Clinical Department, St. Luke's Hospital, Malosa, Malawi.
Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
Hum Resour Health. 2020 Nov 9;18(1):87. doi: 10.1186/s12960-020-00516-5.
Medical doctors with postgraduate training in Global Health and Tropical Medicine (MDGHTM) from the Netherlands, a high-income country with a relatively low caesarean section rate, assist associate clinicians in low-income countries regarding decision-making during labour. Objective of this study was to assess impact of the presence of MDGHTMs in a rural Malawian hospital on caesarean section rate and indications.
This retrospective pre- and post-implementation study was conducted in a rural hospital in Malawi, where MDGHTMs were employed from April 2015. Indications for caesarean section were audited against national protocols and defined as supported or unsupported by these protocols. Caesarean section rates and numbers of unsupported indications for the years 2015 and 2016 per quarter for different staff cadres were assessed by linear regression.
Six hundred forty-five women gave birth by caesarean section in the study period. The caesarean rate dropped from 20.1 to 12.8% (p < 0.05, R = 0.53, y = - 0.0086x + 0.2295). Overall 132 of 501 (26.3%) auditable indications were not supported by documentation in medical records. The proportion of unsupported indications dropped significantly over time from 47.0 to 4.4% (p < 0.01, R = 0.71, y = - 0.0481x + 0.4759). Stratified analysis for associate clinicians only (excluding caesarean sections performed by medical doctors) showed a similar decrease from 48.3 to 6.5% (p < 0.05, R = 0.55, y = - 0.0442x + 0.4805).
Our results indicate that presence of MDGHTMs was accompanied by considerable decreases in caesarean section rate and proportion of unsupported indications for caesarean section in this facility. Their presence is likely to have influenced decision-making by associate clinicians.
来自荷兰的具有全球健康和热带医学研究生学历的医学博士（MDGHTM）在一个高收入国家，剖腹产率相对较低，他们在劳动力期间协助低收入国家的助理临床医生做出决策。本研究的目的是评估在马拉维的一家农村医院中 MDGHTM 的存在对剖腹产率和指征的影响。
这是一项在马拉维农村医院进行的回顾性实施前和实施后研究，MDGHTM 于 2015 年 4 月开始在该医院工作。剖腹产的指征是根据国家方案进行审核，并定义为这些方案支持或不支持。通过线性回归评估不同员工阶层在 2015 年和 2016 年每季度的剖腹产率和未支持的指征数量。
研究期间共有 645 名妇女接受了剖腹产。剖腹产率从 20.1%降至 12.8%（p < 0.05，R = 0.53，y = - 0.0086x + 0.2295）。在可审核的 501 项指征中，有 132 项未得到医疗记录中文件的支持。未支持的指征比例随时间显著下降，从 47.0%降至 4.4%（p < 0.01，R = 0.71，y = - 0.0481x + 0.4759）。仅对助理临床医生（不包括医生进行的剖腹产）进行分层分析显示，从 48.3%降至 6.5%（p < 0.05，R = 0.55，y = - 0.0442x + 0.4805）。
我们的结果表明，在该设施中，MDGHTM 的存在伴随着剖腹产率和未支持剖腹产指征比例的显著下降。他们的存在可能影响了助理临床医生的决策。
