Determinants and materno-fetal outcomes related to cesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review and meta-analysis protocol

Abstract

BackgroundDespite the well-established morbidity, mortality, long-term effects, and unnecessary extra-cost burden associated with cesarean section delivery (CSD) worldwide, its rate has grown exponentially. This has become a great topical challenge for the international healthcare community and individual countries. Estimated at three times the acceptable rate as defined by the World Health Organization in 1985, the continued upward trend has been fuelled by higher income countries. Some low- and middle-income countries (LMICs) have now taken the lead, and the factors contributing to this situation are poorly understood. The expansion of the private healthcare sector may be playing a significant role. Distinguishing between the public and private hospitals’ role is critical in this investigation as it has not yet been approached. This review aims to systematically synthesize knowledge on the determinants of the CSD rate rise in private and public hospitals in LMICs and to investigate materno-fetal and materno-infant outcomes of CSD in perinatal period, between private and public hospitals.Methods/designWe will include studies published in English, French, Spanish, and Portuguese since 2000, using any experimental design, including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, and interrupted time series. Outcomes of interest are the determinants of CSD and materno-fetal and materno-infant outcomes. We will only include studies carried out in private and public hospitals in LMICs. The literature searches will be conducted in the following databases: MEDLINE, Embase, CINAHL, Cochrane database, LILACS, and HINARI. We will also include unpublished studies in the gray literature (theses and technical reports). Using the two-person approach, two independent review authors will screen eligible articles, extract data, and assess risk of bias. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. If possible, a meta-analysis will be conducted and, subsequently, an analysis for heterogeneity will be implemented.DiscussionThe proposed systematic review of the CSD rate rise will provide up-to-date evidence in regard to differences in proportions, determinants, and materno-fetal and materno-infant outcomes in perinatal period, between private and public hospitals in LMICs. We believe that this knowledge synthesis will help to shed light on the evidence and support evidence-informed decision-making with a view to addressing the issue in LMICs.Systematic review registrationPROSPERO CRD42016036871 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0402-6) contains supplementary material, which is available to authorized users.

Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review

“…This review is shaped from the published protocol [32], which was registered within the International…”

Trends in Cesarean Section

“…In the last decades, an invariable upward trend has been evident mainly in low-and middle-income countries. China (64.1%), Colombia (46.4%), Dominican Republic (56.4%), Egypt (51.8%), Iran (47.9%), and Brazil (55.6%, 80% for second deliveries) -when the first was by cesarean, are some examples [7,11,15].…”

“…Several systematic reviews have shown that, although CS can be a truly life-saving procedure in some cases, it's also associated with anomalous short-term immune response in the newborn, and a greater risk of developing immune-mediated diseases such as asthma, allergies, or DM type 1. From a financial perspective, globally, the cost of practicing CS without a clear medical indication has been estimated at $2.32 billion [15,16].…”

Phenotypes and markers of cesarean delivery among Colombian women

“…The CD rate increase persists despite established consequences including morbidity, mortality, long‐term effects, and unnecessary costs of non‐medically indicated CDs. Moreover, there is evidence that higher rates of CDs are not associated with improved maternal or fetal outcomes …”

“…The upward trend in CDs, once led by some high‐income countries, is now being surpassed by low‐ and middle‐income countries . For example, Colombia, a middle‐income country, has experienced an increase in CDs in the past two decades .…”