Every year, some 7.5 million mothers and new-borns die during pregnancy or childbirth, almost all of whom are in low and middle-income countries. One reason for this is the lack of trained medical staff, particularly doctors. A doctoral thesis from Karolinska Institutet now shows that a solution could be the training of nurses in caesarean sections and other life-saving surgery.
The recently presented thesis by obstetrician Caetano Pereira from Mozambique is the first in the world to scientifically examine the result of advanced surgery performed by non-physician clinicians (NPCs). One of the studies, carried out in Mozambique, looked at the results of over 2,000 Caesarean sections, half of which were performed by NPCs and half by doctors with formal medical training. The results show that the mothers and babies in both groups fared equally well, in that they had just as few complications and the same post-delivery survival rate.
In Mozambique and Tanzania, around 90 per cent of all Caesarean sections in district hospitals are already performed by NPCs, who lack formal medical training and who have 3-years' basic training as nurses and an average of 7 years practical experience, often of surgery. Caetano Pereira's thesis shows that NPCs carry out highly professional surgical work with great success.
One major problem in many low-income countries is that the few formally trained doctors there rarely remain at village and rural hospitals. The thesis presents statistics showing that almost 90 per cent of the NPCs included in the studies were still active at these district hospitals in Mozambique seven years after starting there, while all formally trained doctors had left. Calculated in terms of a full working life (30 years), the non-medically trained health-workers were three times more cost-effective than the doctors.
Caetano Pereira is a specialist in gynaecology and obstetrics, and works at Maputo Central Hospital, Mozambique. He was supervised by Professor Staffan Bergström. His thesis was presented at the Division of Global Health, the Department of Public Health Sciences, Karolinska Institutet.
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