Analysis of caesarean section practices and consequences in Goma, DR Congo: Frequency, indications, maternal and perinatal morbidity and mortality

Michel, Dikete Ekanga; Mitangala, Prudence; Coppieters, Yves; Kirkpatrick, Christine; Kabuseya, Richard; Simon, Philippe; Englert, Yvon; Racapé, Judith; Zang, Wei-Hong

doi:10.17352/2455-5479.000060

Cited by 5 publications

(17 citation statements)

References 29 publications

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“…The emergency CS rate in both groups is as high as the rates given in the literature for the DRC and other regions in developing countries, which report emergency CS rates ranging from 58% to 98%. Some reasons for these high CS rates include the absence of quality antenatal care which can prophylactically detect and refer high-risk pregnancies toward specialist facilities, the dramatic rise in makeshift and uncertified maternity units, the low level of qualification of health staff working in these maternity units, lack of awareness of the counter-indications for vaginal birth followed by delayed transfer to specialist facilities, poor distribution of health centers and difficult access to referral facilities, as well as poverty and illiteracy among these populations [ 10 , 22 ]. These are common factors and characteristics, in varying degrees, of developing countries.…”

Section: Discussionmentioning

confidence: 99%

“…The first, baseline population was recruited from referral hospitals in the city of Goma from the period 01/11/2013 to 01/01/2016 (group 1). It is a retrospective, descriptive and analytical study concerning all CS performed across all deliveries that occurred during the period under study [ 10 ]. Twin pregnancies were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

“…In the Democratic Republic of Congo (DRC), the latest demographic and health surveys show that the CS rate rose from 4% in 2007 [ 9 ] to 5% in 2013 [ 9 ]. A study conducted in Goma (North Kivu) between 2013 and 2016 in four referral hospitals reported a caesarean rate of 16%, that the majority of CS were performed as an emergency and under loco regional anaesthesia, and that the perinatal risk was higher when the CS was performed as an emergency and under loco regional anaesthesia [ 10 ]. Several risk factors which increase maternal and perinatal morbidity and mortality in the intra- and post-CS period have been identified, in particular the shortage of qualified health staff, lack of health staff training, inadequate medical infrastructure, difficulties in performing the CS in due time when women need one, as well as the high cost of the procedure in relation to the population’s income [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Evolution in caesarean section practices in North Kivu: Impact of caregiver training

Ekanga

Mitangala²,

Coppieters³

et al. 2022

PLoS ONE

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Introduction A caesarean section is a major obstetric procedure that can save the life of mother and child. Its purpose is to protect the mother’s health from the complications of childbirth and to protect the baby’s health. In sub-Saharan Africa (SSA), there are major inequalities in access to caesarean sections and significant variations in practices to determine the indications for the procedure. Periodic analyses of maternal deaths have shown that more than half of maternal and new born deaths are due to suboptimal care and are therefore potentially preventable. The objective of our study is to assess the impact of health staff training under the PADISS project (to support the health system’s integrated development) on the quality of CS procedures in North Kivu, by comparing two periods. Material and methods The populations compared were recruited from the referral hospitals in North Kivu, DRC (Democratic Republic of Congo). The first (group 1) was made up of patient files studied retrospectively for the period from 01/11/2013 to 01/01/2016. The second group (group 2), studied prospectively, comprised patient files from June 2019 to January 2020. Obstetric, maternal and foetal data were compared. Statistical analyses were performed using STATA/IC 15.0 for Windows. Univariate and multiple logistic regression was performed to determine which characteristics are associated with maternal and perinatal morbidity and mortality. A p value < 0.05 was considered statistically significant. Results CS frequency was approximately 17% in both study periods. We observed a CS frequency of about 34% at North Kivu provincial hospital for the two populations studied. The main indications for CS were dystocia, foetal distress and scarred uterus for both populations. In the population studied prospectively, after the implementation of health staff training, there were fewer incidence rate of dystocia, foetal distress and neonatal death, a more complete patient record, shorter hospital stay, and fewer blood transfusions but more incidence rate of scarred uterus, post-operative complications and low birth weight. Intervention had no statistically significant impact on low birth weight (OR = 1.9, p = 0.13), on neonatal mortality (OR = 0.69, p = 0.21). Conclusion Our study shows a decrease in neonatal deaths, dystocia and foetal distress, but an increase in post-operative complications, maternal deaths and cases of scarred uterus and low birth weight. However, multiple logistic regression did no support the conclusion.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evolution in caesarean section practices in North Kivu: Impact of caregiver training

Ekanga

Mitangala²,

Coppieters³

et al. 2022

PLoS ONE

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“…Caesarean birth (CB) is a vital surgical procedure needed to manage some complications related to pregnancy and childbirth. 1 Caesarean birth is an operative practice in which an incision is made through a mother’s abdomen and uterus to extract one or multiple babies, or infrequently, extract a dead fetus. 2 Because of the perceived safeness of the procedure and the convenience (for the mother and doctor) of being able to plan birth, CB has become a popular mode of giving birth.…”

Section: Introductionmentioning

confidence: 99%

Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review

Minani,

Ross

2024

African Journal of Primary Health Care & Family Medicine

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Background: Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality.Aim: The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB.Methods: A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies.Results: These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention.Conclusion: The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions: This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.

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“… 11 Similar experiences have been reported in sub-Saharan Africa (SSA), where only 7.3% of newborns are born via CD. 12 Data regarding the Tanzania CDR are scarce, but it is estimated to range between 5% and 6%. 13…”

Section: Introductionmentioning

confidence: 99%

Rationale of indications for caesarean delivery and associated factors among primigravidae in Tanzania

Mpotora

Yahaya

Ng’weshemi

et al. 2021

Journal of Taibah University Medical Sciences

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Objective This study aimed to determine the prevalence of modes of delivery and associated maternal and newborn outcomes among singleton primigravidae in the Iringa region of Tanzania. Methods A cross-sectional, analytical hospital-based study was conducted in the Iringa region among 356 singleton primigravidae between April and August 2018. Convenience sampling and consecutive collection of data using a face-to-face interviewer-administered questionnaire was done. Results A total of 356 singleton primigravid women with a mean age of 22.0 years (range: 15–49) participated in the study. The majority of the participants (73.0%, n = 250) were in the 20–35 age group. Caesarean and vaginal delivery were performed in 41.3% (n = 147) and 58.7% (n = 209) of the cases, respectively. The maternal height and weight of the newborn were significantly associated with caesarean delivery; ( p = 0.001) and ( p = 0.029), respectively. After adjusting for all variables, birth asphyxia (AOR = 3.25, 95% CI: 1.867–5.646, p = 0.000) and low birth weight (AOR = 0.03, 95% CI: 0.003–0.211, p = 0.001) were associated with caesarean delivery. Conclusions The findings of our study indicated the prevalence of caesarean section to be three times more than that recommended by the World Health Organization. Pregnant women with a height of less than 150 cm should be considered for caesarean section. Therefore, it is necessary for stakeholders in the health sector to formulate guidelines for absolute indications for caesarean section.

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Analysis of caesarean section practices and consequences in Goma, DR Congo: Frequency, indications, maternal and perinatal morbidity and mortality

Cited by 5 publications

References 29 publications

Evolution in caesarean section practices in North Kivu: Impact of caregiver training

Evolution in caesarean section practices in North Kivu: Impact of caregiver training

Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review

Rationale of indications for caesarean delivery and associated factors among primigravidae in Tanzania

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