By far the largest part of the women and babies that die during pregnancy or childbirth die in low- and middle-income countries. A large proportion of these deaths take place in small rural hospitals. Little is known about the interventions that can improve the quality of care in these settings. This thesis consists of different studies about the differences between what has been studied before in larger hospitals and the situation in a rural hospital. In these rural hospitals, women with (pre-)eclampsia, for example, have different characteristics in these settings compared with those in high-income countries. Medication to prepare the lungs of babies in case of threatening preterm birth has no place here, in contrast to hospitals that are better equipped. In Tanzania, the surgical technique of caesarean sections is often performed with a vertical abdominal incision, while this technique has more disadvantages and an increased risk of adhesions. The best method for diagnosing an ectopic pregnancy is with ultrasound, but abdominal aspiration of blood can also be useful in rural settings. Women whose pregnancy is complicated by (pre-)eclampsia have long-term effects, such as hypertension and several physical and mental complaints. Long-term problems can affect the whole household and male partners play an important role in the period around childbirth and afterwards. These studies show that small scale, locally driven research from rural settings can add new knowledge to studies conducted in better-equipped hospitals. Medical doctors in global health and tropical health can contribute to this research.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2020|