@article{fdi:010058837,
  title = {{I}ndividual and institutional determinants of caesarean section in referral hospitals in {S}enegal and {M}ali : a cross-sectional epidemiological survey},
  author = {{B}riand, {V}al{\'e}rie and {D}umont, {A}lexandre and {A}brahamowicz, {M}. and {T}raore, {M}. and {W}atier, {L}. and {F}ournier, {P}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {T}wo years after implementing the free-{CS} policy, we assessed the non-financial factors associated with caesarean section ({CS}) in women managed by referral hospitals in {S}enegal and {M}ali. {M}ethods: {W}e conducted a cross-sectional survey nested in a cluster trial ({QUARITE} trial) in 41 referral hospitals in {S}enegal and {M}ali (10/01/2007-10/01/2008). {D}ata were collected regarding women's characteristics and on available institutional resources. {I}ndividual and institutional factors independently associated with emergency (before labour), intrapartum and elective {CS} were determined using a hierarchical logistic mixed model. {R}esults: {A}mong 86 505 women, 14% delivered by intrapartum {CS}, 3% by emergency {CS} and 2% by elective {CS}. {F}or intrapartum, emergency and elective {CS}, the main maternal risk factors were, respectively: previous {CS}, referral from another facility and suspected cephalopelvic-disproportion (adjusted {O}dds {R}atios from 2.8 to 8.9); vaginal bleeding near full term, hypertensive disorders, previous {CS} and premature rupture of membranes (adjusted {OR}s from 3.9 to 10.2); previous {CS} (adjusted {OR}=19.2 [17.2-21.6]). {A}ccess to adult and neonatal intensive care, a 24-h/day anaesthetist and number of annual deliveries per hospital were independent factors that affected {CS} rates according to degree of urgency. {T}he presence of obstetricians and/or medical-anaesthetists was associated with an increased risk of elective {CS} (adjusted {OR}s [95% {CI}] = 4.8 [2.6-8.8] to 9.4 [5.1-17.1]). {C}onclusions: {W}e confirm the significant effect of well-known maternal risk factors affecting the mode of delivery. {A}vailable resources at the institutional level and the degree of urgency of {CS} should be taken into account in analysing {CS} rates in this context.},
  keywords = {{C}aesarean section ; {A}frica ; {E}pidemiology ; {SENEGAL} ; {MALI}},
  booktitle = {},
  journal = {{B}mc {P}regnancy and {C}hildbirth},
  volume = {12},
  numero = {},
  pages = {114},
  ISSN = {1471-2393},
  year = {2012},
  DOI = {10.1186/1471-2393-12-114},
  URL = {https://www.documentation.ird.fr/hor/fdi:010058837},
}