@article{fdi:010075650,
  title = {{DECIDE} : a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in {B}urkina {F}aso},
  author = {{K}abore, {C}. and {R}idde, {V}al{\'e}ry and {C}haillet, {N}. and {B}ocoum, {F}. {Y}. and {B}etran, {A}. {P}. and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {I}n {B}urkina {F}aso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. {E}ffective and safe strategies are needed to prevent unnecessary caesarean deliveries. {M}ethods {W}e conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in {B}urkina {F}aso. {T}he 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. {T}he primary outcome was the change in the percentage of unnecessary caesarean deliveries. {U}nnecessary caesareans were defined on the basis of the literature review and expert consensus. {D}ata were collected daily using a standardized questionnaire, in the same way at both the intervention and control hospitals. {C}aesareans were classified as necessary or unnecessary in the same way, in both arms of the trial using a standardized computer algorithm.{R}esults{A} 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%).{T}he 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). {T}he overall perinatal mortality data were not available.{C}onclusion {P}romotion 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.},
  keywords = {{C}aesarean section ; {M}obile phone-based interventions ; {C}linical audit ; {T}raining ; {BURKINA} {FASO}},
  booktitle = {},
  journal = {{BMC} {M}edicine},
  volume = {17},
  numero = {},
  pages = {art. 87 [14 ]},
  ISSN = {1741-7015},
  year = {2019},
  DOI = {10.1186/s12916-019-1320-y},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075650},
}