Yanjun Zhao1,2, Jun Zhang1, Javier Zamora3,4, Joshua Peter Vogel5, João P Souza6, Kapila Jayaratne7, Togoobaatar Ganchimeg8, Eduardo Ortiz-Panozo9, Bernardo Hernandez10, Olufemi T Oladapo5, Maria R Torloni11, Naho Morisaki12, Rintaro Mori13, Cynthia Pileggi-Castro14, Özge Tunçalp5, Xiaoming Shen1, Ana Pilar Betrán5. 1. MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China. 3. Clinical Biostatistics Unit, Hospital Ramon y Cajal, CIBER Epidemiology and Public Health, Madrid, Spain. 4. Women Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University, London, UK. 5. UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. 6. Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. 7. Family Health Bureau, Ministry of Health, Colombo, Sri Lanka. 8. Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 9. Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. 10. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 11. Evidence Based Health Care Post Graduate Program, Department of Medicine, Sao Paulo Federal University, Sao Paulo, Brazil. 12. Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan. 13. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. 14. Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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.
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.
Authors: Naho Morisaki; Xun Zhang; Togoobaatar Ganchimeg; Joshua P Vogel; Joo Paulo Dias Souza; Jose G Cecatti; Maria Regina Torloni; Erika Ota; Rintaro Mori; Suneeta Mittal; Suzanne Tough; Siobhan Dolan; Michael S Kramer Journal: BMJ Glob Health Date: 2017-05-18
Authors: Mercedes Colomar; Franco Gonzalez Mora; Ana Pilar Betran; Newton Opiyo; Meghan A Bohren; Maria Regina Torloni; Monica Siaulys Journal: BMJ Open Date: 2021-12-16 Impact factor: 2.692