Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low- and Middle-Income Countries: A Hospital-Level Analysis of Two WHO Surveys

Yanjun Zhao, Javier Zamora, Joshua Peter Vogel, João P. Souza, Kapila Jayaratne, Togoobaatar Ganchimeg, Eduardo Ortiz-Panozo, Bernardo Hernandez, Olufemi T. Oladapo, Maria R. Torloni, Naho Morisaki, Rintaro Mori, Cynthia Pileggi-Castro, Özge Tunçalp, Xiaoming Shen, Ana Pilar Betrán, Jun Zhang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)251-262
Number of pages12
JournalPaediatric and Perinatal Epidemiology
Volume31
Issue number4
DOIs
Publication statusPublished - Jul 2017

Bibliographical note

Funding Information:
This study was partially funded by a grant from UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland and by the National Natural Science Foundation of China (Grant No. 81273091).The funders had no role in any aspect of the study. The authors have independence of research from the funders and have not been paid to write this article. This article represents the views of the authors only, and does not represent the views of the World Health Organization. This work was supported by the National Natural Science Foundation of China (Grant No. 81273091) and the Department of Reproductive Health and Research, WHO, Geneva. The WHO Global Survey on Maternal and Perinatal Health was financially supported by the 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; WHO; the Governments of China, India, and Japan; and the United States Agency for International Development (USAID). The WHO Multi-Country Survey on Maternal and Newborn Health was financially supported by the 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; WHO; USAID; the Ministry of Health, Labour and Welfare of Japan; and Gynuity Health Projects. We thank all members of the WHO Global Survey on Maternal and Perinatal Health Research Network and the WHO Multi-Country Survey on Maternal and Newborn Health Research Network, including regional and country coordinators, data collection coordinators, facility coordinators, data collectors, and all staff of the participating facilities who made the surveys possible.

Publisher Copyright:
© 2017 John Wiley & Sons Ltd

Keywords

  • adverse outcomes
  • caesarean delivery
  • low and middle income countries
  • perinatal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Epidemiology

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