Loading

Medical Journal of Obstetrics and Gynecology

Indications and linked complications of Caesarean Delivery in Durame General Hospital: A Three Year Retrospective Study in Southern Ethiopia

Research Article | Open Access Volume 9 | Issue 2 |

  • 1. Lecturer at Jimma University, Ethiopia
  • 2. General practitioner at Jimma University, Ethiopia
  • 3. PhD Fellow at Jimma University, Ethiopia
+ Show More - Show Less
Corresponding Authors
Daniel Geleta, PhD Fellow, Jimma University, Oromia, Jimma, Ethiopia, Tel: 125(0)911723400;
Abstract

Background: Cesarean section, the most frequent abdominal surgery among adults, is rapidly growing and currently occurs in 20 million of deliveries worldwide each year. The indications and complications of cesarean section are unevenly distributed and unpredictably change. Therefore, this study aims to identify the contemporary cesarean section indications and complications among mothers and their newborns in Durame General Hospital.

Methods: A three year retrospective cross-sectional study was conducted by reviewing maternity data at Durame General Hospital from July 1, 2015, to July 1, 2017. The data were obtained from records of mothers who underwent caesarian-section during the specified period. A total of 255 samples were estimated using a single proportion formula and randomly selected using a serial number of the registration log. Data were abstracted using a semi structured and pretested questionnaire. The collected data were entered into Epi info software and transported to SPSS software version 22 for analysis, and finally, the descriptive outcomes of the study were displayed by figures, tables & graphs.

Result: The study has enrolled a total of 255 study participants whose mean age was 26.87 (SD ± 6.3) years. Cephalo-pelvic disproportion was the leading indication for cesarean-section (40.0%), followed by fetal distress (29.9%) and Mal-presentation (17.2%). After cesarean delivery, 16.1% of neonates and 6.7% of mothers were reported to suffer complications. The most complication of the neonates and mothers in the area were Birth Asphyxia (6.3%), and wound infection (2.7%), respectively.1.4. Conclusion and recommendations

The incidence of caesarian delivery was higher in this hospital particularly for CPD leading to either maternal or newborn complications. Therefore, health care service providers jointly with the community & government should work to recognize the status of pregnancy at the early stage of labor to anticipate problems early.

Citation

Berhanu H, Ayele M, Geleta D (2021) Indications and linked complications of Caesarean Delivery in Durame General Hospital: A Three Year Retrospective Study in Southern Ethiopia. Med J Obstet Gynecol 9(2): 1148.

Keywords

•    Cesarean-delivery
•    Complication
•    Indication

INTRODUCTION

Cesarean section (CS), is the most frequent abdominal surgery performed every year among adults, occurring currently in about 20 million deliveries worldwide [1]. Numerous women undergo this operation and the condition that exposes them to the procedure is rapidly growing in a continuous way in both developed and developing countries [2]. The procedure has started as a routine procedure following the growth of hospitals and increased urbanization though the concerns of women about the operation have been rising globally regardless of medical condition, age, race, or gestational age [3]. International concerns over such increases has prompted the World Health Organization (WHO) to suggest that CS rates should not exceed 15 % [4], as evidences from different sources indicate raising the rate of CS above cut-off point would not reduce both maternal & child mortality and mortality [4,5].

Literatures report many factors to attribute to the increased cesarean-section rates across the world. Accordingly, Premature Rupture of the amniotic fluid Membrane (PROM), Cephalic Pelvic Disproportion (CPD), fetal distress, multiple pregnancy, and mal-presentation were identified as some of the factors [6]. CS has both short and long-term risk that range from mild to severe [7,8]. Furthermore, literatures showed that infants born with CS are more likely to develop respiratory distress compared to those born with normal delivery [9,10].

Even though CS was indicated to reduce pregnancy and related material and neonatal morbidity & mortality, it has some scientific proven indications. In this regard, reports from different studies in different countries including karpagavineyaga and India showed the commonest indications to be repeat c/s (43%), CPD (15%), failed labor (10%), repeat C/S (32.4%), fetal distress (7%), and maternal morbidity (20%) [11-13], where the overall indication for maternal and neonatal fall to be 68 & 32 percent in respective order [14].

During the process of delivery of CS, the mother, newborns or both could experience risks that commonly named complications [13]. The commonest complications experienced as reported by different studies were primary hemorrhage, wound infection, intraoperative and postoperative maternal deaths [11,14-17]. The dynamics of CS indications and complications frequently changes based on several reasons. Therefore, the current study aimed to address the statuses of these factors in the specified area and time.

METHODS AND MATERIALS

A three year retrospective cross-sectional study was conducted by reviewing maternity data at Durame General Hospital situated in Southern Ethiopia from July 1, 2015, to July 1, 2017. The study population comprised the records of all women who gave birth, and the data obtained from records of mothers who underwent caesarian-section during the specified period. A total of 255 sample sizes was calculated using a single proportion formula assuming 21% CS prevalence in the study area [18], that randomly selected using a serial number of records. The records of all mothers who had undergone caesarian section during the study period and fulfilled the inclusion criteria were collected from the card room, operation register log and new born registration books. During the data collection process, data with incomplete records, data related to miscarriage or termination of pregnancy before 28 weeks of gestations, regardless of their reasons, were excluded.

A semi-structured questionnaire was used for data abstraction that includes demographic data, gravidity, parity, and specific information on maternal or fetal pregnancy-related complications, gestational age at delivery, method of delivery, all primary indications for CS, newborn’s birth weight and Apgar score; and the maternal and perinatal outcomes. Primary indications for CS were divided into maternal and fetal categorical indications. Maternal indications include previous caesarean delivery, elderly primigravida, cephalo-pelvic disproportion, prolonged labor (dystocia), and maternal infection. Fetal indications included malpresentation, fetal distress, macrosomia and multiple fetuses. The questionnaire was designed by experts from research and care providers and finalized after pretest at different Hospital of similar characteristics with the study area Hospital.

Data were collected by six clinical nurses and two supervisors who were deployed from the study area and received a two days training. During the data collection a full informed consent was taken from maternity ward and record room managers. To ensure data quality, all data were checked for completeness and consistency on daily base by data collectors at spot and finally reviewed for the same issue by supervisor. The collected data were entered into Epinfosoftware and transported to SPSS software version 22 for analysis. During analysis the researchers continuously checked data for completeness & consistency, and finally the descriptive outcomes of the study was displayed by figures tables & graphs.

Ethical consideration

Before data collection an ethical clearance was obtained from Jimma university student research project office. Then formal letter of cooperation was written to Durame General Hospital maternity department and record room.

RESULTS

Socio-demographic Characteristics of Respondents

Table 1 presents the socio-demographic characteristics of 255 study participants. The mean age of the study participants was 26.87 (SD ± 6.3).While teenagers age < 20 years contributed the least proportion of the study participants 73(29%), whereas age between 21 and 40 years accounted the highest percentage to have caesarian section. Residentially, majority of the study participants 149 (58%), were from rural. Regarding antenatal follow-up 148 (58%), of the study participants had followed ANC for at least once while the rest 107 (42%), did not get follow-up service during their pregnancy time.

During the process of delivery, Sixty four (25%), of the new born babies were reported to be term while 56(22%), preterm and 89 (35%), post-term. Majority of the mothers 132(52%), had given 1-4 births while prim gravid comprises 29(24%). A large proportion of the study participants had live birth outcome 242(95%), while those encountered still birth and neonatal death were 1.5 and 3% respectively. Regarding fetal weight, 97(37.93 %), have normal fetal weight of 2500-3999 gram. low birth weight accounts 116(47.77%) and 42 (16.3%), account macorsomic (>4000 gram) (Table 1).

According to the current study, the most common C/S indication was CPD (40%), followed by fetal distress (29.88%), Ma-presentations (17.23%), failed induction (6.35%), Previous C/S (4.64%) and others (1.46%), as indicated by Figure 1. After cesarean delivery, 16.1% of neonates and 6.7% of mothers were reported to suffer complications. From the reported proportion, the most complication of the neonate and maternal were Birth Asphyxia (6.3%), and wound infection (2.7%), in respective order (Table 2).

DISCUSSION

The study has simultaneously summarized the most reasons for mothers to undergo cesarean-section and the related post-operative health problems among newborns & mothers. The majority of the operation occurred for the indications soared from the maternal side. As of the result CPD (40.44%), fetal distress (29.88%), mal-presentation (17.23%), failed induction (6.4%), previous C/S (4.6%) was identified the most common indications in the area.

The current results are not consistently overlap with the studies conducted in different countries; when compared with the study conducted in India the percentage of all identified CS indicators were reported higher by thrice for CPD (15%), and fetal distress (7%). On the other hand the result of the current study revealed 3.6% lower reason of CS due to failed induction and 27.8% lower for repeat C/S when compared with the study in India with relatively similar comparability result in Karpaga Vineyaga [11-13]. The disparity among the result could rely on different factors where socio-economic, infrastructure, availability & skill of health care providers are the prominent factors.

Regarding complications, the current results showed that both mothers and newborns suffered comparable percentages of different problems. Accordingly, wound infection, wound dehiscent, and maternal death are the commonest maternal complications. This results consistent with the study conducted in Tigray region of Ethiopia for wound infection and wound dehiscence [16], but lower than the study result in Santhanalakshmi [12]. From the newborn side, from 16.1% of all cesarean section, 6.3%, 4.7%, 3.5% & 1.6 % were suffered Birth asphyxia, neonatal sepsis, respiratory distress and Hyperbilirubinemia in the respective order. The overall neonatal complication of the current result is higher by 6.1% from the study report of Rehana [13]. The possible explanation for this could be the simplicity of supplies and medication to manage newborn complications.

Table 1: Characteristics of the study populations (N=255).

 #  Variables Categories Number %
 1 Residence Urban 106 42
Rural 149 58
 2 Age in years ≤20 73 29
21-34 110 43
>35 72 28
 3 ANC F/UP ≥ for current pregnancy Yes 148 58
No 107 42
 4 Gestational age Unknown 46 18
<37 56 22
37-42 64 25
>42 89 35
 5 Parity Primi 74 29.58
1-4 132 52
Above 4 49 18.3
 6 Birth outcome Live birth 242 95
Stillbirth  3 1.5
Neonatal death 10  3
 7 Birth weight in grams 1000-1499 47 18.62
1500-2499 69 27.15
2500-3999 97 37.93
Above 4000 42 16.3

Table 2: Complications of C/S among woman at Durame Genearal Hospital.

 # Complications Number (%) Percent (%)
Neonatal
 1 Birth asphyxia 16 6.3
 2 Neonatal Sepsis 12 4.7
 3 Respiratory distress  9 3.5
 4 Hyperbilirubinemia  4 1.6
  Total 41 16.1
Maternal
 1 Wound infection  7 2.7
 2 Wound dehiscence  6 2.4
 3 Maternal death in Hospital  4 1.6
  Total 17 6.7

 

CONCLUSION

Cesarean-section in the study area was commonly conducted as a result of indications occurring from the maternal side with much less difference from the newborn side. Similarly, postoperative complications are also distributed with nearly equal percentages for both mothers and newborns. Therefore, health care service providers jointly with community & government should work to recognize the status of pregnancy at the early stage of labor to anticipate problems early.

FINANCIAL DISCLOSURE

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

REFERENCES

1. Gutema H. Caesarean Section and Associated Factors at Mizan Aman General Hospital Southwest Ethiopia. J Gynecol Obstet. 2014; 2: 37.

2. United Nations. The fourth domain for gender equality, decision-making and power. Achieving Gender Equality, Women’s Empowerment and Strengthening Development Cooperation. 2010; 55-59.

3. Gauld R, Blank R, Burgers J, Cohen AB, Dobrow MK, Ikegami NKI, et al. The World Health report 2008 - Primary healthcare: How wide is the gap between its agenda and implementation in 12 high-income health systems? Healthc Policy. 2012; 7: 38-58.

4. Bailey P, Lobis S, Maine D, Fortney JA. Monitoring Emergency Obstetric Care: a handbook. World Health Organization. 2009; 30: 430.

5. Abebe FE, Gebeyehu AW, Kidane AN, Eyassu GA. Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: A retrospective record review. Reprod Health. 2016; 13: 1-7.

6. Yaya S, Uthman OA, Amouzou A, Bishwajit G. Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries. Glob Heal Res Policy. 2018; 3: 1-9.

7. Deneux-Tharaux C, Carmona E, Bouvier-Colle M-H, Bréart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol. 2006; 108: 541-548.

8. SciELO - Public Health - Maternal complications and cesarean section without indication_ systematic review and meta-analysis Maternal complications and cesarean section without indication_ systematic review and meta-analysis.

9. Khasawneh W, Obeidat N, Yusef D, Alsulaiman JW. The impact of cesarean section on neonatal outcomes at a university-based tertiary hospital in Jordan. BMC Pregnancy Childbirth. 2020; 20: 1-9.

10. Tzaki M. Cronicon The Impact of Elective Cesarean Section on Neonatal Morbidity. 2019; 5: 387-391.

11. Fesseha N, Getachew A, Hiluf M, Gebrehiwot Y, Bailey P. A national review of cesarean delivery in Ethiopia. Int J Gynaecol Obstet. 2011; 115: 106-111.

12. Bala S. A Retrospective Analysis of Annual Cesarean Section Rate in a Tertiary Care Hospital, KOTA. J Med Sci Clin Res. 2017; 5: 2097-2099.

13. CHANDNA H. Caesarean deliveries have become an ‘epidemic’ in India — record 300% jump in last decade – The Print.

14. Halil HM, Abdo RA, Helill SE, Kedir RD. Predictors of Cesarean Section among Women Delivered at Durame General Hospital, Southern Ethiopia. 2020; 9: 1-5.

15. Mekbeb T, Ketsela K. Pre-eclampsia/eclampsia at Yekatit 12 Hospital, Addis Ababa, Ethiopia (1987-1989). East Afr Med J. 1991; 68: 893- 899.

16. Mengesha MB, Adhanu HH, Weldegeorges DA, Assefa NE, Werid WM, Weldemariam MG, et al. Maternal and fetal outcomes of cesarean delivery and factors associated with its unfavorable management outcomes; In Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. BMC Res Notes. 2019; 12: 4-9.

17. Tenaw Z, Yohannes Z, Siyoum M, Mekonnene S, Bekele G, Astatkie A, et al. Prevalence, indications and associated factors of cesarean section delivery at public hospitals in Wolayta Zone Southern, Ethiopia. 2020; 1-13.

18. Shit S, Shifera A. Prevalence of cesarean section and associated factor among women who give birth in the last one year at Butajira General Hospital, Gurage Zone, SNNPR, Ethiopia, 2019. Int J Pregnancy Child Birth. 2020; 6: 16-21.

Berhanu H, Ayele M, Geleta D (2021) Indications and linked complications of Caesarean Delivery in Durame General Hospital: A Three Year Retrospective Study in Southern Ethiopia. Med J Obstet Gynecol 9(2): 1148.

Received : 21 Apr 2021
Accepted : 26 Jun 2021
Published : 28 Jun 2021
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X