOC.

Uterine evacuation by vaginal misoprostol after second trimester pregnancy interruption.

Background The purpose was to study the capacity of vaginal misoprostol in combination with methylergometrine to achieve complete evacuation of the uterus without ensuing surgical evacuation of the uterine cavity.

Obstetric implications of Rhesus Antigen Distribution in Mozambican and Swedish Women

AB0 and Rhesus phenotypes were analyzed in 199 Mozambican women and the gene frequencies were calculated. The frequencies of the K and Fya antigens were also investigated. The findings were interpreted against the background of the corresponding phenotype distribution of a Swedish population. D- and Du-positive women amounted to 97.0%, which is significantly more than in Sweden (p < 0.001). Among AB0 groups it was found that blood group 0 is significantly more predominant in Mozambican than in Swedish women (p < 0.001). The reverse is true for blood group A (p < 0.001). Blood group B has a similar prevalence in Mozambican and Swedish women. The obstetric implication of the low prevalence of D-negative women is that the Rhesus alloimmunization problem may be of a much smaller magnitude than would be expected.

Parity-Related Prevalence of Rhesus Antigens among Mozambican Parturients

The potential risk of rhesus alloimmunization and the ensuing risk of fetal death with increasing parity were investigated in two groups of parturients; primiparous and grand multiparous (para > or = 5) women with liveborns. It was hypothesized that significantly fewer women of the latter than of the former group would be rhesus negative, since grand multiparity would be expected to be associated with an increased risk of late fetal death in rhesus-negative parturients. Primiparous (n = 390) and grand multiparous (n = 755) parturients with liveborns were studied in order to identify D- and Du-negative individuals. Sixteen out of 390 primiparas (4.10%) and 28/755 (3.71%) grand multiparas were D and Du negative. The difference did not reach statistical significance. It appears that being a D- and Du-negative grand multiparous parturient, in the absence of anti-D prophylaxis, is not a significant reproductive disadvantage to being primipara in terms of an increased risk of having stillborn babies.

Role of Rhesus Alloimmunization in the Etiology of Late Fetal Death in Maputo

Grand multiparous parturients with unexplained late fetal death (n = 70) and with surviving newborns (n = 755) were analyzed and compared regarding blood group in general and presence of D and Du antigens in particular. In the stillbirth group, none of the parturients had any signs of disease (syphilis, preeclampsia, placental abruption, severe anemia or fever) that could be associated with the fetal death. It was found that none of the parturients with stillbirth were D- and Du-negative while 28/755 (3.71%) of parturients with liveborn babies were D- and Du-negative. It is concluded that, among grand multiparous parturients with otherwise unexplained late fetal death, the risk of having fetomaternal rhesus incompatibility as stillbirth etiology is insignificant. The advantage of introducing anti-D immunoglobulin for prophylaxis against rhesus alloimmunization would presumably be insignificant.