Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low- and Middle-Income Countries: A Hospital-Level Analysis of Two WHO Surveys

Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low- and Middle-Income Countries: A Hospital-Level Analysis of Two WHO Surveys

Author Zhao, Yanjun Google Scholar
Zhang, Jun Google Scholar
Zamora, Javier Google Scholar
Vogel, Joshua Peter Google Scholar
Souza, Joao P. Google Scholar
Jayaratne, Kapila Google Scholar
Ganchimeg, Togoobaatar Google Scholar
Ortiz-Panozo, Eduardo Google Scholar
Hernandez, Bernardo Google Scholar
Oladapo, Olufemi T. Google Scholar
Torloni, Maria R. Autor UNIFESP Google Scholar
Morisaki, Naho Google Scholar
Mori, Rintaro Google Scholar
Pileggi-Castro, Cynthia Google Scholar
Tuncalp, Oezge Google Scholar
Shen, Xiaoming Google Scholar
Betran, Ana Pilar Google Scholar
Abstract Background: Maternal and neonatal outcomes have improved substantially. During the same period, the caesarean delivery rate soared. The aim of this analysis was to determine whether an increase in caesarean rate was associated with an improvement in perinatal outcome at an institutional level in low- and middle-income countries. Methods: The WHO Global Survey on Maternal and Perinatal Health (WHOGS) and the WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS) were two multi-country, facility-based, cross-sectional surveys conducted in 2004-08 and 2010-11, respectively. The increase in caesarean rate and the change of prevalence of adverse perinatal outcomes were calculated using a two-point estimator of percent change annualized (PCA) method. Maternal, perinatal, and neonatal composite indexes were used as the outcomes. A linear mixed model was used to assess the association between the change of caesarean rate and the change of perinatal outcome. Results: A total of 259 facilities in 20 countries participated in both surveys, with 217 844 women in WHOGS and 227 734 women in WHOMCS. The caesarean rate in these facilities increased, on average, by 4.0% annually, while the prevalence of adverse perinatal outcomes decreased by 4.6% annually. However, after adjustments for potential confounders, no association was found between the increase in caesarean rate and the change of adverse outcome indexes, regardless of whether starting caesarean rates were already high (above 10%) or not. Conclusions: In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not.
Keywords caesarean delivery
perinatal
adverse outcomes
low and middle income countries
xmlui.dri2xhtml.METS-1.0.item-coverage Hoboken
Language English
Sponsor World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
National Natural Science Foundation of China
Grant number UNDP.UNFPA.UNICEF.WHO. World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
National Natural Science Foundation of China: 81273091
Date 2017
Published in Paediatric And Perinatal Epidemiology. Hoboken, v. 31, n. 4, p. 251-262, 2017.
ISSN 0269-5022 (Sherpa/Romeo, impact factor)
Publisher Wiley
Extent 251-262
Origin http://dx.doi.org/10.1111/ppe.12363
Access rights ACESSO RESTRITO
Type Article
Web of Science ID WOS:000405827300001
URI https://repositorio.unifesp.br/handle/11600/53575

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