Research obtained from the Muhimbili National Hospital indicates a significant increase in CS in Tanzania
TANZANIA conducts a high number of caesarean births that exceed the World Health Organisation (WHO) recommended rates, a scientific research at the National referral hospital indicates.
The research obtained from the Muhimbili National Hospital (MHN) indicates a significant increase in CS rates from 21.5 per cent in 1999 to 31.8 per cent in 2006 and 49 per cent in 2012.
According to WHO since the mid-1980s, doctors have said the ideal rate of Caesarean -Section (CS) should range between 10 and 15 per cent.
The C-section is a surgical procedure in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies.
The WHO warns that too many women in developing and wealthy countries alike are resorting unnecessarily to Caesarean sections to give birth as other pregnant women with a real medical need for a C-section simply do not have access to the operation.
“In a lot of developing and developed countries, there is really an epidemic of Caesarean sections, even when there is no medical need,” said Marleen Temmerman, director of the The main clinical indications of CS include a previous scar on the uterus scar, obstructed labour and fetal distress.
However, the research evidence has shown medical litigation pressure, motivation by incentives or maternal requests and care givers desire to satisfy the clients were found to contribute to unnecessary use of CS.
In an inteview with the ’Sunday News’ recently, the Director of Surgery at MNH, Dr Andrew Mgaya, said that apart from the unncessary cases, major reasons for high CS delivery included non-clinical situations at the referring points (regional and district hospitals and health centres) including limited theatre space.
Other reasons could be nonfunctional or lack of theatre equipment, consumables and sterile gauns, lack of blood for transfusion, under staffing and inadequate facility to care for expected premature babies at referring hospitals.
He mentioned other motives as insufficient amount of blood for transfusion, drugs and consumables running out of stock, increased wound infection rates and sadly pregnant/sick mothers sleeping on the floor.
“Together or independently, these deficiencies not only lead to unavoidable suffering and death but also diminish health care givers volition to work,” he said.
He said the setbacks lead to overwhelming numbers of women referred to MNH for CS, create a scramble over limited resources and as a result outbalance medical supplies, hence substandard care in terms of timeline of intervention and quality of care.
“Good examples include: Queueing in theatre waiting for surgery, (currently decision to delivery interval can reach 60mins,” he noted.
Commenting on the ways to achieve optimal emergency maternity care in the country, Dr Mgaya said that there is a need to improve access to all elements of emergency obstetric care and not by optimising CS only.
“They include reliable blood banking for safe blood transfusion, sufficient supply of essential drugs, ability to safely manage abortions and assist normal delivery by vacuum extractor and care of normal, sick and premature newborns,” he said.
According to him, this can be met by building capacity of regional and lower referral facility to ensure adequate obstetric care at the health facility of first contact to patients and thus reduce avoidable referrals.
Other interventions should include one to one antenatal education and counselling birth preparedness and informed decision making of mode of delivery to couples, introducing evidence based standard management guidelines of obstetric emergencies, care providers adherence to ethical conduct among others.
Commenting on the reasons behind unnecessary CS being undertaken without medical advice, Dr Mgaya noted that the practice is contrary to the ethics of medical practice which prioritise the mother over baby.
He said that unnecessary CS practices conducted under medical litigation pressure, pressure to satisfy clients and poorly setup routine health care auditing systems with blaming and over transparency have also been reported to induce fear to health care providers and hence a shift of focus from patient safety to safe guiding themselves.
Commenting on the WHO recommended rate, Dr Mgaya notes that there is no consensus regarding an optimal CS rate and CS rates, because variation between different delivery units usually depend on their obstetric populations, obstetric performance and referral system pattern.
”The WHO has recommended a community CS rate of not higher than 5 to 15 per cent . This means that CS rates lower than 5 per cent reflects in deprivation of access to CS to those in need, hence associated delivery complications,” he added.
Commenting on the matter, a resident of Dar es Salaam, Lucy Ndunga, calls upon government and other well-wishers to improve clinical maternity check-ups by providing more medical training to pregnant women to encourage them to deliver normally.
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