Dataset Information

Health system factors and caesarean sections in Kosovo: a cross-sectional study.

ABSTRACT:

Objective

To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo.

Design

Cross-sectional survey.

Setting

Five largest public hospitals in Kosovo.

Participants

859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo.

Outcome measures

The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital.

Results

Women with personal monthly income had increased odds for caesarean (OR 1.55, 95%?CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95%?CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95%?CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95%?CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95%?CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95%?CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95%?CI 0.24 to 0.90).

Conclusions

We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.

SUBMITTER: Hoxha I

PROVIDER: S-EPMC6500236 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Health system factors and caesarean sections in Kosovo: a cross-sectional study.

Hoxha Ilir I Fejza Alban A Aliu Mrika M Jüni Peter P Goodman David C DC

BMJ open 20190411 4

<h4>Objective</h4>To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo.<h4>Design</h4>Cross-sectional survey.<h4>Setting</h4>Five largest public hospitals in Kosovo.<h4>Participants</h4>859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo.<h4>Outcome measures</h4>The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by h ...[more]

PMID: 30975683

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Project description:OBJECTIVE:To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. DESIGN:Cross-sectional study. SETTING:Two public and two private hospitals in Argentina. POPULATION:Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. METHODS:Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. MAIN OUTCOME MEASURES:Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. RESULTS:168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19-18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. CONCLUSIONS:Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. TWEETABLE ABSTRACT:Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.

Project description:Background Global caesarean section (CS) rates have raised concern of a potential overuse of the procedure in both high- and low-resource settings. We sought to assess management and outcomes of deliveries with emergency CSs due to fetal distress and prolonged labor at 12 public hospitals in Nepal and determine factors associated with suboptimal CS indications. Methods We conducted a cross-sectional study on all deliveries between the 14th of April 2017 and the 17th of October 2018 at 12 public hospitals in Nepal and included all emergency CSs due to fetal distress and prolonged labor. Analysis was conducted using Pearson chi-square test and bivariate and multivariate logistic regression. Results The total cohort included 104,322 deliveries of which 18,964 (18%) were CSs (13,095 [13%] emergency CSs and 5230 [5.0%] elective CSs). We identified 1806 emergency CSs due to fetal distress and 1322 emergency CSs due to prolonged labor. Among CSs due to fetal distress, only 36% had fetal heart rate monitoring performed according to protocol, and among CSs due to prolonged labor, the partograph was completely filled in only 8.6%. Gestational age?<?37 weeks and birth weight?<?2500 g were associated with more suboptimal CS indications due to fetal distress (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.1–1.8 and aOR 1.7, 95% CI 1.3–2.2 respectively) than those with gestational age?>?37 weeks and birth weight?>?2500 g. We found no association between suboptimal CS indications and maternal ethnicity or education level. Conclusions As fetal heart rate monitoring and partograph are fundamental to diagnose fetal distress and prolonged labor, the inappropriate monitoring proceeding CS decisions disclosed in our study indicate that CSs were performed on suboptimal indications. We call for improved quality of intrapartum monitoring, enhanced documentation in medical records, and structured auditing of CS indications in order to curb the potentially harmful CS trend.

Dataset Information

Health system factors and caesarean sections in Kosovo: a cross-sectional study.

Objective

Design

Setting

Participants

Outcome measures

Results

Conclusions

Publications

Health system factors and caesarean sections in Kosovo: a cross-sectional study.

Similar Datasets

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