You are here

  • Home
  • Archive
  • Volume 12, Issue 10
  • Does hospital variation in intrapartum-related perinatal mortality among caesarean births reflect differences in quality of care? Cross-sectional study in 21 hospitals in Burkina Faso

Article Text

Article menu
Obstetrics and gynaecology
Original research
Does hospital variation in intrapartum-related perinatal mortality among caesarean births reflect differences in quality of care? Cross-sectional study in 21 hospitals in Burkina Faso
  1. Francesca L Cavallaro1,2,
  2. Charles P Kabore3,4,
  3. Rachel Pearson5,
  4. Ruth M Blackburn6,
  5. Soha Sobhy7,
  6. Ana Pilar Betran8,
  7. Carine Ronsmans9,
  8. Alexandre Dumont4
  1. 1Population, Policy and Practice, University College London Institute of Child Health, London, UK
  2. 2The Health Foundation, London, UK
  3. 3Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
  4. 4CEPED, Université Paris Cité, IRD, INSERM, Paris, France
  5. 5UCL Institute of Child Health, University College London, London, UK
  6. 6UCL Institute of Health Informatics, University College London, London, UK
  7. 7Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  8. 8UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
  9. 9Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Francesca L Cavallaro; francesca.cavallaro{at}health.org.uk

Abstract

Objectives To examine hospital variation in crude and risk-adjusted rates of intrapartum-related perinatal mortality among caesarean births.

Design Secondary analysis of data from the DECIDE (DECIsion for caesarean DElivery) cluster randomised trial postintervention phase.

Setting 21 district and regional hospitals in Burkina Faso.

Participants All 5134 women giving birth by caesarean section in a 6-month period in 2016.

Primary outcome measure Intrapartum-related perinatal mortality (fresh stillbirth or neonatal death within 24 hours of birth).

Results Almost 1 in 10 of 5134 women giving birth by caesarean experienced an intrapartum-related perinatal death. Crude mortality rates varied substantially from 21 to 189 per 1000 between hospitals. Variation was markedly reduced after adjusting for case mix differences (the median OR decreased from 1.9 (95% CI 1.5 to 2.5) to 1.3 (95% CI 1.2 to 1.7)). However, higher and more variable adjusted mortality persisted among hospitals performing fewer caesareans per month. Additionally, adjusting for caesarean care components did not further reduce variation (median OR=1.4 (95% CI 1.2 to 1.8)).

Conclusions There is a high burden of intrapartum-related perinatal deaths among caesarean births in Burkina Faso and sub-Saharan Africa more widely. Variation in adjusted mortality rates indicates likely differences in quality of caesarean care between hospitals, particularly lower volume hospitals. Improving access to and quality of emergency obstetric and newborn care is an important priority for improving survival of babies at birth.

Trial registration number ISRCTN48510263.

  • OBSTETRICS
  • PERINATOLOGY
  • NEONATOLOGY

Data availability statement

Data are available upon reasonable request. Reasonable requests may be directed to CK (kaborewendyam@yahoo.fr).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-055241

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. Reasonable requests may be directed to CK (kaborewendyam@yahoo.fr).

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Twitter @cescacava

    • Contributors FC conceptualised the study, with help from CR. CK and AD designed the DECIDE trial and oversaw data collection. FC designed the analyses and analysed the data, with support from RP, RB and AD. All authors, including SS and APB, contributed to the interpretation of results and writing of the final manuscript. FC is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.