TY - JOUR
T1 - Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania
T2 - A pre-evaluation and postevaluation of a multicomponent safe surgery intervention
AU - Ernest, Edwin Charles
AU - Hellar, Augustino
AU - Varallo, John
AU - Tibyehabwa, Leopold
AU - Bertram, Margaret Mary
AU - Fitzgerald, Laura
AU - Katoto, Adam
AU - Mshana, Stella
AU - Simba, Dorcas
AU - Gwitaba, Kelvin
AU - Boddu, Rohini
AU - Alidina, Shehnaz
AU - Giiti, Geofrey
AU - Kihunrwa, Albert
AU - Balandya, Belinda
AU - Urassa, David
AU - Hussein, Yahya
AU - Damien, Caroline
AU - Wackenreuter, Brendan
AU - Barash, David
AU - Morrison, Melissa
AU - Reynolds, Cheri
AU - Christensen, Alice
AU - Makuwani, Ahmed
N1 - Funding Information:
This paper describes interventions and results from a multicomponent Safe Surgery 2020 project funded by the GE Foundation/ELMA Philanthropies and implemented in two regions, Kagera and Mara, in the Lake Zone of Tanzania. The project was implemented in 30 facilities providing Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services, from January 2018 to December 2020. A pre-cross-sectional/post-cross-sectional study design was used to evaluate WHO SSC utilisation (adherence to each step of the 3-phase tool), SSI rates and CS-related POMR using quantitative analysis before the intervention and, again, 18 months after implementation of the safe surgery interventions.
Funding Information:
1JHPIEGO, Dar es Salaam, Tanzania, United Republic of 2JHPIEGO, Baltimore, Maryland, USA 3Johns Hopkins University, Baltimore, Maryland, USA 4Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA 5Department of Surgery, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania, United Republic of 6Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania, United Republic of 7Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of 8President Office Regional Authority and Local Government, Dar es Salaam, Tanzania, United Republic of 9Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of 10Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA 11The ELMA Philanthropies Services (U.S.), New York, New York, USA 12Assist International, Ripon, New York, USA Acknowledgements Safe Surgery 2020 is a unique multi-stakeholder partnership that transforms surgical systems through an ecosystem approach, implemented by Jhpiego, Dalberg, Assist International, Harvard PGSSC and other stakeholders in surgery, obstetric and anaesthesia care. The work presented here involves the commitment and dedication of a multitude of healthcare workers including health facility managers, surgical providers, anaesthetists and nurses, as well as CS clients, district and regional authorities in Kagera and Mara regions. We are grateful for the leadership and collaboration from the Ministry of Health Community Development Gender Elderly and Children and Presidents’ Office Regional Authorities and Local Governments for their contribution to this work. This project was funded under grant number 5R18HS024235-02 from the GE Foundation and grant number 17-F0012 from The ELMA Foundation. The contents are the responsibility of the authors and do not necessarily reflect the views of the GE Foundation or The ELMA Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/12/7
Y1 - 2021/12/7
N2 - Introduction Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs). Methods We conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15. Results The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions. Conclusion Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
AB - Introduction Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs). Methods We conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15. Results The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions. Conclusion Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.
KW - cross-sectional survey
KW - hospital-based study
KW - intervention study
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U2 - 10.1136/bmjgh-2021-006788
DO - 10.1136/bmjgh-2021-006788
M3 - Article
C2 - 34876458
AN - SCOPUS:85121267717
SN - 2059-7908
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
IS - 12
M1 - e006788
ER -