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Kabore C., Ridde Valéry, Chaillet N., Bocoum F. Y., Betran A. P., Dumont Alexandre. (2019). DECIDE : a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso. BMC Medicine, 17, art. 87 [14 p.]. ISSN 1741-7015

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Lien direct chez l'éditeur doi:10.1186/s12916-019-1320-y

Titre
DECIDE : a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso
Année de publication2019
Type de documentArticle référencé dans le Web of Science WOS:000466955300001
AuteursKabore C., Ridde Valéry, Chaillet N., Bocoum F. Y., Betran A. P., Dumont Alexandre.
SourceBMC Medicine, 2019, 17, p. art. 87 [14 p.]. p. art. 87 [14 p.] ISSN 1741-7015
RésuméBackground In Burkina Faso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. Effective and safe strategies are needed to prevent unnecessary caesarean deliveries. Methods We conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in Burkina Faso. The evidence-based intervention was designed to promote the use of clinical algorithms for caesarean decision-making using in-site training, audits and feedback of caesarean indications and SMS reminders. The primary outcome was the change in the percentage of unnecessary caesarean deliveries. Unnecessary caesareans were defined on the basis of the literature review and expert consensus. Data were collected daily using a standardized questionnaire, in the same way at both the intervention and control hospitals. Caesareans were classified as necessary or unnecessary in the same way, in both arms of the trial using a standardized computer algorithm.ResultsA total of 2138 and 2036 women who delivered by caesarean section were analysed in the pre and post-intervention periods, respectively. A significant reduction in the percentage of unnecessary caesarean deliveries was evident from the pre- to post-intervention period in the intervention group compared with the control group (18.96 to 6.56% and 18.27 to 23.30% in the intervention and control groups, respectively; odds ratio [OR] for incremental change over time, adjusted for hospital and patient characteristics, 0.22; 95% confidence interval [CI], 0.14 to 0.34; P<0.001; adjusted risk difference, -17.02%; 95% CI, -19.20 to -13.20%).The intervention did not significantly affect the rate of maternal death (0.75 to 0.19% and 0.92 to 0.40% in the intervention and control groups, respectively; adjusted OR 0.32; 95% CI 0.04 to 2.23; P=0.253) or intrapartum-related neonatal death (4.95 to 6.32% and 5.80 to 4.29% in the intervention and control groups, respectively, adjusted OR 1.73; 95% CI 0.82 to 3.66; P=0.149). The overall perinatal mortality data were not available.Conclusion Promotion and training on clinical algorithms for decision-making, audit and feedback and SMS reminders reduced unnecessary caesarean deliveries, compared with usual care in a low-resource setting.
Plan de classementSanté : aspects socioculturels, économiques et politiques [056] ; Santé : généralités [050]
Descr. géo.BURKINA FASO
LocalisationFonds IRD [F B010075650]
Identifiant IRDfdi:010075650
Lien permanenthttp://www.documentation.ird.fr/hor/fdi:010075650

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