@article{fdi:010063958,
  title = {{E}ffect of maternal death reviews and training on maternal mortality among cesarean delivery : post-hoc analysis of a cluster-randomized controlled trial},
  author = {{Z}ongo, {A}. and {D}umont, {A}lexandre and {F}ournier, {P}. and {T}raore, {M}. and {K}ouanda, {S}. and {S}ondo, {B}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives: {T}o explore the differential effect of a multifaceted intervention on hospital-based maternal mortality between patients with cesarean and vaginal delivery in low-resource settings. {S}tudy design: {W}e reanalyzed the data from a major cluster-randomized controlled trial, {QUARITE} ({Q}uality of care, {R}isk management and technology in obstetrics). {T}hese subgroup analyses were not prespecified and were treated as exploratory. {T}he intervention consisted of an initial interactive workshop and quarterly educational clinically oriented and evidence-based outreach visits focused on maternal death reviews ({MDR}) and best practices implementation. {T}he trial originally recruited 191,167 patients who delivered in each of the 46 participating hospitals in {M}ali and {S}enegal, between 2007 and 2011. {T}he primary endpoint was hospital-based maternal mortality. {S}ubgroup-specific {O}dds {R}atios ({OR}s) of maternal mortality were computed and tested for differential intervention effect using generalized linear mixed model between two subgroups (cesarean: 40,975; and vaginal delivery: 150,192). {R}esults: {T}he test for homogeneity of intervention effects on hospital-based maternal mortality among the two delivery mode subgroups was statistically significant (p-value: 0.0201). {C}ompared to the control, the adjusted {OR} of maternal mortality was 0.71 (95% {CI}: 0.58-0.82, p = 0.0034) among women with cesarean delivery. {T}he intervention had no significant effect among women with vaginal delivery (adjusted {OR} 0.87, 95% {CI} 0.69-1.11, p = 0.6213). {T}his differential effect was particularly marked for district hospitals. {C}onclusion: {M}aternal deaths reviews and on-site training on emergency obstetric care may be more effective in reducing maternal mortality among high-risk women who need a cesarean section than among low-risk women with vaginal delivery.},
  keywords = {{E}mergency obstetric care ; {C}esarean delivery ; {Q}uality improvement ; {M}aternal mortality ; {S}ub-{S}aharan {A}frica ; {AFRIQUE} {SUBSAHARIENNE} ; {SENEGAL} ; {MALI}},
  booktitle = {},
  journal = {{E}uropean {J}ournal of {O}bstetrics and {G}ynecology and {R}eproductive {B}iology},
  volume = {185},
  numero = {},
  pages = {174--180},
  ISSN = {0301-2115},
  year = {2015},
  DOI = {10.1016/j.ejogrb.2014.12.023},
  URL = {https://www.documentation.ird.fr/hor/fdi:010063958},
}