Journal des soins de santé des femmes
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Trends in Institutional Caesarean Delivery among Low-Risk Patients in Senegal and Mali: Secondary Analysis of a Cluster-Randomized Trial (Quarite)

Augustin Zongo, Séni Kouanda, Pierre Fournier, Mamadou Traore, Blaise Sondo and Alexandre Dumont

Objective: To measure the trends of institutional caesarean rates in Senegal and Mali and to assess if these trends were modified by the Advances in Labour and Risk Management (ALARM) international program.

Methods: We conducted a secondary analysis of the QUARITE trial to examine the trends in caesarean delivery among low-risk patients in 46 hospitals which were randomized into an intervention group (n = 23) and a control group (n = 23). ALARM combined maternal death reviews and continuous medical education to improve the quality of obstetric care.

Results: Between the pre-intervention period and the post-intervention period, the institutional caesarean rate among low-risk patients increased from 17.1% to 18.6% in the intervention hospitals (adjusted OR=1.03; 95% CI =0.89-1.15) and from 16.1% to 21.1% in the control arm (adjusted OR=1.47; 95% CI=1.27-1.52). The increase was significantly higher in the control group than in the intervention group, p<0.0001.

Conclusion: Caesarean delivery rates increased in referral hospitals in Senegal and Mali after the free caesarean policy was implemented. Because of potential arms for mothers and newborns associated with unnecessary caesarean delivery, ALARM international program should be considered as a promising intervention to limit excessive rise of caesareans in this context.