Emergency obstetric care in a rural district of Burundi: What are the surgical needs?
OBJECTIVE
In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.


METHODS
A retrospective analysis of EmOC data (2011 and 2012).


RESULTS
A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by 'general practitioners with surgical skills' and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.


CONCLUSIONS
Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium.
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http://orcid.org/0000-0003-4266-8159
E
De Plecker
Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
R
R
Zachariah
International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi India.
A M V
AM
Kumar
Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium.
M
M
Trelles
Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium.
S
S
Caluwaerts
Medecins sans Frontieres, Bujumbura, Burundi.
W
W
van den Boogaard
Ministry of Health, Kabezi district, Burundi.
J
J
Manirampa
Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
K
K
Tayler-Smith
Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
M
M
Manzi
Medecins sans Frontieres, Bujumbura, Burundi.
K
K
Nanan-N'zeth
Medecins sans Frontieres, Bujumbura, Burundi.
B
B
Duchenne
Medecins sans Frontieres, Bujumbura, Burundi.
B
B
Ndelema
Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium.
W
W
Etienne
Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium.
P
P
Alders
Medecins sans Frontieres, Operational department, Brussels Operational Centre, Brussels, Belgium.
R
R
Veerman
Medecins sans Frontieres, Medical department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
R
R
Van den Bergh
D000293:Adolescent; D000328:Adult; D002063:Burundi / Q000453:epidemiology; D036861:Delivery, Obstetric; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology; D013513:Obstetric Surgical Procedures; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies; D012424:Rural Population; D055815:Young Adult