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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Sectio Caesarea | Research

How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project

Authors: Camille Etcheverry, Ana Pilar Betrán, Myriam de Loenzien, Michael Robson, Charles Kaboré, Pisake Lumbiganon, Guillermo Carroli, Quoc Nhu Hung Mac, Celina Gialdini, Alexandre Dumont, the QUALI-DEC research group

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

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Abstract

Background

Improving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso.

Methods

A cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women’s characteristics.

Results

A total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%.

Conclusion

Our results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women’s preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care.

Trial registration

The QUALI-DEC trial is registered on the Current Controlled Trials website (https://​www.​isrctn.​com/​) under the number ISRCTN67214403.
Appendix
Available only for authorised users
Literature
1.
Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671.PubMedPubMedCentralCrossRef
2.
3.
Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–8.PubMedCrossRef
4.
5.
Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260-270.PubMedCrossRef
6.
Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016;123(5):745–53.PubMedCrossRef
7.
Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.PubMedPubMedCentralCrossRef
8.
Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41(3):237–44.PubMedCrossRef
9.
O’Leary C, De Klerk N, Keogh J, Pennell C, De Groot J, York L, et al. Trends in mode of delivery during 1984–2003: can they be explained by pregnancy and delivery complications? BJOG. 2007;114(7):855–64.PubMedCrossRef
10.
Bell JS, Campbell DM, Graham WJ, Penney GC, Ryan M, Hall MH. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. BMJ. 2001;322(7291):894–5.PubMedPubMedCentralCrossRef
11.
Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, et al. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet. 2018;392(10155):1358–68.PubMedCrossRef
12.
Boatin AA, Schlotheuber A, Betran AP, Moller AB, Barros AJD, Boerma T, et al. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries. BMJ. 2018;360:k55.PubMedPubMedCentralCrossRef
13.
Begum T, Rahman A, Nababan H, Hoque DME, Khan AF, Ali T, et al. Indications and determinants of caesarean section delivery: evidence from a population-based study in Matlab, Bangladesh. PLoS One. 2017;12(11):e0188074.PubMedPubMedCentralCrossRef
14.
15.
Tenaw Z, Kassa ZY, Kassahun G, Ayenew A. Maternal Preference, mode of delivery and associated factors among women who gave birth at public and private hospitals in Hawassa City, Southern Ethiopia. Ann Glob Health. 2019;85(1):115.PubMedPubMedCentralCrossRef
16.
Briand V, Dumont A, Abrahamowicz M, Traore M, Watier L, Fournier P. Individual and institutional determinants of caesarean section in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy Childbirth. 2012;12(1):1–8.CrossRef
17.
Vieira GO, Fernandes LG, de Oliveira NF, Silva LR, de Vieira T. Factors associated with cesarean delivery in public and private hospitals in a city of northeastern Brazil: a cross-sectional study. BMC Pregnancy Childbirth. 2015;15:132.PubMedPubMedCentralCrossRef
18.
Panda S, Begley C, Daly D. Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative and mixed methods studies. PLoS One. 2018;13(7):e0200941.PubMedPubMedCentralCrossRef
19.
Panda S, Begley C, Daly D. Clinicians’ views of factors influencing decision-making for CS for first-time mothers-a qualitative descriptive study. PLoS One. 2022;17(12):e0279403.PubMedPubMedCentralCrossRef
20.
Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: a mixed-methods systematic review. PLoS Med. 2018;15(10):e1002672.PubMedPubMedCentralCrossRef
21.
Takegata M, Smith C, Nguyen HAT, Thi HH, Thi Minh TN, Day LT, et al. Reasons for increased caesarean section rate in Vietnam: a qualitative study among Vietnamese mothers and health care professionals. Healthcare. 2020;8(1):41.PubMedPubMedCentralCrossRef
22.
Elaraby S, Altieri E, Downe S, Erdman J, Mannava S, Moncrieff G, et al. Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: a scoping review. BMJ Open. 2023;13(4):e070454.PubMedPubMedCentralCrossRef
23.
24.
Sakai-Bizmark R, Ross MG, Estevez D, Bedel LEM, Marr EH, Tsugawa Y. Evaluation of hospital cesarean delivery-related profits and rates in the United States. JAMA Netw Open. 2021;4(3):e212235.PubMedPubMedCentralCrossRef
25.
Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, et al. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ Open. 2014;4(12):e005982.PubMedPubMedCentralCrossRef
26.
Bhatia M, Banerjee K, Dixit P, Dwivedi LK. Assessment of variation in cesarean delivery rates between public and private health facilities in India from 2005 to 2016. JAMA Netw Open. 2020;3(8):e2015022.PubMedPubMedCentralCrossRef
27.
Phadungkiatwattana P, Tongsakul N. Analyzing the impact of private service on the cesarean section rate in public hospital Thailand. Arch Gynecol Obstet. 2011;284(6):1375–9.PubMedCrossRef
28.
29.
Dumont A, Betrán AP, Kaboré C, de Loenzien M, Lumbiganon P, Bohren MA, et al. Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial. Implement Sci. 2020;15(1):72.PubMedPubMedCentralCrossRef
30.
Bohren MA, Opiyo N, Kingdon C, Downe S, Betrán AP. Optimising the use of caesarean section: a generic formative research protocol for implementation preparation. Reprod Health. 2019;16(1):170.PubMedPubMedCentralCrossRef
31.
Shah A, Faundes A, Machoki M, Bataglia V, Amokrane F, Donner A, et al. Methodological considerations in implementing the WHO global survey for monitoring maternal and perinatal health. Bull World Health Organ. 2008;86(2):126–31.PubMedCrossRef
32.
Duvillier C, Rousseau A, Bouyer C, Goffinet F, Rozenberg P. [Impact of organizational factors on the cesarean delivery occurrence in a low-risk population]. Gynecol Obstet Fertil Senol. 2018;46(10–11):706–12.PubMed
33.
Lin HC, Xirasagar S. Institutional factors in cesarean delivery rates: policy and research implications. Obstet Gynecol. 2004;103(1):128–36.PubMedCrossRef
34.
Betrán AP, Gulmezoglu AM, Robson M, Merialdi M, Souza JP, Wojdyla D, et al. WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections. Reprod Health. 2009;6:18.PubMedPubMedCentralCrossRef
35.
Schantz C, Ravit M, Traoré AB, Aboubakar M, Goyet S, de Loenzien M, et al. Why are caesarean section rates so high in facilities in Mali and Benin? Sex Reprod Healthc. 2018;16:10–4.PubMedCrossRef
36.
Dorji T, Dorji P, Gyamtsho S, Tamang ST, Wangden T, Wangmo S, et al. Rates and indications of caesarean section deliveries in Bhutan 2015–2019: a national review. BMC Pregnancy Childbirth. 2021;21(1):698.PubMedPubMedCentralCrossRef
37.
Ehtisham S, Akhtar Hashmi H. Determinants of caesarean section in a tertiary hospital. J Pak Med Assoc. 2014;64(10):1175–8.PubMed
38.
Maskey S, Bajracharya M, Bhandari S. Prevalence of cesarean section and its indications in a tertiary care hospital. JNMA J Nepal Med Assoc. 2019;57(216):70–3.PubMedPubMedCentral
39.
Perrotta C, Romero M, Sguassero Y, Ingram C, Righetti N, Gialdini C, et al. Women’s mode of birth preferences and preparedness of hospitals to support vaginal birth in the public health sector in Argentina. Repro Female Child Health. 2022;1:111–21.
40.
Perrotta C, Romero M, Sguassero Y, Straw C, Gialdini C, Righetti N, et al. Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees. BMJ Open. 2022;12(1):e053419.PubMedPubMedCentralCrossRef
41.
Nuampa S, Ratinthorn A, Lumbiganon P, Rungreangkulkij S, Rujiraprasert N, Buaboon N, et al. “Because it eases my childbirth plan”: a qualitative study on factors contributing to preferences for caesarean section in Thailand. BMC Pregnancy Childbirth. 2023;23(1):280.PubMedPubMedCentralCrossRef
42.
Coates D, Thirukumar P, Spear V, Brown G, Henry A. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth. 2020;33(4):323–33.PubMedCrossRef
43.
Colomar M, Opiyo N, Kingdon C, Long Q, Nion S, Bohren MA, et al. Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences. PLoS One. 2021;16(5):1–23.CrossRef
44.
Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective cesarean section on maternal request: a systematic review. J Matern Fetal Neonatal Med. 2020;33(22):3867–72.PubMedCrossRef
45.
Valizadeh F, Heshmat F, Mohammadi S, Motaghi Z. Affecting factors of parturient women’s privacy preservation in the maternity ward: a qualitative study. J Family Reprod Health. 2021;15(3):186–95.PubMedPubMedCentral
46.
Hong X. Factors related to the high cesarean section rate and their effects on the “price transparency policy” in Beijing, China. Tohoku J Exp Med. 2007;212(3):283–98.PubMedCrossRef
47.
Shah A, Fawole B, M’imunya JM, Amokrane F, Nafiou I, Wolomby JJ, et al. Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa. Int J Gynaecol Obstet. 2009;107(3):191–7.PubMedCrossRef
48.
Banchani E, Tenkorang EY. Risk factors for caesarean sections in Ghana: evidence from the Ghana maternal health survey. J Biosoc Sci. 2022;54(1):21–38.PubMedCrossRef
49.
Yaya S, Uthman OA, Amouzou A, Bishwajit G. Disparities in caesarean section prevalence and determinants across sub-saharan Africa countries. Glob Health Res Policy. 2018;3(1):1–9.CrossRef
50.
Verma V, Vishwakarma RK, Nath DC, Khan HTA, Prakash R, Abid O. Prevalence and determinants of caesarean section in South and South-East Asian women. PLoS One. 2020;15(3):e0229906.PubMedPubMedCentralCrossRef
51.
Leone T, Padmadas SS, Matthews Z. Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries. Soc Sci Med. 2008;67(8):1236–46.PubMedCrossRef
52.
Kim SY, Park JY, Bak SE, Jang YR, Wie JH, Ko HS, et al. Effect of maternal age on emergency cesarean section. J Matern Fetal Neonatal Med. 2020;33(23):3969–76.PubMedCrossRef
53.
Taye MG, Nega F, Belay MH, Kibret S, Fentie Y, Addis WD, et al. Prevalence and factors associated with caesarean section in a comprehensive specialized hospital of Ethiopia: a cross-sectional study; 2020. Ann Med Surg. 2021;67:102520.CrossRef
54.
Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018;2018(9):CD005528.PubMedCentral
55.
World Health Organization. Companion of choice during labour and childbirth for improved quality of care. 2020.
56.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2013;7:CD003766.PubMed
57.
Metadata
Title
How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project
Authors
Camille Etcheverry
Ana Pilar Betrán
Myriam de Loenzien
Michael Robson
Charles Kaboré
Pisake Lumbiganon
Guillermo Carroli
Quoc Nhu Hung Mac
Celina Gialdini
Alexandre Dumont
the QUALI-DEC research group
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06257-w

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