{
    "abstract": "Despite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).\nWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p\u22640.05 using STATA V.15.\nThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.\nOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.",
    "authors": [
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of Edwin.Ernest@jhpiego.org.",
            "firstname": "Edwin Charles",
            "initials": "EC",
            "lastname": "Ernest"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Augustino",
            "initials": "A",
            "lastname": "Hellar"
        },
        {
            "affiliation": "JHPIEGO, Baltimore, Maryland, USA.",
            "firstname": "John",
            "initials": "J",
            "lastname": "Varallo"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Leopold",
            "initials": "L",
            "lastname": "Tibyehabwa"
        },
        {
            "affiliation": "JHPIEGO, Baltimore, Maryland, USA.",
            "firstname": "Margaret Mary",
            "initials": "MM",
            "lastname": "Bertram"
        },
        {
            "affiliation": "JHPIEGO, Baltimore, Maryland, USA.",
            "firstname": "Laura",
            "initials": "L",
            "lastname": "Fitzgerald"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Adam",
            "initials": "A",
            "lastname": "Katoto"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Stella",
            "initials": "S",
            "lastname": "Mshana"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Dorcas",
            "initials": "D",
            "lastname": "Simba"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Kelvin",
            "initials": "K",
            "lastname": "Gwitaba"
        },
        {
            "affiliation": "Johns Hopkins University, Baltimore, Maryland, USA.",
            "firstname": "Rohini",
            "initials": "R",
            "lastname": "Boddu"
        },
        {
            "affiliation": "Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.",
            "firstname": "Shehnaz",
            "initials": "S",
            "lastname": "Alidina"
        },
        {
            "affiliation": "Department of Surgery, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania, United Republic of.",
            "firstname": "Geofrey",
            "initials": "G",
            "lastname": "Giiti"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania, United Republic of.",
            "firstname": "Albert",
            "initials": "A",
            "lastname": "Kihunrwa"
        },
        {
            "affiliation": "Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Belinda",
            "initials": "B",
            "lastname": "Balandya"
        },
        {
            "affiliation": "Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "David",
            "initials": "D",
            "lastname": "Urassa"
        },
        {
            "affiliation": "President Office Regional Authority and Local Government, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Yahya",
            "initials": "Y",
            "lastname": "Hussein"
        },
        {
            "affiliation": "Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Caroline",
            "initials": "C",
            "lastname": "Damien"
        },
        {
            "affiliation": "JHPIEGO, Baltimore, Maryland, USA.",
            "firstname": "Brendan",
            "initials": "B",
            "lastname": "Wackenreuter"
        },
        {
            "affiliation": "Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA.",
            "firstname": "David",
            "initials": "D",
            "lastname": "Barash"
        },
        {
            "affiliation": "The ELMA Philanthropies Services (U.S.), New York, New York, USA.",
            "firstname": "Melissa",
            "initials": "M",
            "lastname": "Morrison"
        },
        {
            "affiliation": "Assist International, Ripon, New York, USA.",
            "firstname": "Cheri",
            "initials": "C",
            "lastname": "Reynolds"
        },
        {
            "affiliation": "JHPIEGO, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Alice",
            "initials": "A",
            "lastname": "Christensen"
        },
        {
            "affiliation": "Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania, United Republic of.",
            "firstname": "Ahmed",
            "initials": "A",
            "lastname": "Makuwani"
        }
    ],
    "conclusions": "Our findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.",
    "copyrights": "\u00a9 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
    "doi": "10.1136/bmjgh-2021-006788\n10.1016/S2214-109X(19)30036-1\n10.1371/journal.pone.0214807\n10.1016/S0140-6736(18)32386-9\n10.1016/S0140-6736(15)60160-X\n10.1089/sur.2019.142\n10.17352/2455-2968.000034\n10.21203/rs.2.10745/v1\n10.1186/s13756-020-00740-7\n10.1111/tmi.12836\n10.1186/1756-0500-7-500\n10.1007/s00268-018-4767-7\n10.1037/amp0000298\n10.1136/bmjopen-2019-031800\n10.1016/j.bja.2017.08.002\n10.1097/AOG.0000000000002249\n10.5152/jtgga.2013.07\n10.3389/fmed.2018.00100\n10.1016/j.ajog.2019.04.030\n10.2307/30148464\n10.1186/s13104-015-1338-y\n10.1007/s00268-019-05292-5\n10.1186/2047-2994-3-25\n10.1016/j.jhin.2016.02.021\n10.1056/NEJMsa0810119\n10.1097/QMH.0b013e318231357c\n10.1016/j.ajic.2011.04.186\n10.1055/s-0039-3400993\n10.1111/j.1471-0528.2010.02729.x\n10.1186/s12884-015-0514-3\n10.1136/bmjoq-2020-000976\n10.1016/j.ajog.2010.01.005\n10.1001/archsurg.2010.137\n10.1002/bjs.11044",
    "journal": "BMJ global health",
    "keywords": [
        "cross-sectional survey",
        "hospital-based study",
        "intervention study"
    ],
    "methods": null,
    "publication_date": "2021-12-09",
    "pubmed_id": "34876458\n30879511\n30964909\n30929893\n25924834\n31816263\n29306587\n36424947\n32430026\n28072493\n25100042\n30128771\n29792459\n31594896\n29397122\n28885421\n24592067\n29719833\n31055033\n1334988\n26285824\n31741072\n25126415\n27125664\n19144931\n21971026\n31887748\n21159119\n25884350\n26598777\n32788171\n20207251\n20713922\n30620060",
    "results": "The SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.",
    "title": "Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.",
    "xml": "<Element 'PubmedArticle' at 0x7885066c66b0>"
}