Christian Mazimpaka1, Eline Uwitonze2, Teena Cherian3, Bethany Hedt-Gauthier4, Fredrick Kateera2, Robert Riviello5, Ziad El-Khatib6, Kristin Sonderman5, Magdalena Gruendl7, Caste Habiyakare8, Sadoscar Hakizimana8, Daniella Kayitesi2, Theoneste Nkurunziza2. 1. Primary Health Care, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda. Electronic address: machrist2020@yahoo.fr. 2. Primary Health Care, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda. 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 4. Primary Health Care, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 5. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts. 6. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 7. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Technical University Munich, Munich, Germany. 8. Obstetric and Gynecology, Ministry of Health, Kigali, Rwanda.
Abstract
BACKGROUND: Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. METHODS: This retrospective cohort study included all women aged ≥ 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. RESULTS: Of the 621 women included in the study, 45.7% (n = 284) were aged 25-34 y; 42.2% (n = 262) were married; 67.5% (n = 419) had primary education; and 75.7% (n = 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n = 85) of the study population. The most common indication for c-section was having undergone a c-section previously (31.9%, n = 198), followed by acute fetal distress (30.8%, n = 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7% spent less than 4 d at the hospital and 96.1% had no postoperative complications before discharge. Approximately 10% (59/572) of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n = 31). CONCLUSIONS: Our study found that previous delivery via c-section was the primary indication for c-section and that most of these cases were emergent or urgent on presentation. This study highlights the need for further research to explore the feasibility, safety, and appropriateness of vaginal birth after cesarean in rural district hospitals in sub-Saharan Africa.
BACKGROUND: Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. METHODS: This retrospective cohort study included all women aged ≥ 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. RESULTS: Of the 621 women included in the study, 45.7% (n = 284) were aged 25-34 y; 42.2% (n = 262) were married; 67.5% (n = 419) had primary education; and 75.7% (n = 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n = 85) of the study population. The most common indication for c-section was having undergone a c-section previously (31.9%, n = 198), followed by acute fetal distress (30.8%, n = 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7% spent less than 4 d at the hospital and 96.1% had no postoperative complications before discharge. Approximately 10% (59/572) of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n = 31). CONCLUSIONS: Our study found that previous delivery via c-section was the primary indication for c-section and that most of these cases were emergent or urgent on presentation. This study highlights the need for further research to explore the feasibility, safety, and appropriateness of vaginal birth after cesarean in rural district hospitals in sub-Saharan Africa.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Thomas G Weiser; Alex B Haynes; George Molina; Stuart R Lipsitz; Micaela M Esquivel; Tarsicio Uribe-Leitz; Rui Fu; Tej Azad; Tiffany E Chao; William R Berry; Atul A Gawande Journal: Bull World Health Organ Date: 2016-03-01 Impact factor: 9.408
Authors: T Nkurunziza; F Kateera; K Sonderman; M Gruendl; E Nihiwacu; B Ramadhan; T Cherian; E Nahimana; G Ntakiyiruta; C Habiyakare; P Ngamije; A Matousek; E Gaju; R Riviello; B Hedt-Gauthier Journal: Br J Surg Date: 2019-01 Impact factor: 6.939