Quality of caesarean delivery: A cross-sectional study in 12 hospitals in Benin

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Study Justification:
– Caesarean section (CS) is a major obstetric intervention that can reduce maternal and perinatal mortality when performed correctly.
– CS numbers and rates are regularly published, but the quality of CS is often overlooked.
– This study aims to assess the quality of caesarean delivery in selected hospitals in Benin.
Study Highlights:
– The study was conducted in 12 randomly selected hospitals in Benin.
– Data was collected from hospital files and questionnaires from women and hospital directors.
– The quality of CS was assessed based on four pillars: access, diagnosis, procedure, and postoperative care.
– 579 women who had undergone a CS were included in the study.
– The average CS rate was 37.6%.
– Maternal mortality was 2000 maternal deaths per 100,000 deliveries.
– Perinatal mortality was 7.4%, with 88.4% due to stillbirths.
Study Recommendations:
– Improve access to CS by addressing difficulties in reaching hospitals.
– Reduce errors in diagnosis and excessive delays in performing CS.
– Enhance the completeness of the admission examination and the use of the partograph.
– Increase the availability and use of trained anesthetists for CS procedures.
– Implement measures to reduce maternal and perinatal mortality.
Key Role Players:
– Hospital administrators and directors
– Obstetricians and gynecologists
– Nurses and midwives
– Anesthetists
– Policy makers and government officials
Cost Items for Planning Recommendations:
– Training programs for healthcare professionals
– Equipment and supplies for CS procedures
– Transportation infrastructure improvements
– Implementation of quality improvement measures
– Monitoring and evaluation systems for tracking progress
Please note that the cost items provided are general categories and not specific cost estimates.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional study conducted in 12 hospitals in Benin. The study collected data from hospital files and questionnaires from women and hospital directors. The study provides information on various aspects of caesarean delivery, including access, diagnosis, procedure, and postoperative care. However, the evidence is limited to a specific time period and geographical location, which may affect its generalizability. To improve the strength of the evidence, future studies could consider a larger sample size and include hospitals from different regions to increase the representativeness of the findings.

Background Caesarean section (CS) is a major obstetric intervention, widely recognized as an effective means to reduce maternal and perinatal mortality, when appropriately performed. CS numbers and rates are regularly published but quality is rarely taken into account. This study aims to describe the quality of caesarean delivery in selected hospitals in Benin. Methods A cross-sectional study was performed among women who had undergone a CS between 18 December 2013 and 8 February 2014 in one randomly selected hospital in each of the 12 administrative districts of Benin. The quality of CS was defined according to the analytical framework of Dujardin and Delvaux (1998) with its four pillars (access, diagnosis, procedure, postoperative care). Data were collected from hospital files and questionnaires from women and hospital directors. Data analysis was performed using Epi Info 3.5.1. Results Six hundred and thirty-two women delivered by CS during the period and 579 were eligible for the study. They were aged 26.5 ± 6.3 years, 73.2% living more than 5 km from the hospital, 63.0% referred to a health facility of whom 46.0% and 21.8% were transported by motorcycle and by ambulance respectively. The median expenditure by family was FCFA 30 000, ranging from 0 to FCFA 200 000. The admission examination was complete in 12.6% of women and the partograph used in 32.6%. The average CS rate was 37.6%, the average response time, 124 minutes. Emergency CS was performed in 80.7%, for absolute maternal indications in 48.0% and under spinal anesthesia in 84.2% (98.3% of which were conducted by a nurse or midwife anesthetist). Maternal mortality was 2000 maternal deaths per 100 000 deliveries, while perinatal mortality was 7.4% (88.4% due to stillbirths). Conclusion CS in Benin hospitals partially fulfilled quality criteria. However access to CS remains difficult and errors of diagnosis or excessive delay are too frequent. Quality CS is not yet a reality in Benin hospitals.

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

1. Telemedicine: Implementing telemedicine services can improve access to maternal health by allowing remote consultations and monitoring for pregnant women. This can help overcome geographical barriers and provide timely medical advice.

2. Mobile clinics: Setting up mobile clinics that travel to remote areas can improve access to maternal health services for women who live far from hospitals or healthcare facilities. These clinics can provide prenatal care, screenings, and basic obstetric services.

3. Training programs for healthcare providers: Implementing comprehensive training programs for healthcare providers can improve the quality of caesarean deliveries. This can include training on proper diagnosis, procedures, and postoperative care, as well as the use of standardized protocols and guidelines.

4. Strengthening referral systems: Developing and strengthening referral systems between primary healthcare centers and hospitals can ensure that pregnant women with complications are promptly referred to appropriate facilities for caesarean deliveries. This can help reduce delays in accessing emergency obstetric care.

5. Financial support: Providing financial support or subsidies for transportation costs can help overcome financial barriers and improve access to caesarean deliveries for women who cannot afford the expenses associated with hospital visits.

6. Community awareness and education: Conducting community awareness campaigns and educational programs can help increase knowledge about the importance of caesarean deliveries and encourage women to seek timely medical care during pregnancy.

7. Improving infrastructure: Investing in the improvement of healthcare infrastructure, including hospitals and healthcare facilities, can enhance the capacity to perform caesarean deliveries and provide quality maternal health services.

These innovations, if implemented effectively, can contribute to improving access to maternal health and the quality of caesarean deliveries in Benin.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health and develop innovation could be:

1. Strengthening Access to Caesarean Sections (CS): Efforts should be made to improve access to CS in Benin hospitals. This could include increasing the number of hospitals that offer CS services, especially in remote areas, and ensuring that transportation is readily available for pregnant women who need to travel to access these services.

2. Enhancing Diagnosis and Referral Systems: Improving the accuracy of diagnosis and referral systems is crucial to ensure that women who require a CS are identified and referred in a timely manner. This could involve training healthcare providers on proper diagnosis techniques and implementing standardized referral protocols.

3. Improving Quality of Care: To ensure that CS procedures are performed with high quality, it is important to address gaps in the provision of care. This could involve implementing protocols and guidelines for CS, ensuring that healthcare providers are adequately trained, and promoting the use of standardized tools such as the partograph to monitor labor progress.

4. Reducing Maternal and Perinatal Mortality: Efforts should be focused on reducing maternal and perinatal mortality rates associated with CS. This could include improving emergency response systems, ensuring the availability of skilled healthcare providers for emergency CS, and implementing measures to prevent stillbirths.

5. Innovation in Maternal Health: To drive improvements in access to maternal health, innovative approaches could be explored. This could include leveraging technology, such as telemedicine, to provide remote consultations and support for healthcare providers in areas with limited access to specialized maternal health services. Additionally, exploring community-based interventions and partnerships with local organizations could help reach pregnant women in underserved areas.

Overall, a comprehensive approach that addresses access, diagnosis, procedure, postoperative care, and quality of care is needed to improve maternal health outcomes and ensure that quality CS becomes a reality in Benin hospitals.
AI Innovations Methodology
To improve access to maternal health in Benin, here are some potential recommendations:

1. Strengthening transportation infrastructure: Improve road networks and transportation systems to ensure easier access to healthcare facilities, especially for women living in remote areas.

2. Enhancing referral systems: Develop efficient referral systems between primary healthcare centers and hospitals to ensure timely access to specialized maternal healthcare services.

3. Increasing availability of skilled healthcare providers: Train and deploy more skilled healthcare providers, including doctors, nurses, and midwives, to address the shortage of personnel in maternal healthcare facilities.

4. Implementing telemedicine solutions: Introduce telemedicine technologies to provide remote consultations and support for healthcare providers in underserved areas, enabling them to access expert advice and guidance.

5. Improving health information systems: Establish robust health information systems to collect and analyze data on maternal health outcomes, enabling evidence-based decision-making and targeted interventions.

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

1. Baseline data collection: Gather data on the current state of maternal health access, including indicators such as distance to healthcare facilities, transportation availability, healthcare provider-to-patient ratios, and maternal health outcomes.

2. Define simulation parameters: Determine the specific variables and parameters to be simulated, such as changes in transportation infrastructure, referral system efficiency, healthcare provider availability, and telemedicine implementation.

3. Model development: Develop a simulation model that incorporates the baseline data and the defined parameters. This model should simulate the interactions between different factors and their impact on access to maternal health.

4. Scenario testing: Run the simulation model with different scenarios, representing the potential impact of each recommendation. For example, simulate the effects of improving transportation infrastructure, increasing healthcare provider availability, or implementing telemedicine solutions.

5. Analyze results: Evaluate the simulation results to assess the potential impact of each recommendation on improving access to maternal health. Compare the scenarios to identify the most effective interventions and their potential outcomes.

6. Refine and validate the model: Continuously refine and validate the simulation model by incorporating additional data, feedback from experts, and real-world observations to improve its accuracy and reliability.

By using this methodology, policymakers and healthcare stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health and make informed decisions on implementing the most effective interventions.

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