Abstract
BackgroundCesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR).Methods and FindingsThis study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic.ConclusionsQuestions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted.
Highlights
Cesarean section rates are rising in many low- and middleincome countries
Questions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires
In the Dominican Republic, 2,949 women were delivered by cesarean section during the study, of which 52% (1531 women) were interviewed before hospital discharge and included in the analysis
Summary
Cesarean section rates are rising in many low- and middleincome countries. Even in a low-income country like Bangladesh, recent data show the cesarean section rate increased from 3% to 12% between 2001 and 2010 [3]. Extreme socioeconomic disparities in access to cesarean section exist within low-income countries as well. Women in the wealthiest households often have rates above 20%, whereas among the poorest households in many countries, cesarean section rates are less than one percent [4]. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR)
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