A national review of cesarean delivery in Ethiopia

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Study Justification:
– The study aimed to assess the cesarean delivery rates in Ethiopia and identify the indications for cesarean delivery, fetal and maternal outcomes, and aspects of quality of care.
– This information is important for understanding the current state of obstetric care in the country and identifying areas for improvement.
– The study provides valuable data for policymakers and healthcare providers to make informed decisions and implement interventions to improve maternal and neonatal health.
Highlights:
– The national population-based cesarean delivery rate in Ethiopia was found to be 0.6%, with regional rates varying from 0.2% to 9%.
– The overall institutional cesarean delivery rate was 18%, with a higher rate of 46% in the private for-profit sector and a lower rate of 15% in the public sector.
– Maternal indications accounted for 66% of the cesarean deliveries reviewed, while fetal indications accounted for 34%.
– Only 12% of the emergency cesareans had their labor monitored with a partograph, indicating a need for improved monitoring practices.
– The study identified a need for clinical management protocols for obstetric and newborn care, as well as audits of cesarean deliveries in all institutions, particularly in the private sector.
– Improving record-keeping practices was highlighted as crucial for informed decision-making at the local level.
Recommendations:
– Monitor the appropriateness of obstetric care in all sectors and increase access to cesarean deliveries in rural areas.
– Develop and implement clinical management protocols for obstetric and newborn care.
– Conduct audits of cesarean deliveries in all institutions, with a particular focus on the private sector.
– Improve record-keeping practices to facilitate informed decision-making.
Key Role Players:
– Ministry of Health: Responsible for overseeing and implementing interventions to improve obstetric care and access to cesarean deliveries.
– Healthcare providers: Responsible for adhering to clinical management protocols and participating in audits of cesarean deliveries.
– Professional associations and organizations: Involved in advocating for improved obstetric care and providing guidance and support to healthcare providers.
– Researchers and academics: Conduct further studies and provide evidence-based recommendations for improving cesarean delivery practices.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on clinical management protocols: Includes costs for organizing workshops, materials, and trainers.
– Monitoring and evaluation: Includes costs for data collection, analysis, and reporting to assess the impact of interventions.
– Infrastructure and equipment: Includes costs for upgrading facilities and providing necessary equipment for cesarean deliveries.
– Information systems and record-keeping: Includes costs for developing and implementing electronic health record systems and training staff on record-keeping practices.
– Awareness campaigns and community engagement: Includes costs for developing and disseminating educational materials, conducting community outreach programs, and raising awareness about the importance of appropriate obstetric care.
Please note that the cost items provided are general categories and may vary depending on the specific context and resources available in Ethiopia.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides national population-based and institutional cesarean delivery rates, indications for cesarean delivery, and maternal and fetal outcomes. However, the study is based on a cross-sectional survey of 797 facilities, which may not fully represent the entire population. To improve the strength of the evidence, a larger sample size and a longitudinal study design could be considered. Additionally, conducting follow-up studies to assess the impact of interventions aimed at improving obstetric care and reducing cesarean rates would provide more robust evidence.

Objective: To describe Ethiopian national population-based and institutional cesarean delivery rates by sector, and to describe indications for cesarean delivery, fetal and maternal outcomes, and aspects of quality of care. Methods: The data source was the national baseline assessment of emergency obstetric and newborn care-a cross-sectional, facility-based survey of 797 facilities. Two instruments were used to collect the data for the present paper: a retrospective record review of 267 cesarean deliveries based on the last 3 performed in each facility; and a 12-month summary of each facility’s statistics on vaginal and abdominal deliveries. Results: The national population-based cesarean delivery rate was 0.6%, with regional rates varying from 0.2% to 9%. The overall institutional rate was 18%, which varied between 46% in the private for- profit sector and 15% in the public sector. Maternal indications accounted for 66% of the cesareans reviewed, and fetal indications for 34%. Three-quarters of the cesareans were recorded as emergencies, but only 12% of these had their labor monitored with a partograph. The interval between decision and delivery was within 30 minutes for 36% of the women, 31-60 minutes for 23%, and more than 5 hours for 19%. Antibiotics were given in 94% of the reviewed cases; nevertheless, 12% of the cases reported wound infection. There were 2 maternal deaths and 14% of the newborns were stillbirths or died shortly after birth. Conclusion: The study showed little progress in the proportion of all births delivered by cesarean and a high rate of cesarean among women attended in the private sector-indicating a need to monitor the appropriateness of obstetric care in all sectors and to increase access in rural areas. Clinical management protocols for obstetric and newborn care are needed, and audits of cesareans should be performed at all institutions, especially in the private sector. The importance of improving record keeping is crucial for informed local decision-making. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Based on the information provided, here are some potential innovations that could improve access to maternal health in Ethiopia:

1. Telemedicine and Teleconsultation: Implementing telemedicine services can help connect healthcare providers in rural areas with specialists in urban areas. This would allow for remote consultations and guidance on complicated cases, improving access to specialized care for pregnant women.

2. Mobile Health (mHealth) Applications: Developing mobile applications that provide information and resources on maternal health can help educate and empower pregnant women, especially in remote areas. These apps can provide guidance on prenatal care, nutrition, and warning signs during pregnancy.

3. Community Health Workers: Expanding the role of community health workers can improve access to maternal health services. Training and equipping these workers to provide basic prenatal care, conduct health education sessions, and facilitate referrals to healthcare facilities can help reach pregnant women in remote areas.

4. Quality Improvement Initiatives: Implementing quality improvement initiatives in healthcare facilities can help address the gaps identified in the study. This can include improving record-keeping systems, ensuring timely monitoring of labor using partographs, and conducting regular audits of cesarean deliveries to ensure appropriateness and quality of care.

5. Public-Private Partnerships: Collaborating with private healthcare providers to improve access to maternal health services can be beneficial. This can involve establishing referral networks, providing training and support to private facilities, and ensuring that services are affordable and accessible to all women, regardless of their socioeconomic status.

6. Infrastructure Development: Investing in infrastructure, particularly in rural areas, can improve access to maternal health services. This can include building and upgrading healthcare facilities, ensuring the availability of essential equipment and supplies, and improving transportation networks to facilitate timely access to care.

These are just a few potential innovations that could be considered to improve access to maternal health in Ethiopia. Each innovation would need to be carefully planned, implemented, and evaluated to ensure its effectiveness and sustainability.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health in Ethiopia is to develop and implement clinical management protocols for obstetric and newborn care. This would involve creating standardized guidelines and procedures for healthcare providers to follow during cesarean deliveries and other obstetric interventions.

Additionally, it is important to conduct regular audits of cesarean deliveries at all healthcare institutions, especially in the private sector. These audits would help identify any inappropriate or unnecessary cesarean deliveries and ensure that quality of care is being maintained.

Improving record keeping is also crucial for informed decision-making. Implementing a system for accurate and comprehensive documentation of maternal and fetal outcomes, indications for cesarean delivery, and other relevant data would provide valuable information for monitoring and evaluating the effectiveness of interventions and identifying areas for improvement.

Lastly, efforts should be made to increase access to maternal health services in rural areas. This could involve initiatives such as training and deploying more healthcare providers to rural areas, improving transportation infrastructure to facilitate access to healthcare facilities, and raising awareness about the importance of maternal health among rural communities.

By implementing these recommendations, it is hoped that access to maternal health services in Ethiopia will be improved, leading to better maternal and fetal outcomes and overall improvement in the quality of care provided.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase availability of obstetric care in rural areas: Implement mobile clinics or outreach programs to provide prenatal care and emergency obstetric services in remote areas where access to healthcare facilities is limited.

2. Strengthen healthcare infrastructure: Invest in improving the quality and capacity of healthcare facilities, particularly in the public sector, to ensure they are equipped to handle maternal health emergencies and provide comprehensive care.

3. Enhance training and education: Provide training programs for healthcare providers, especially in rural areas, to improve their skills and knowledge in managing maternal health complications and performing cesarean deliveries when necessary.

4. Implement clinical management protocols: Develop and implement standardized protocols for obstetric and newborn care to ensure consistent and evidence-based practices across all healthcare facilities.

5. Conduct regular audits of cesarean deliveries: Establish a system for monitoring and auditing cesarean deliveries in all institutions, with a particular focus on the private sector, to ensure appropriate and necessary procedures are being performed.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather baseline data on maternal health indicators, such as cesarean delivery rates, maternal and fetal outcomes, and access to obstetric care in different regions and sectors.

2. Define simulation parameters: Determine the specific variables and factors that will be simulated, such as the increase in availability of obstetric care in rural areas, improvements in healthcare infrastructure, and changes in healthcare provider training.

3. Model development: Develop a simulation model that incorporates the collected data and the defined parameters. This model should simulate the impact of the recommendations on maternal health outcomes, such as changes in cesarean delivery rates, reduction in maternal and fetal mortality rates, and improvements in access to obstetric care.

4. Simulation runs: Run the simulation model multiple times, adjusting the parameters to reflect different scenarios and potential implementation strategies. This will allow for the evaluation of various combinations of recommendations and their potential impact on improving access to maternal health.

5. Analysis and interpretation: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. Compare the different scenarios and identify the most effective strategies for achieving the desired outcomes.

6. Recommendations and implementation: Based on the simulation results, make recommendations for the implementation of specific strategies to improve access to maternal health. These recommendations should be evidence-based and take into account the potential challenges and limitations of implementation.

7. Monitoring and evaluation: Establish a system for monitoring and evaluating the implementation of the recommendations to assess their actual impact on improving access to maternal health. This will help identify any necessary adjustments or additional interventions that may be required.

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