Browsing by Author "Bergstrom, Staffan"

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    Audit of severe maternal morbidity in Uganda - implications for quality of obstetric care
    (Acta Obstetricia et Gynecologica, 2006) Okong, Pius; Byamugisha, Josaphat; Mirembe, Florence; Byaruhanga, Romano; Bergstrom, Staffan
    For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. Methods. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Results. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. Conclusions. A systemic analysis found substandard care and records, and patient-related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non-threatening stimulus for improving the quality of obstetric care.
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    Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group
    (PLoS Med, 2009) Luboga, Sam; Macfarlane, Sarah B.; Schreeb, Johan von; Kruk, Margaret E.; Cherian, Meena N.; Bergstrom, Staffan; Bossyns, Paul B. M.; Denerville, Ernest; Dovlo, Delanyo; Galukande, Moses; Hsia, Renee Y.; Jayaraman, Sudha P.; Lubbock, Lindsey A.; Mock, Charles; Ozgediz, Doruk; Sekimpi, Patrick; Wladis, Andreas; Zakariah, Ahmed; Babadi Dade, Nameoua; Donkor, Peter; Kabutu Gatumbu, Jane; Hoekman, Patrick; IJsselmuiden, Carel B.; Jamison, Dean T.; Jessani, Nasreen; Jiskoot, Peter; Kakande, Ignatius; Mabweijano, Jacqueline R.; Mbembati, Naboth; McCord, Colin; Mijumbi, Cephas; Miranda, Helder de; Mkony, Charles A.; Mocumbi, Pascoal; Ndihokubwayo, Jean Bosco; Ngueumachi, Pierre; Ogbaselassie, Gebreamlak; Okitombahe, Evariste Lodi; Tidiane Toure, Cheikh; Vaz, Fernando; Zikusooka, Charlotte M.; Debas, Haile T.
    In sub-Saharan Africa, only 46% of births are attended by skilled personnel, compared to 96% in Europe (according to data for the African Region of the World Health Organization [WHO] from 2000 to 2008 [1]). In 2005, slightly over one quarter of a million women died from complications of childbirth [1]; most of these deaths could have been avoided by providing women with access to basic obstetric care and obstetric surgical care. On average, across sub- Saharan Africa, a population of 10,000 is served by two doctors and 11 nursing and midwifery personnel, compared to 32 and 79 respectively serving the same number of people in Europe (WHO data 2000–2007 [1]). A child born in sub- Saharan Africa in 2007 could expect to live only 52 years, which is 22 years less than its European counterpart [1].