How do low-birthweight neonates fare 2 years after discharge from a low-technology neonatal care unit in a rural district hospital in Burundi?

OBJECTIVES: As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children. METHODS: Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012. RESULTS: Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02). CONCLUSIONS: Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.

Emergency obstetric care in a rural district of Burundi: What are the surgical needs?

OBJECTIVES: In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. METHODS: A retrospective analysis of EmOC data (2011 and 2012). RESULTS: A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by 'general practitioners with surgical skills' and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. CONCLUSION: Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.

Caesarean sections in rural Burundi: how well are mothers doing two years on?

SETTING: A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death. OBJECTIVES: Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes. METHODS: A household survey among women who underwent C-sections. RESULTS: Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths. CONCLUSIONS: Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.

Contexte : Une césarienne est une intervention d'urgence destinée à sauver une vie. Eviter une nouvelle grossesse pendant au moins 24 mois après une césarienne est important afin de prévenir une rupture utérine et un décès maternel.Objectifs : Deux ans après une césarienne en urgence, dans le Burundi rural, nous avons évalué : les complications et les décès maternels pendant la période post-natale ; la couverture de la planification familiale et son adhérence ; les grossesses suivantes et leur devenir pour la mère et le nouveau-né.Méthodes : Enquête à domicile auprès de femmes qui ont bénéficié d'une césarienne.Résultat : Sur 156 femmes qui ont bénéficié d'une césarienne, 116 (74%) ont pu être retrouvées ; 1 était décédée du choléra, 8 avaient déménagé et 31 n'ont pas pu être localisées. Sur les 116 femmes retrouvées, il n'y a eu aucune complication post-opératoire et aucun décès. Lors de leur sortie de l'hôpital, 83 (72%) femmes ont accepté une contraception. A 24 mois après leur sortie (n = 116), 23 (20%) avaient accouché et 17 (15%) étaient enceintes. Sur les 76 femmes restantes, 48 (63%) n'avaient pas de contraception. Les motifs principaux étaient la religion ou le désaccord du mari. Parmi les 23 qui avaient accouché, il y a eu une rupture utérine, aucun décès maternel, mais il y a eu trois mort-nés.Conclusion : En dépit de résultats encourageants pour les mères, cette étude pose la question de l'efficacité des approches actuelles de la promotion et de la pérennité de la planification familiale pendant un minimum de 24 mois. Il est urgent de trouver des manières innovantes de promouvoir la planification familiale dans ce groupe vulnérable.

Marco de referencia: La cesárea es una intervención de urgencia que salva vidas. Es importante evitar un embarazo por lo menos durante los 24 meses que siguen a la operación, con el fin de evitar la ruptura uterina y la mortalidad materna.Objetivos: El seguimiento durante 2 años después de una cesárea de urgencia en una zona rural de Burundi tuvo por objeto evaluar las complicaciones y la mortalidad materna durante el período posnatal, la aceptación y el cumplimiento del método de anticoncepción y examinar los siguientes embarazos con su desenlace materno y neonatal.Método: Se llevó a cabo una encuesta domiciliaria de las mujeres en quienes se había practicado una cesárea.Resultados: Se evaluaron 116 de las 156 mujeres (74%) que se sometieron a una cesárea; una paciente falleció por cólera, 8 migraron y fue imposible localizar 31 mujeres. Durante el seguimiento de las 116 mujeres no se observaron complicaciones postoperatorias ni defunciones. En el momento del alta hospitalaria, 83 mujeres aceptaron practicar un método anticonceptivo (72%). Veinticuatro meses después del alta hospitalaria, 23 mujeres habían tenido un parto (20%) y 17 estaban embarazadas (15%). De las 76 mujeres restantes, 48 no seguían ningún método de planificación familiar (63%); las principales razones aducidas fueron religiosas o el desacuerdo del cónyuge. En los 23 casos de mujeres que tuvieron un parto, ocurrió una ruptura uterina sin mortalidad materna, pero hubo tres mortinatos.Conclusión: Pese a la buena perspectiva de los desenlaces maternos favorables, el estudio pone de manifiesto inquietudes con respecto a la eficacia de las estrategias vigentes de promoción y mantenimiento de los métodos anticonceptivos durante un mínimo de 24 meses. Se precisan con urgencia estrategias innovadoras que estimulen la planificación familiar en este grupo vulnerable de mujeres.