Surgical Task Shifting Helps Reduce Neonatal Mortality in Ethiopia: A Retrospective Cohort Study

Abstract

Background. To improve access to surgical service and to reduce neonatal mortality Ethiopia implemented surgical task shifting to nonphysician surgeons (NPSs). We aim at assessing surgical outcomes between NPSs and physician surgeons working in two hospitals. Methods. We collected data from two hospitals on 474 maternal medical records. Completed maternal medical records were included in this study. Data were entered into Epi Info version 7 and analyzed by SPSS version 20 software. Both descriptive and inferential statistics were done. If the 95% confidence interval values exclude the null value, the factor was considered as a significant factor. Result. Totally, 3429 mothers delivered in two hospitals. Of them, 840 (24.5%) delivered by caesarian section (CS), but 474 mothers’ records meet the inclusion criteria included in this study. Of 474 CS deliveries, the majority (82%) of them were performed by NPS. Maternal or fetal emergency conditions were the main reasons (92.0%, n=436) for CS. Task shifting does not affect immediate newborn outcomes (ARR, 1.24 (0.55, 2.78)), but duration of hospitalization (ARR: 4 (2.3, 7.5)), condition of the fetus during admission (ARR: 5.22 (2.9, 9.2)), and type of anesthesia used (ARR: 0.2 (0.1, 0.4)) significantly determine the outcome. Conclusion. Surgical task shifting to NPS does not affect the immediate newborn outcome. But general anesthesia is one of the major factors that affects the outcome.