Research

Safe caesarean sections in South Africa: Is internship training sufficient?

L Temlett, D G Bishop, N Moran

Abstract


Background. In Africa, the maternal mortality rate after caesarean section (CS) is 50 times higher than that in high-income countries. In South Africa (SA), women who undergo CS have a three times higher mortality rate than those who deliver vaginally. Anaesthetic complications and obstetric haemorrhage are major drivers of poor outcomes, and the case fatality rate for CS at district hospitals is particularly high.
Objectives. To assess the adequacy of anaesthetic and obstetric internship training in preparing interns to perform CS independently and safely. Methods. This was an observational cross-sectional survey of all community service officers (CSOs) in KwaZulu-Natal (KZN), SA, in 2020. Data were collected via an electronic survey that comprised 68 questions in 4 domains, covering personal information, obstetric surgical training, obstetric anaesthetic training and support received as a CSO.

Results. Surveys were sent to 228 CSOs in KZN, with 160 responses received (70% response rate). Respondents included participants from 8 medical schools and 33 internship facilities across the country. One in 8 interns (n=21/160) did not perform the required 10 CSs. Supervision in theatre was provided by an obstetric specialist for at least 1 CS in n=57/160 (35.62%; 95% confidence interval (CI) 28.54 - 43.39) participants, and n=45/160 (28.13%; 95% CI 21.66 - 35.64) interns never performed an emergency CS. Interns had limited opportunity to be the primary surgeon for complicated cases. Only 1/5 interns performed >5 obstetric general anaesthetics.

Conclusions. This survey showed that there are deficiencies in the current CS-related training of interns in SA. A lack of exposure to adequate obstetric surgical training and obstetric general anaesthesia is likely to impact on the performance of CSOs and on the safety of the CS service provided at district hospitals. The content and quality of the CS-related intern training programme needs to be enhanced to improve the competence of CSOs. The Health Professions Council of South Africa (HPCSA)’s stipulations for internship training must be adhered to and should look to include simulation training, basic surgical skills courses and prioritisation of exposure to complicated surgical scenarios.


Authors' affiliations

L Temlett, Department of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

D G Bishop, Department of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

N Moran, KwaZulu-Natal Department of Health; Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Full Text

PDF (204KB)

Cite this article

South African Journal of Obstetrics and Gynaecology 2022;28(1):4. DOI:10.7196/sajog.1647

Article History

Date submitted: 2022-05-11
Date published: 2022-05-12

Article Views

Abstract views: 1971
Full text views: 1724

Comments on this article

*Read our policy for posting comments here


The South African Medical Association is the official publisher of the SAJOG.

                                                           

                                        SOUTH AFRICAN MEDICAL ASSOCIATION

                                                         Events | Careers | CPD

 

The South African Journal of Obstetrics and Gynaecology| Online ISSN: 2305-8862 | Print ISSN: 0038-2329 | 

Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0) | 

This journal is protected by a Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0) | Read our privacy policy.

SAMA Journals: South African Medical Journal African Journal of Health Professions Education South African Journal of Bioethics and Law South African Journal of Child Health | Southern African Journal of Critical Care  | South African Journal of Obstetrics and Gynaecology | Undergraduate Research in Health African Journal of Thoracic and Critical Care Medicine  | Southern African Journal of Public Health