@article{fdi:010088947,
  title = {{H}ow does hospital organisation influence the use of caesarean sections in low- and middle-income countries ? {A} cross-sectional survey in {A}rgentina, {B}urkina {F}aso, {T}hailand and {V}ietnam for the {QUALI}-{DEC} project},
  author = {{E}tcheverry, {C}. and {B}etrán, {A}. {P}. and {L}oenzien de, {M}yriam and {R}obson, {M}. and {K}abor{\'e}, {C}. and {L}umbiganon, {P}. and {C}arroli, {G}. and {M}ac, {Q}. {N}. {H}. and {G}ialdini, {C}. and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground{I}mproving the understanding of non-clinical factors that lead to the increasing caesarean section ({CS}) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. {T}he objective of this study was to study the influence of organizational factors on the {CS} use in {A}rgentina, {V}ietnam, {T}hailand and {B}urkina {F}aso.{M}ethods{A} cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). {W}e selected women with no potential medical need for {CS} among a random sample of women who delivered at each of the participating facilities during the data collection period. {W}e used multilevel multivariable logistic regression to analyse the association between {CS} use and organizational factors, adjusted on women's characteristics. {R}esults {A} total of 2,092 low-risk women who had given birth in the participating hospitals were included. {T}he overall {CS} rate was 24.1%, including 4.9% of pre-labour {CS} and 19.3% of intra-partum {CS}. {P}re-labour {CS} was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward ({OR}a = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery ({OR}a = 0.28 [0.09; 0.87]). {I}ntra-partum {CS} was significantly associated with a higher bed occupancy level ({OR}a = 1.45 [1.09; 1.93]): intrapartum {CS} rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%.{C}onclusion{O}ur results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women's preference for {CS}, and the excessive workload of healthcare providers drive the {CS} overuse in these hospitals. {I}t is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care.{T}rial registration{T}he {QUALI}-{DEC} trial is registered on the {C}urrent {C}ontrolled {T}rials website (https://www.isrctn.com/) under the number {ISRCTN}67214403.},
  keywords = {{C}aesarean section ; {H}ospital organization ; {M}ode of birth ; {L}ow- and middle-income countries ; {ARGENTINE} ; {BURKINA} {FASO} ; {THAILANDE} ; {VIET} {NAM} ; {PAYS} {EN} {DEVELOPPEMENT}},
  booktitle = {},
  journal = {{BMC} {P}regnancy and {C}hildbirth},
  volume = {24},
  numero = {1},
  pages = {67 [16 ]},
  year = {2024},
  DOI = {10.1186/s12884-024-06257-w},
  URL = {https://www.documentation.ird.fr/hor/fdi:010088947},
}