ABSTRACT
Background: A 2010 survey in The Gambia among women of reproductive age put the prevalence rate of FGM/C at 76.3%. FGM/C was banned in 2015, but there is no real effort at enforcement of the ban. This study aimed to provide national data on obstetric outcomes to support advocacy and health education. A multicentre observational study to assess the obstetric and neonatal outcomes of parturient women with and without FGM/C was carried out across 4 healthcare facilities in The Gambia. The primary outcome was postpartum haemorrhage (>500ml) and secondary outcomes were caesarean section, perineal tears (including episiotomy), neonatal resuscitation and perinatal death. Of the 1,569 participants recruited into the study, 23% had no FGM/C while 77% had FGM/C of varying severity. The risk of postpartum haemorrhage was doubled for women with type I FGM/C, tripled in type II FGM/C and increased by 5-fold for those with type III and IV FGM/C. Caesarean section and perineal tears were also increased. FGM/C was associated with increased risk for neonatal resuscitation and perinatal death. FGM/C is associated with poor obstetric and neonatal outcomes in the Gambia with degree of risk correlating with the severity of FGM/C.
Subject(s)
Circumcision, Female , Obstetric Labor Complications , Perinatal Death , Postpartum Hemorrhage , Pregnancy , Female , Infant, Newborn , Humans , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/etiology , Cesarean Section/adverse effects , Pregnancy Outcome/epidemiology , Perinatal Death/etiology , Obstetric Labor Complications/epidemiology , Obstetric Labor Complications/etiology , Gambia/epidemiology , Circumcision, Female/adverse effects , Resuscitation/adverse effectsABSTRACT
OBJECTIVE: Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). METHODS: Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years. RESULTS: At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals. CONCLUSIONS: Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures.