Individual and institutional determinants of caesarean section in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey

BMC Pregnancy and Childbirth

Pierre Fournier⁵  Laurence Watier³  Mamadou Traore¹  Michal Abrahamowicz²  Alexandre Dumont⁴  Valérie Briand⁴ 

[1] Referral health center of the Commune V, Bamako, Mali;Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada;Université Versailles Saint Quentin, EA4499, Garches, 92380, France;UMR 216, Paris Descartes University, Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France;CRCHUM Research Centre, University of Montreal, Montreal, Canada

关键词: Epidemiology;    Africa;    Caesarean section;   

Others  :  1152084
DOI  :  10.1186/1471-2393-12-114

 received in 2012-05-18, accepted in 2012-10-20,  发布年份 2012

【 摘 要 】

Background

Two years after implementing the free-CS policy, we assessed the non-financial factors associated with caesarean section (CS) in women managed by referral hospitals in Senegal and Mali.

Methods

We conducted a cross-sectional survey nested in a cluster trial (QUARITE trial) in 41 referral hospitals in Senegal and Mali (10/01/2007–10/01/2008). Data were collected regarding women’s characteristics and on available institutional resources. Individual and institutional factors independently associated with emergency (before labour), intrapartum and elective CS were determined using a hierarchical logistic mixed model.

Results

Among 86 505 women, 14% delivered by intrapartum CS, 3% by emergency CS and 2% by elective CS. For intrapartum, emergency and elective CS, the main maternal risk factors were, respectively: previous CS, referral from another facility and suspected cephalopelvic-disproportion (adjusted Odds Ratios from 2.8 to 8.9); vaginal bleeding near full term, hypertensive disorders, previous CS and premature rupture of membranes (adjusted ORs from3.9 to 10.2); previous CS (adjusted OR=19.2 [17.2-21.6]). Access to adult and neonatal intensive care, a 24-h/day anaesthetist and number of annual deliveries per hospital were independent factors that affected CS rates according to degree of urgency. The presence of obstetricians and/or medical-anaesthetists was associated with an increased risk of elective CS (adjusted ORs [95%CI] = 4.8 [2.6-8.8] to 9.4 [5.1-17.1]).

Conclusions

We confirm the significant effect of well-known maternal risk factors affecting the mode of delivery. Available resources at the institutional level and the degree of urgency of CS should be taken into account in analysing CS rates in this context.

【 授权许可】

   
2012 Briand et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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