INTRODUCTION: Surgical physician extenders are used in Ethiopia and sub-Saharan Africa where there is a lack of surgical providers. METHODS: We tested characteristics associated with and outcomes of births attended by an integrated emergency surgical officers (IESOs) as compared to midwives and physician providers. RESULTS: Of 1,000 women in our convenience sample, data on birth attendant was missing on 5 women (0.5%). Of the remaining women, almost three-fourths (73.6%, n = 732) of women were attended by a midwife, almost a quarter were attended by an IESO (24.4%, n = 243), 10 women were attended by a physician with a General Practitioner level of training (1.0%), 5 women were delivered by an Ob/Gyn resident (0.5%), and 5 women were attended by an Ob/Gyn (0.5%). Women had a higher likelihood of being attended by an IESO than a midwife if they underwent forceps-assisted (RR 88.4, p < 0.05), vacuum-assisted (RR 45.2, p < 0.05), or cesarean birth (RR 161.8, p < 0.05) as compared to an unassisted vaginal birth. IESOs are performing more operative vaginal and cesarean births than other delivery providers. Outcomes of their deliveries are worse than those of midwives, but this is likely due to the acuity level of the patients and not the provider type.
INTRODUCTION: Surgical physician extenders are used in Ethiopia and sub-Saharan Africa where there is a lack of surgical providers. METHODS: We tested characteristics associated with and outcomes of births attended by an integrated emergency surgical officers (IESOs) as compared to midwives and physician providers. RESULTS: Of 1,000 women in our convenience sample, data on birth attendant was missing on 5 women (0.5%). Of the remaining women, almost three-fourths (73.6%, n = 732) of women were attended by a midwife, almost a quarter were attended by an IESO (24.4%, n = 243), 10 women were attended by a physician with a General Practitioner level of training (1.0%), 5 women were delivered by an Ob/Gyn resident (0.5%), and 5 women were attended by an Ob/Gyn (0.5%). Women had a higher likelihood of being attended by an IESO than a midwife if they underwent forceps-assisted (RR 88.4, p < 0.05), vacuum-assisted (RR 45.2, p < 0.05), or cesarean birth (RR 161.8, p < 0.05) as compared to an unassisted vaginal birth. IESOs are performing more operative vaginal and cesarean births than other delivery providers. Outcomes of their deliveries are worse than those of midwives, but this is likely due to the acuity level of the patients and not the provider type.
Authors: Margo S Harrison; Omrana Pasha; Sarah Saleem; Sumera Ali; Elwyn Chomba; Waldemar A Carlo; Ana L Garces; Nancy F Krebs; K Michael Hambidge; Shivaprasad S Goudar; Bhala Kodkany; Sangappa Dhaded; Richard J Derman; Archana Patel; Patricia L Hibberd; Fabian Esamai; Edward A Liechty; Janet L Moore; Dennis Wallace; Elizabeth M Mcclure; Menachem Miodovnik; Marion Koso-Thomas; Jose Belizan; Antoinette K Tshefu; Melissa Bauserman; Robert L Goldenberg Journal: Acta Obstet Gynecol Scand Date: 2017-03-09 Impact factor: 3.636
Authors: Ana Pilar Betrán; Marleen Temmerman; Carol Kingdon; Abdu Mohiddin; Newton Opiyo; Maria Regina Torloni; Jun Zhang; Othiniel Musana; Sikolia Z Wanyonyi; Ahmet Metin Gülmezoglu; Soo Downe Journal: Lancet Date: 2018-10-13 Impact factor: 79.321
Authors: Adeline Adwoa Boatin; Anne Schlotheuber; Ana Pilar Betran; Ann-Beth Moller; Aluisio J D Barros; Ties Boerma; Maria Regina Torloni; Cesar G Victora; Ahmad Reza Hosseinpoor Journal: BMJ Date: 2018-01-24