title: Emergency obstetric surgery by non-physician clinicians in Tanzania.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  All hospitals in the 2 regions were visited to determine the proportion of major obstetric interventions performed by AMOs and MOs. All deliveries (n = 38 758) in these hospitals in 2003 were reviewed. The estimated met need for emergency obstetric care (EmOC) was calculated using UN process indicators, as was the contribution to that attainment by AMOs. Hospital case fatality rates were also determined.
  
  
  RESULTS
  Estimated met need was 35% in Mwanza and 23% in Kigoma. AMOs operating independently performed most major obstetric surgery. Outside of the single university hospital, AMOs performed 85% of cesareans and high proportions of other obstetric surgeries. The case fatality rate was 2.0% in Mwanza and 1.2% in Kigoma.
  
  
  CONCLUSIONS
  AMOs carried most of the burden of life-saving EmOC-particularly cesarean deliveries-in the regions investigated. Case fatality was close to the 1% target set by the UN process indicators, but met need was far below the goal of 100%.
authors.affiliation: Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Caetano
authors.initials: C
authors.lastname: Pereira
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.forename: Calist
authors.initials: C
authors.lastname: Nzabuhakwa
authors.forename: Staffan
authors.initials: S
authors.lastname: Bergström
authors.forename: Colin
authors.initials: C
authors.lastname: McCord
mesh_terms: D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D013513:Obstetric Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D013636:Tanzania / Q000453:epidemiology; D000078329:Workforce