Meeting the need for emergency obstetric care in Mozambique:: work performance and histories of medical doctors and assistant medical officers trained for surgery
Meeting the need for emergency obstetric care in Mozambique:: work performance and histories of medical doctors and assistant medical officers trained for surgery
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DOI：
10.1111/j.1471-0528.2007.01489.x
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发表时间：
2007-12-01
影响因子：
5.8
通讯作者：
Bergstroem, S.
中科院分区：
文献类型：
--
作者：
Pereira, C.;Cumbi, A.;Bergstroem, S.
目的 莫桑比克的非医师人员进行大手术已有20多年，有记录的手术结果与专科医生相当。本研究的目的是对所有政府医院进行清查，以记录“外科技术员”（TCs）所做的产科手术，并阐明他们在地区层面的留任情况。
设计 2002年手术操作的横断面研究；对1987年、1988年和1996年毕业的外科技术员和医生的纵向研究。
地点 莫桑比克所有34家设有手术室的医院。
人群 检查了12178例重大产科手术记录，并对59名医务官员和34名外科技术员进行了访谈。
方法 分析2002年莫桑比克所有政府农村、省级、综合及中心医院的所有手术登记册。追踪并访谈在特定年份毕业的外科技术员和医生；查阅卫生部记录以确认任职情况。
主要观察指标 外科技术员进行的重大产科手术的比例。毕业7年后仍在农村/地区层面的外科技术员和医生的比例。
结果 在审查的12178例手术中，57%的重大产科手术由非医师人员进行。在地区医院，他们进行了3246例手术中的92%。外科技术员和医生在地区医院层面的留任情况差异显著：7年后，88%的外科技术员仍在职，而医生无一人留任。
结论 在莫桑比克，接受过外科培训的非医师人员进行了大部分急诊产科手术，且几乎所有地区医院的此类手术均由他们完成。与医师相比，非医师在农村地区留任时间更长。7年后，约90%的非医师仍在地区医院工作，而几乎没有医师留在那里。
Objective Nonphysicians in Mozambique have been performing major surgery for more than 20 years, with documented outcomes equivalent to those of specialists. The purpose of this study was to make an inventory of all government hospitals so as to document obstetric surgery performed by 'tecnicos de cirurgia' (TCs) and to elucidate their retention at district level.Design Cross-sectional study of surgical procedures during 2002; longitudinal study of TCs and doctors graduating in 1987, 1988 and 1996.Setting All 34 hospitals with an operating theatre in Mozambique.Population Records of 12 178 major surgical obstetric operations were examined, and 59 medical officers and 34 TCs were interviewed.Methods Analysis of all surgical registers during 2002 in all government rural, provincial, general and central hospitals in Mozambique. TCs and doctors who had graduated in the specified years were traced and interviewed; health ministry records were reviewed to confirm assignments.Main outcome measures Proportion of major obstetric surgeries performed by TCs. Proportion of TCs and medical doctors still at rural/district level at 7 years after graduation.Results Major obstetric surgery is conducted by nonphysicians in 57% of the 12 178 operations scrutinised. In district hospitals, they conducted 92% of 3246 operations. Retention of TCs and medical doctors at district hospital level differed markedly: after 7 years, 88% of the TCs remained in post compared with none of the medical doctors.Conclusion Nonphysicians, trained in surgery, do most of the emergency obstetric surgery in Mozambique, and almost all of that performed in district hospitals. Nonphysicians, compared with physicians, stay longer in rural areas. After 7 years, around 90% of nonphysicians are still working in district hospitals, while almost no physicians remain there.