2021
DOI: 10.1136/bmjopen-2020-042076
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Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

Abstract: ObjectiveThe aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.SettingOver 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020.ParticipantsWomen at birth. Over 18.5 million births.InterventionCaesarean section.Primary and secondary outcome measuresThe primary outcome measures are the adjus… Show more

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Cited by 7 publications
(7 citation statements)
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“…The study was modelled after our previous meta-analyses [18,19,21,22,35] and was also designed to adhere to existing guidelines: the Preferred Reporting Items for Systematic Reviews (PRISMA), [36,37] Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Aetiology (COSMOS-E) [38] and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines [39]. Prior to study initiation, the protocol was submitted to Prospero (CRD42020158434).…”
Section: Methodsmentioning
confidence: 99%
See 1 more Smart Citation
“…The study was modelled after our previous meta-analyses [18,19,21,22,35] and was also designed to adhere to existing guidelines: the Preferred Reporting Items for Systematic Reviews (PRISMA), [36,37] Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Aetiology (COSMOS-E) [38] and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines [39]. Prior to study initiation, the protocol was submitted to Prospero (CRD42020158434).…”
Section: Methodsmentioning
confidence: 99%
“…The association of CS with health system factors has been investigated, and various factors appear to influence CS rates, including country-level factors [4,12,15,16] such as cultural preferences, insurance systems, payment practices; [4,[17][18][19] hospital-level characteristics, such as for-profit or teaching status [17,[19][20][21] and micro-level factors, i.e. factors related to physician, [22] patient and clinical units [17,23].…”
Section: Introductionmentioning
confidence: 99%
“…Cesarean sections (CS) are an important procedure for improving long-term health outcomes in high-risk births, but there is concern that CS rates continue to rise globally and are widely used in low-risk pregnancies (Hoxha et al, 2021), possibly due to higher payment for CS than for vaginal births. Using data from a national survey of women who gave birth in 2011 to 2012, Morris et al (2017) report that the probability of delivery by CS is up to twice higher in FPs than in NFPs, controlling for maternal attributes and other factors-results consistent with an earlier study of CS versus vaginal delivery by Gruber and Owings (1996).…”
Section: Quality: Structure Several Papers Have Used Cardiovascularmentioning
confidence: 99%
“…τ 2 with values of 0.04, 0.16, and 0.36 represent low, moderate, and high heterogeneity between studies. 26 For similar studies, [27][28][29][30] we have used τ 2 as it is more informative due to the high precision of included studies. For groups with only one study, we did not perform meta-analysis but only presented them in the forest plots.…”
Section: Midwife Present In the Institutionmentioning
confidence: 99%