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 - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue BMC Pregnancy and Childbirth Année : 2024

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

Ana Pilar Betrán
  • Fonction : Auteur
Michael Robson
  • Fonction : Auteur
Charles Kaboré
  • Fonction : Auteur
Pisake Lumbiganon
  • Fonction : Auteur
Guillermo Carroli
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Quoc Nhu Hung Mac
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Celina Gialdini
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Newton Opiyo
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Meghan Bohren
  • Fonction : Auteur
Charles Kaboré
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Fadima Yaya Bocoum
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Simon Tiendrébéogo
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Roger Zerbo
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Dittakarn Boriboonhirunsarn
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Nampet Jampathong
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Kiattisak Kongwattanakul
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Ameporn Ratinthorn
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Olarik Musigavong
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Liana Campodonico
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Berenise Carroli
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Gabriela Garcia Camacho
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Daniel Giordano
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Hugo Gamerro
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Quoc Nhu Hung Mac
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Thao Truong
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Tran Minh Thien Ngo
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Bui Duc Toan
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Huynh Nguyen Khanh Trang
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Hoang Thi Diem Tuyet
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Claudia Hanson
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Helle Molsted-Alvesson
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Kristi Sidney Annerstedt
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Mariana Romero
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Ramon Escuriet
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Olga Canet
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Karen Zamboni
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Laurence Lombard
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Résumé

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.
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hal-04403281 , version 1 (18-01-2024)

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Camille Etcheverry, Ana Pilar Betrán, Myriam de Loenzien, Michael Robson, Charles Kaboré, et al.. 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. BMC Pregnancy and Childbirth, 2024, 24 (1), pp.67. ⟨10.1186/s12884-024-06257-w⟩. ⟨hal-04403281⟩
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