alexa Trends in Institutional Caesarean Delivery among Low-Risk Patients in Senegal and Mali: Secondary Analysis of a Cluster-Randomized Trial (Quarite)
ISSN: 2167-0420

Journal of Womens Health Care
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Research Article

Trends in Institutional Caesarean Delivery among Low-Risk Patients in Senegal and Mali: Secondary Analysis of a Cluster-Randomized Trial (Quarite)

Augustin Zongo1,2*, Séni Kouanda2, Pierre Fournier3, Mamadou Traore4, Blaise Sondo5 and Alexandre Dumont1,3

1Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, Paris, France

2Health Sciences Research Institute (IRSS), Ouagadougou, Burkina Faso, West Africa

3Hospital Research Centre, University of Montreal (CRCHUM), Canada

4URFOSAME, Referral Health Centre of Commune V, Bamako, Mali, West Africa

5University of Ouagadougou, UFR-SDS, Ouagadougou, Burkina Faso, West Africa

*Corresponding Author:
Augustin Zongo
Research Institute for Development
Université Paris Descartes, Sorbonne Paris Cité
UMR 216, Paris, France
Tel: 70 26 22 91 2
E-mail: [email protected]

Received date: June 02, 2014; Accepted date: September 26, 2014; Published date: October 02, 2014

Citation: Zongo A, Kouanda S, Fournier P, Traore M, Sondo B, et al. (2014) Trends in Institutional Caesarean Delivery among Low-Risk Patients in Senegal and Mali: Secondary Analysis of a Cluster-Randomized Trial (Quarite). J Women’s Health Care 3:192. doi: 10.4172/2167-0420.1000192

Copyright: © 2014 Zongo A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Objective: To measure the trends of institutional caesarean rates in Senegal and Mali and to assess if these trends were modified by the Advances in Labour and Risk Management (ALARM) international program.

Methods: We conducted a secondary analysis of the QUARITE trial to examine the trends in caesarean delivery among low-risk patients in 46 hospitals which were randomized into an intervention group (n = 23) and a control group (n = 23). ALARM combined maternal death reviews and continuous medical education to improve the quality of obstetric care.

Results: Between the pre-intervention period and the post-intervention period, the institutional caesarean rate among low-risk patients increased from 17.1% to 18.6% in the intervention hospitals (adjusted OR=1.03; 95% CI =0.89-1.15) and from 16.1% to 21.1% in the control arm (adjusted OR=1.47; 95% CI=1.27-1.52). The increase was significantly higher in the control group than in the intervention group, p<0.0001.

Conclusion: Caesarean delivery rates increased in referral hospitals in Senegal and Mali after the free caesarean policy was implemented. Because of potential arms for mothers and newborns associated with unnecessary caesarean delivery, ALARM international program should be considered as a promising intervention to limit excessive rise of caesareans in this context.


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