Scientific and Technological Research
Reducing maternal mortality in conflict areas: Surgical-anesthetic experience in Boost Hospital – Afghanistan
Reduciendo la Mortalidad Materna en zonas de conflicto: Experiencia quirúrgica-anestésica en el Hospital Boost, Afganistán
Gilda Izquierdoa,
, Miguel Trellesb, Nasrullah Khanc
Corresponding author
glizquierdo@hotmail.com
Corresponding author at: 2 calle A 11-50, Pinares de San Cristóbal, Zona 8 de Mixco, 01063, Guatemala.
Corresponding author at: 2 calle A 11-50, Pinares de San Cristóbal, Zona 8 de Mixco, 01063, Guatemala.
a Doctors Without Borders – Mexico, Anesthesiologist, Gerentologist, Guatemala
b Doctors Without Borders – Brussels Operation Center, Surgical Activity Coordinator, Brussels, Belgium
c Doctors Without Borders – Afghanistan Mission, Surgery and Anesthesia Department Head, Boost Hospital, Lashkar-Gah, Helmand Province, Afghanistan
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Nevertheless, in many conflicts, the majority of surgical care is provided by non-military actors – including humanitarian organizations – that work with limited resources.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A recent study in the Democratic Republic of Congo showed that mortality from obstetric emergencies and random injuries in conflict zones were four times higher than mortality due to violence.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In many situations, the population is more vulnerable to threats such as poor hygiene, poor nutrition, contagious diseases, rape, and poor prenatal care. Obstetric emergencies contribute to mortality, and, in these cases, surgical interventions contribute in an important way to reducing deaths.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The population of Afghanistan has lived in conditions of poverty with a general lack of access to medical care, particularly secondary health care, for decades. Most Afghans must choose between poor-functioning public hospitals or costly private clinics. Furthermore, due to the lack of security in the country, people in need had to travel hundreds of kilometers through highly dangerous areas to access care.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Afganistán is a country located in the heart of Asia, part of a bloc of countries between the Indian subcontinent and the Middle East.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,5</span></a> It has a surface area of 647,947<span class="elsevierStyleHsp" style=""></span>km<span class="elsevierStyleSup">2</span> and a population of 32,358,000 inhabitants with a low human development index rating (HDI ranking 175). 24% of Afghans live in urban areas.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">When the Soviet Union was present in Afghanistan, some health infrastructure was built. Many health services – up to 80% – have been supported by non-governmental organizations, including MSF.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,9</span></a> Afghanistan has a maternal mortality rate of 460 per 1000 live births.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> In 2001, when the Taliban regime fell, Afghanistan had one of the worst health indicators in the world.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,7</span></a> The maternal mortality ratio (MMR) is an important measure of the level of maternal health and has been used to measure international development of one of the 8th Milennium Development Goal which is reducing MMR by 75% between 1990 and 2015 (ODM5). In order to achieve these goals, it is necessary to expand access to emergency obstetric care and to provide access to antibiotics, oxytocics, and anticonvulsants, blood transfusions and cesarean sections.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Afghanistan is a country with a critical lack of doctors and paramedical personnel. To resolve the problem of a lack of health workers in remote areas, the health sector supports a program of community training for midwives. In addition, community health volunteers are trained, and new health care centers are opened to improve the quality of health care of millions of people in rural areas.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> This increases the national coverage of primary health care.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Doctors Without Borders has supported the Boost Hospital since 2009. This hospital is one of the two referral hospitals in southern Afghanistan. Doctors Without Borders, also known by its French name <span class="elsevierStyleItalic">Médecins sans frontières</span> (MSF), is an international humanitarian organization that provides aid to populations affected by armed conflicts, epidemics, natural disasters, as well as those excluded from health systems, regardless of race, religion, gender, or political affiliation. MSF has provided surgical services for more than 40 years and currently runs projects in more than 70 countries.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,14,15</span></a> The team in Boost has improved the provision of medical care through several departments including maternity, pediatrics, internal medicine, surgery, and emergency care. By the end of 2011, the hospital admitted an average of 1500 patients per month. In addition, external consultations were also offered to which more than 6000 patients per month attend. Many of these travel from areas outside Lashkar-Gah.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16,17</span></a> Due to the reigning insecurity, MSF could not carry out activities involving active referrals with institutional ambulances, something which is a pilar of health care provision. Instead, it had to restrict itself to simply receiving patients that arrived by their own means to the hospital.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">This study intends to describe the surgical-anesthetic activity carried out at Boost Hospital located in the city of Lashkar-Gah in Helmando province, Afghanistan. During the period of study, these activities were supported by the NGO Doctors Without Borders (<span class="elsevierStyleItalic">Médecins sans frontières</span> – MSF).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0045" class="elsevierStylePara elsevierViewall">The Brussels Operational Center of Doctors Without Borders (MSF-BOC), one of the five operational centers worldwide, is responsible for collecting data from projects around the world. The data from all of the surgical procedures performed in the operating room are recorded using a standard form developed by MSF. This data is transcribed monthly into an electronic database. This data is then reviewed in the Brussels Operational Center.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Boost Hospital is a unit with 180 beds and is equipped with services of maternity, pediatrics, internal medicine, surgery, intensive care unit, emergency radiology, laboratory, and two operating rooms, 24<span class="elsevierStyleHsp" style=""></span>h per day. In the Boost Hospital operating rooms the following personnel is on call: head of the room, anesthetist nurse, 8 anesthetic technicians, and one expatriate anesthetesiologist.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Close to 30% of emergency cases come from outside Lashkar-Gah, sometimes from areas more than 150<span class="elsevierStyleHsp" style=""></span>km away. This suggests there is a lack of services in remote districts.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">For this study, a review of the statistical database of Boost Hospital for the period from February 11, 2010 to September 30th, 2012 was carried out. Variables of age, gender, surgical indication, and type of anesthesia were included. The surgical indications were classified as trauma (violence, accident), non-traumatic pathology (infection, ischemia, tumor, hemorrhage), or obstetric (prenatal and postnatal). Surgical procedures classified as minor included those related to wounds, visceral surgery, orthopedic surgery, gynecological/obstetric surgery, and specialized surgery.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As a retrospective review, this study complies with the ethical criteria of exoneration of the MSF review board.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Of the surgical patients, the male group predominated with 2613 patients (60.3%). The average age was 27.7 years with a range of 1–95 years. The main age group was 20–40 years. Of these, 52% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22,680) patients were classified as ASA II, and 38% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1647) were ASA I. 47.2% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2698) of patients required emergency surgery. 75% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4334) of patients underwent surgery for the first time. Of these, the causes of the intervention were trauma (T) in 44.3% of cases (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2540), 38.5% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2222) non-traumatic pathology (P), and 17% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span> 957) obstetric patients (O).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 5719 surgical procedures that were performed, 31.4% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1795) were visceral surgeries (exploratory laparotomy, hernioplasty, hemorrhoidectomy, etc.), 24.4% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1398) were wound surgeries (W: debridements, fasciotomies, finger amputations, etc.), and 19.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1122) were gyneco-obstetric surgeries (C: Cesarean sections, ectopic pregnancies, vesicovaginal fistula, hysterectomy and variants, curettage, postpartum complications and others). The average surgical time was 50<span class="elsevierStyleHsp" style=""></span>min.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In terms of the type of anesthesia, 57% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3258) used general anesthesia without intubation (GA−), 10% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>560) used general anesthesia with endotracheal intubation (GA+), 21% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1219) used spinal anesthesia (SA), and 12% used other types. The transoperatory mortality was 0.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) and 0.9% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span> 50) of patients received a blood transfusion.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the gyneco-obstetric area (G), the average age was 31.3 years, with a range of between 12 and 90 years. 848 Cesarean sections (76%) were performed. Of these, 95% were emergency C-sections (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The surgical indication was fetal or maternal. Postpartum complications were not observed. Of these patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>598), 64% were ASA II. When it comes to the type of anesthesia, spinal anesthesia (SA) was administered in 44.4% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>415) of cases, followed by general anesthesia without intubation (GA−) in 39.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>367), and general anesthesia with endotracheal intubation (GA+) in 16% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>151) of cases. Transoperatory mortality was 0.8% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">In Boost Hospital, the surgical area is primordial due to the quantity of procedures performed. No statistical references are available to carry out a comparative analysis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">This hospital is supported by the NGO Doctors Without Borders. With the application of rigorous standards of health and minimal requirements for surgical activities, including infrastructure, medical team, and medical material, as well as strict adherence to policies, directives, and institutional therapeutic protocols, this organization has contributed to improved health among the Afghan population by achieving a transoperatory mortality rate of 1%.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> At the same time, after having performed 848 Cesareans and 58 interventions due to complications in the postpartum period, Boost Hospital helped, in this period, to directly reduce maternal mortality in this region. The hospital continues to offer this support at the present time.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors received no sponsorship to produce this article.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres599816" "titulo" => "Keywords" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec614157" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres599817" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec614158" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-17" "fechaAceptado" => "2015-11-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec614157" "palabras" => array:5 [ 0 => "Maternal mortality" 1 => "Armed conflicts" 2 => "Afghanistan" 3 => "Cesarean section" 4 => "Anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec614158" "palabras" => array:5 [ 0 => "Mortalidad materna" 1 => "Conflictos armados" 2 => "Afganistán" 3 => "Cesárea" 4 => "Anestesia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Keywords" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Helmand province, whose capital is Lashkar-Gah, is one of the most volatile provinces affected by the conflict in Afghanistan. Doctors without Borders began to work in Boost Hospital in 2009.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of surgical procedures at the Doctors without Borders Operational Center in Brussels, February 11, 2010 to September 30, 2012.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">5719 surgeries were performed on 4334 patients. 47% were emergency interventions and 75% were first interventions. 39.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1721) of patients were female. In the Gyneco-obstetric (G) area, the average age was 31.3 years. 848 Cesarean operations (76%) were performed and 95% of these were urgent. Of these patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>598) 64% were at ASA II. Spinal anesthesia (SA) was administered in 44.4% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>415) of patients, followed by general anesthesia without intubation (GA−) in 39.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>367). In 16% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>151), general anesthesia was administered with endotracheal intubation (GA+). Transoperatory mortality was 0.8% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Boost Hospital offers a surgical service of relevance in the south of Afghanistan. This hospital is supported by Doctors without Borders (MSF) and has helped to reduce the maternal mortality in that region through the provision of quality care in obstetric emergencies. By applying health standards, and medical teams and material, MSF has helped the Afghan population, particularly gestating mothers, to improve its health while achieving a transoperatory mortality in Cesareans of <1%.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Helmand cuya capital es Lashkar-Gah es una de las provincias más volátiles entre las más afectadas por conflictos en Afganistán. Médicos sin Fronteras empezó a trabajar en el Hospital Boost en 2009.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisión retrospectiva de procedimientos quirúrgicos en Médicos sin Fronteras-Centro Operacional de Bruselas del 11 de febrero de 2010 al 30 de septiembre de 2012.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 5719 cirugías a 4334 pacientes, siendo de urgencia un 47% y primera intervención un 75%. 39.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1721) de pacientes fueron de género femenino. En relación al área Gineco-obstétrica (G), la edad media fue de 31.3 años. Se realizaron 848 cesáreas (76%) de las cuales el 95% fueron urgentes. De estas pacientes (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>598) el 64% era ASA II. En cuanto al tipo de anestesia, se administró Anestesia espinal (SA) en un 44.4% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>415), seguido de anestesia general sin intubación (GA−) en un 39.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>367), y en un 16% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>151) se administró anestesia general con intubación endotraqueal (GA+); con una mortalidad transoperatoria de 0.8% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El Hospital Boost brinda un servicio quirúrgico de relevancia en el sur de Afganistán. Dicho hospital es apoyado por Médicos sin Fronteras (MSF), lo cual ha ayudado a reducir la mortalidad materna en esa región con la provisión de asistencia de calidad en emergencias obstétricas. Con la aplicación de estándares de salud, equipo, y material médico, MSF ha logrado que la población afgana, y particularmente las gestantes, mejore su salud, logrando una mortalidad transoperatoria de intervenciones por Cesáreas de < 1%.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Izquierdo G, Trelles M, Khan N. Reduciendo la Mortalidad Materna en zonas de conflicto: Experiencia quirúrgica-anestésica en el Hospital Boost, Afganistán. Rev Colomb Anestesiol. 2016;44:13–16.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Procedures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C: Cesarean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">847 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EP: Ectopic pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VF: Vesicovaginal fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HV: Hysterectomy and variants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">U: Urology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCA: Placenta<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>curettage<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>abortion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O: Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab981245.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">List of gyneco-obstetric procedures performed in Boost Hospital, 2010–2012.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of anesthesia \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General anesthesia without intubation (GA−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">367 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General anesthesia with intubation (GA+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Local anesthesia (LA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spinal anesthesia (SA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">415 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">935 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab981246.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">List of anesthetic procedures in gyneco-obstetric surgeries, Boost Hospital, 2010–2012.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rethinking surgical care in conflict" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 9 | 1 | 10 |
| 2024 September | 8 | 6 | 14 |
| 2024 August | 11 | 2 | 13 |
| 2024 July | 5 | 4 | 9 |
| 2024 June | 10 | 2 | 12 |
| 2024 May | 6 | 3 | 9 |
| 2024 April | 11 | 7 | 18 |
| 2024 March | 20 | 1 | 21 |
| 2024 February | 14 | 7 | 21 |
| 2024 January | 13 | 8 | 21 |
| 2023 December | 17 | 8 | 25 |
| 2023 November | 17 | 5 | 22 |
| 2023 October | 16 | 11 | 27 |
| 2023 September | 19 | 6 | 25 |
| 2023 August | 9 | 3 | 12 |
| 2023 July | 13 | 3 | 16 |
| 2023 June | 5 | 3 | 8 |
| 2023 May | 14 | 4 | 18 |
| 2023 April | 8 | 2 | 10 |
| 2023 March | 12 | 0 | 12 |
| 2023 February | 13 | 8 | 21 |
| 2023 January | 11 | 2 | 13 |
| 2022 December | 36 | 5 | 41 |
| 2022 November | 38 | 11 | 49 |
| 2022 October | 87 | 5 | 92 |
| 2022 September | 17 | 10 | 27 |
| 2022 August | 10 | 4 | 14 |
| 2022 July | 12 | 9 | 21 |
| 2022 June | 19 | 4 | 23 |
| 2022 May | 9 | 5 | 14 |
| 2022 April | 8 | 7 | 15 |
| 2022 March | 16 | 6 | 22 |
| 2022 February | 12 | 4 | 16 |
| 2022 January | 14 | 7 | 21 |
| 2021 December | 14 | 10 | 24 |
| 2021 November | 17 | 8 | 25 |
| 2021 October | 11 | 16 | 27 |
| 2021 September | 9 | 7 | 16 |
| 2021 August | 16 | 7 | 23 |
| 2021 July | 8 | 5 | 13 |
| 2021 June | 15 | 7 | 22 |
| 2021 May | 18 | 6 | 24 |
| 2021 April | 20 | 27 | 47 |
| 2021 March | 18 | 7 | 25 |
| 2021 February | 9 | 6 | 15 |
| 2021 January | 10 | 6 | 16 |
| 2020 December | 11 | 6 | 17 |
| 2020 November | 13 | 5 | 18 |
| 2020 October | 7 | 5 | 12 |
| 2020 September | 7 | 6 | 13 |
| 2020 August | 13 | 12 | 25 |
| 2020 July | 10 | 8 | 18 |
| 2020 June | 8 | 1 | 9 |
| 2020 May | 7 | 4 | 11 |
| 2020 April | 5 | 3 | 8 |
| 2020 March | 5 | 1 | 6 |
| 2020 February | 7 | 3 | 10 |
| 2020 January | 6 | 2 | 8 |
| 2019 December | 9 | 6 | 15 |
| 2019 November | 6 | 2 | 8 |
| 2019 October | 5 | 3 | 8 |
| 2019 September | 2 | 0 | 2 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 1 | 5 | 6 |
| 2019 June | 2 | 7 | 9 |
| 2019 May | 1 | 18 | 19 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 1 | 4 | 5 |
| 2018 May | 15 | 7 | 22 |
| 2018 April | 33 | 8 | 41 |
| 2018 March | 16 | 10 | 26 |
| 2018 February | 13 | 5 | 18 |
| 2018 January | 21 | 6 | 27 |
| 2017 December | 13 | 7 | 20 |
| 2017 November | 9 | 6 | 15 |
| 2017 October | 18 | 4 | 22 |
| 2017 September | 13 | 4 | 17 |
| 2017 August | 7 | 8 | 15 |
| 2017 July | 17 | 3 | 20 |
| 2017 June | 19 | 8 | 27 |
| 2017 May | 24 | 9 | 33 |
| 2017 April | 29 | 19 | 48 |
| 2017 March | 13 | 7 | 20 |
| 2017 February | 9 | 12 | 21 |
| 2017 January | 18 | 6 | 24 |
| 2016 December | 23 | 12 | 35 |
| 2016 November | 20 | 9 | 29 |
| 2016 October | 25 | 13 | 38 |
| 2016 September | 21 | 10 | 31 |
| 2016 August | 31 | 14 | 45 |
| 2016 July | 12 | 7 | 19 |
| 2016 May | 2 | 0 | 2 |
| 2016 April | 0 | 21 | 21 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 3 | 26 | 29 |
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