Abstract
Objective: To measure the trends of institutional caesarean rates in Senegal and Mali and to assess if these trends were modified by the Advances in Labour and Risk Management (ALARM) international program. Methods: We conducted a secondary analysis of the QUARITE trial to examine the trends in caesarean delivery among low-risk patients in 46 hospitals which were randomized into an intervention group (n = 23) and a control group (n = 23). ALARM combined maternal death reviews and continuous medical education to improve the quality of obstetric care. Results: Between the pre-intervention period and the post-intervention period, the institutional caesarean rate among low-risk patients increased from 17.1% to 18.6% in the intervention hospitals (adjusted OR=1.03; 95% CI =0.89-1.15) and from 16.1% to 21.1% in the control arm (adjusted OR=1.47; 95% CI=1.27-1.52). The increase was significantly higher in the control group than in the intervention group, p<0.0001. Conclusion: Caesarean delivery rates increased in referral hospitals in Senegal and Mali after the free caesarean policy was implemented. Because of potential arms for mothers and newborns associated with unnecessary caesarean delivery, ALARM international program should be considered as a promising intervention to limit excessive rise of caesareans in this context.
Highlights
Caesarean rates are rising steadily worldwide, including in developing countries [1]
In sub-Saharan Africa (SSA), where population rates for caesareans are still very low, below the minimum threshold of 5% recommended by the World Health Organization (WHO) [2], there has been an increase in recent years [3,4]
The 46 hospitals included in the study were all followed to the end 49 referral hospitals
Summary
Caesarean rates are rising steadily worldwide, including in developing countries [1]. In sub-Saharan Africa (SSA), where population rates for caesareans are still very low, below the minimum threshold of 5% recommended by the World Health Organization (WHO) [2], there has been an increase in recent years [3,4]. In Senegal, caesarean rates have increased from 2.9% in 2005 to 4.7 in 2011 [3] and in Mali from 0.9% in 2005 to 2.3% in 2009 [7]. In 2007-2008, a cross-sectional survey in 41 referral hospitals in Mali and Senegal showed that institutional caesarean rates varied considerably between health care facilities. The individual and institutional determinants of caesareans explained only part of the great variation of caesarean rates between hospitals [8]
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