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. DESIGN: Cross-sectional study of surgical procedures during 2002; longitudinal study of TCs and doctors graduating in 1987, 1988 and 1996. SETTING: All 34 hospitals with an operating theatre in Mozambique. POPULATION: Records of 12,178 major surgical obstetric operations were examined, and 59 medical officers and 34 TCs were interviewed. METHODS: Analysis of all surgical registers during 2002 in all government rural, provincial, general and central hospitals in Mozambique. TCs and doctors who had graduated in the specified years were traced and interviewed; health ministry records were reviewed to confirm assignments. MAIN OUTCOME MEASURES: Proportion of major obstetric surgeries performed by TCs. Proportion of TCs and medical doctors still at rural/district level at 7 years after graduation. RESULTS: Major obstetric surgery is conducted by nonphysicians in 57% of the 12,178 operations scrutinised. In district hospitals, they conducted 92% of 3246 operations. Retention of TCs and medical doctors at district hospital level differed markedly: after 7 years, 88% of the TCs remained in post compared with none of the medical doctors. CONCLUSION: Nonphysicians, trained in surgery, do most of the emergency obstetric surgery in Mozambique, and almost all of that performed in district hospitals. Nonphysicians, compared with physicians, stay longer in rural areas. After 7 years, around 90% of nonphysicians are still working in district hospitals, while almost no physicians remain there.
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. DESIGN: Cross-sectional study of surgical procedures during 2002; longitudinal study of TCs and doctors graduating in 1987, 1988 and 1996. SETTING: All 34 hospitals with an operating theatre in Mozambique. POPULATION: Records of 12,178 major surgical obstetric operations were examined, and 59 medical officers and 34 TCs were interviewed. METHODS: Analysis of all surgical registers during 2002 in all government rural, provincial, general and central hospitals in Mozambique. TCs and doctors who had graduated in the specified years were traced and interviewed; health ministry records were reviewed to confirm assignments. MAIN OUTCOME MEASURES: Proportion of major obstetric surgeries performed by TCs. Proportion of TCs and medical doctors still at rural/district level at 7 years after graduation. RESULTS: Major obstetric surgery is conducted by nonphysicians in 57% of the 12,178 operations scrutinised. In district hospitals, they conducted 92% of 3246 operations. Retention of TCs and medical doctors at district hospital level differed markedly: after 7 years, 88% of the TCs remained in post compared with none of the medical doctors. CONCLUSION: Nonphysicians, trained in surgery, do most of the emergency obstetric surgery in Mozambique, and almost all of that performed in district hospitals. Nonphysicians, compared with physicians, stay longer in rural areas. After 7 years, around 90% of nonphysicians are still working in district hospitals, while almost no physicians remain there.
Authors: Giorgio Cometto; Edoardo Belgrano; Umberto De Bonis; Guido Giustetto; Alberto Kiss; Peter Taliente; Giuseppe Meo Journal: World J Surg Date: 2012-03 Impact factor: 3.352
Authors: Jonathan D Pollock; Timothy P Love; Bruce C Steffes; David C Thompson; John Mellinger; Carl Haisch Journal: World J Surg Date: 2011-03 Impact factor: 3.352
Authors: Adam Iddriss; Nestor Shivute; Stephen Bickler; Ramou Cole-Ceesay; Bakary Jargo; Fizan Abdullah; Meena Cherian Journal: Bull World Health Organ Date: 2011-05-06 Impact factor: 9.408
Authors: Sam Luboga; Sarah B Macfarlane; Johan von Schreeb; Margaret E Kruk; Meena N Cherian; Staffan Bergström; Paul B M Bossyns; Ernest Denerville; Delanyo Dovlo; Moses Galukande; Renee Y Hsia; Sudha P Jayaraman; Lindsey A Lubbock; Charles Mock; Doruk Ozgediz; Patrick Sekimpi; Andreas Wladis; Ahmed Zakariah; Naméoua Babadi Dade; Peter Donkor; Jane Kabutu Gatumbu; Patrick Hoekman; Carel B Ijsselmuiden; Dean T Jamison; Nasreen Jessani; Peter Jiskoot; Ignatius Kakande; Jacqueline R Mabweijano; Naboth Mbembati; Colin McCord; Cephas Mijumbi; Helder de Miranda; Charles A Mkony; Pascoal Mocumbi; Jean Bosco Ndihokubwayo; Pierre Ngueumachi; Gebreamlak Ogbaselassie; Evariste Lodi Okitombahe; Cheikh Tidiane Toure; Fernando Vaz; Charlotte M Zikusooka; Haile T Debas Journal: PLoS Med Date: 2009-12-22 Impact factor: 11.069