Surgical Deliveries in Low and Middle-Income Countries: A Review of the Surgical Capacity Literature [27L]

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Despite progress in reducing global maternal mortality, an estimated 289,000 women die each year. The World Health Organization (WHO) recommends a surgical delivery rate of 5–10%, yet for many of the world's poorest countries this is unavailable. We sought to review the growing global surgery literature to assess hospital capacity for providing surgical deliveries.


Using PRISMA guidelines, a search of the medical literature was performed to identify studies that documented surgical capacity in low and middle-income countries (LMICs). Numbers of hospitals and percentages that could perform a surgical delivery were identified. Health related country data and maternal mortality rates were obtained from the WHO and World Bank.


Data on hospital surgical capacity were identified from 35 countries. Of these countries, 23 were low-income and 12 were middle-income. Twelve countries had data on percentage of hospitals that performed surgical deliveries, and only 78.1% of the facilities are able to perform surgical deliveries.


The data on availability of surgical deliveries is not well reported in surgical capacity studies. The available data indicates slightly less than 80% of surgical hospitals provided such care. Although maternal deaths are decreasing, a large number of women and children could still be saved with increased access to surgical delivery. We recommend improving access to surgical delivery and better data reporting, better access to data, and more obstetrician involvement in capacity data collection and dissemination. In addition, adding outcomes data is an important next step to evaluating surgical care and surgical delivery in LMICs.

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