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Albarqouni L, Abukmail E, MohammedAli M, Elejla S, Abuelazm M, Shaikhkhalil H, Pathirana T, Palagama S, Effa E, Ochodo E, Rugengamanzi E, AlSabaa Y, Ingabire A, Riwa F, Goraya B, Bakhit M, Clark J, Arab-Zozani M, Alves da Silva S, Pramesh CS, Vanderpuye V, Lang E, Korenstein D, Born K, Tabiri S, Ademuyiwa A, Nabhan A, Moynihan R. Low-Value Surgical Procedures in Low- and Middle-Income Countries: A Systematic Scoping Review. JAMA Netw Open 2023; 6:e2342215. [PMID: 37934494 PMCID: PMC10630901 DOI: 10.1001/jamanetworkopen.2023.42215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
Importance Overuse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures. Objectives To assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs. Evidence Review We searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions. Findings Of 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle-income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders. Conclusions and Relevance This systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Majdeddin MohammedAli
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Sewar Elejla
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, Palestine
| | | | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Sujeewa Palagama
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Emmanuel Effa
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kismu City, Kenya
- Centre for Evidence-Based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eulade Rugengamanzi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yousef AlSabaa
- Faculty of Medicine, Al-Azhar University of Gaza, Gaza Strip, Palestine
| | - Ale Ingabire
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Francis Riwa
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Burhan Goraya
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - C. S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Korenstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Born
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Tabiri
- Department of Surgery, University for Development Studies–School of Medicine and Tamale Teaching Hospital, Tamale, Ghana
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Faculty of Clinical Sciences, College of Medicine of the University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos
| | - Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Vazquez Corona M, Betrán AP, Bohren MA. The portrayal and perceptions of cesarean section in Mexican media Facebook pages: a mixed-methods study. Reprod Health 2022; 19:49. [PMID: 35193590 PMCID: PMC8862237 DOI: 10.1186/s12978-022-01351-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mexico has one of the highest rates of cesarean sections globally at over 45%. There is limited research about social factors influencing these rates. This study explores the portrayal and perceptions of cesarean section in Facebook media pages to better understand the socio-cultural context of childbirth in Mexico. Methods This is a mixed-methods social media analysis using two data sources. First, to study the portrayal of cesarean section, we identified ten Mexican media Facebook pages with the largest audiences (based on number of page “likes”). We searched these pages for articles containing the word “cesárea” (Spanish for cesarean section), and posts (articles) were eligible for inclusion if they contained the word “cesárea”. Second, to understand perceptions of cesarean section portrayal, we extracted comment threads of each Facebook post sharing the included articles. We performed a qualitative thematic analysis of articles and a quantitative content analysis of comments. Results We included 133 Facebook posts depicting 80 unique articles and identified three major themes: (1) information about cesarean section, (2) inequality and violence against women, (3) governance failures. Cesarean section was portrayed as a lifesaving procedure when medical necessary, and riskier than vaginal birth, with a longer recovery time, and possible negative health consequences. We extracted comments from 133 Facebook posts, and 6350 comments were included. We inductively developed 20 codes to then classify comments under six major categories: (1) violence and discrimination, (2) health and health services, (3) mode of birth choice, (4) disbelief at information about cesarean section, (5) abortion, and (6) discontent at the government. Conclusions We found that Facebook media did not promote cesarean section over vaginal birth, and risks and consequences were mostly represented reliably. Perceptions about the portrayal of cesarean section showed strong discontent and distrust against providers and the health system, as well as rejection of factual information about the consequences of cesarean section. We documented gross gender inequality and violence against women, highlighting the urgent need for human rights approaches to maternal health to address these inequalities and prevent harmful practices. Our study also contributes to the emerging field of social media analysis, and demonstrates clear areas where social media communication can be improved. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01351-8. Cesarean section is a medical intervention that can save women and babies when there are complications during pregnancy or birth. Mexico has one of the highest rates of cesarean section in the world (45%); much higher than what we would expect. We do not fully understand why this is happening, but we think social influences are important. We know that traditional and social media are important social influences on health and health-seeking behaviors in other countries. In our study, we aimed to explore how cesarean section is portrayed in Facebook Mexican media pages, and how people (Facebook users) interacted with these articles. To do this, we identified the most popular Facebook media pages in Mexico. Next, we searched for all articles posted to these pages. We found 80 articles and studied them to understand how they discussed cesarean section. We found that media articles posted on Facebook did not encourage women to have cesarean section, and they correctly showed risks and consequences. Then, we explored the comments from Facebook users that were attached to these posts about cesarean section. We found 6350 comments, and classified each comment based on the what the Facebook users said. Lastly, we connected the main themes of the articles to the types of comments. We found that Facebook users distrusted the Mexican health system, rejected information about the consequences of cesarean section, and often responded with the content with sexist and aggressive comments against women. Our research shows that while there is accurate and useful information on social media about cesarean section, other social issues like gender inequality and violence may influence pregnancy and childbirth.
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Affiliation(s)
- Martha Vazquez Corona
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Hoxha I, Braha M, Syrogiannouli L, Goodman DC, Jüni P. Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open 2019; 9:e025356. [PMID: 30833323 PMCID: PMC6443081 DOI: 10.1136/bmjopen-2018-025356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/14/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women. RESULTS 12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ2=0.01); and 0.92 times lower odds for CS in uninsured as compared with publicly insured women (95% CI 0.80 to 1.07), with no relevant heterogeneity between studies (τ2=0.02). We found 0.70 times lower odds in uninsured as compared with privately and publicly insured women (95% CI 0.69 to 0.72). CONCLUSIONS CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
| | - Medina Braha
- International Business College Mitrovica, Mitrovica, Kosovo
| | | | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Veile A, Kramer KL. Pregnancy, Birth, and Babies: Motherhood and Modernization in a Yucatec Village. GLOBAL MATERNAL AND CHILD HEALTH 2018. [DOI: 10.1007/978-3-319-71538-4_11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Freyermuth MG, Muños JA, Ochoa MDP. From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas. Int J Equity Health 2017; 16:88. [PMID: 28545459 PMCID: PMC5445324 DOI: 10.1186/s12939-017-0582-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/12/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cesarean deliveries have increased over the past decade in Mexico, including those states with high percentages of indigenous language speakers, e.g., Chiapas. However, the factors contributing to this trend and whether they affect indigenous languages populations remain unknown. Thus, this work aims to identify some of the factors controlling the prevalence of cesarean sections (C-sections) in Chiapas between the 2011-2014 period. METHODS We analyzed certified birth data, compiled by the Subsystem of Information on Births of the Secretary of Health and the National Institute of Statistics and Geography, and information regarding the Human Development Index (HDI), assembled by the United Nations Development Program. A descriptive analysis of the variables and a multilevel logistics regression model were employed to assess the role of the different factors in the observed trends. RESULTS The results show that the factors contributing to the increased risk of C-sections are (i) women residing in municipalities with indigenous population and municipalities with high HDIs, (ii) advanced schooling, (iii) frequent prenatal checkups, and (iv) deliveries occurring in private health clinics. Furthermore, C-sections might also be associated with prolonged hospital stays. CONCLUSIONS The increasing frequency of C-sections among indigenous populations in Chiapas seems to be related to public policies aimed at reducing maternal mortality in Mexico. Therefore, public health policy needs to be revisited to ensure that reproductive rights are being respected.
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Affiliation(s)
- María Graciela Freyermuth
- The Centro de Investigaciones y Estudios Superiores en Antropología Social (CIESAS), Unidad Sureste and Technical Secretary of the Observatory of Maternal Mortality in Mexico (OMM), San Cristobal de las Casas, Chiapas México
| | - José Alberto Muños
- The CONACYT- Center of Research and Higher Studies in Social Anthropology (CIESAS), South Pacific Unit, Oaxaca, México
| | - María del Pilar Ochoa
- Masters in Population and Development, Advisor in the Ministry of Health, Ciudad de México, México
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6
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Al-Hussaini A, Walijee H, Owens D. The uptake of day-case septoplasty in England and Wales. ACTA ACUST UNITED AC 2016. [DOI: 10.1308/rcsbull.2016.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Is there a relationship between daycase rates and waiting list times?
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Affiliation(s)
| | - H Walijee
- Cardiff and Vale University Health Board
| | - D Owens
- Cardiff and Vale University Health Board
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Abstract
BACKGROUND Changes in health care access and birthing practices may pose barriers to optimal breastfeeding in modernizing rural populations. OBJECTIVES We evaluated temporal and maternal age-related trends in birth and breastfeeding in a modernizing Maya agriculturalist community. We tested 2 hypotheses: (1) home births would be associated with better breastfeeding outcomes than hospital births, and (2) vaginal births would be associated with better breastfeeding outcomes than cesarean births. METHODS We interviewed 58 Maya mothers (ages 21-85) regarding their births and breastfeeding practices. General linear models were used to evaluate trends in birthing practices and breastfeeding outcomes (timing of breastfeeding initiation, use of infant formula, age of introduction of complementary feeding, and breastfeeding duration). We then compared breastfeeding outcomes by location (home or hospital) and mode of birth (vaginal or cesarean). RESULTS Timing of breastfeeding initiation and the rate of formula feeding both increased significantly over time. Younger mothers introduced complementary foods earlier, breastfed for shorter durations, and formula fed more than older mothers. Vaginal hospital births were associated with earlier breastfeeding initiation and longer breastfeeding durations than home births. Cesarean births were associated with later breastfeeding initiation, shorter breastfeeding durations, and more formula feeding than vaginal hospital births. CONCLUSION We have observed temporal and maternal age-related trends toward suboptimal breastfeeding patterns in the Maya community. Contrary to our first hypothesis, hospital births per se were not associated with negative breastfeeding outcomes. In support of our second hypothesis, cesarean versus vaginal births were associated with negative breastfeeding outcomes.
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Heredia-Pi I, Servan-Mori EE, Wirtz VJ, Avila-Burgos L, Lozano R. Obstetric care and method of delivery in Mexico: results from the 2012 National Health and Nutrition Survey. PLoS One 2014; 9:e104166. [PMID: 25101781 PMCID: PMC4125173 DOI: 10.1371/journal.pone.0104166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/10/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To identify the current clinical, socio-demographic and obstetric factors associated with the various types of delivery strategies in Mexico. MATERIALS AND METHODS This is a cross-sectional study based on the 2012 National Health and Nutrition Survey (ENSANUT) of 6,736 women aged 12 to 49 years. Delivery types discussed in this paper include vaginal delivery, emergency cesarean section and planned cesarean section. Using bivariate analyses, sub-population group differences were identified. Logistic regression models were applied, including both binary and multinomial outcome variables from the survey. The logistic regression results identify those covariates associated with the type of delivery. RESULTS 53.1% of institutional births in the period 2006 through 2012 were vaginal deliveries, 46.9% were either a planned or emergency cesarean sections. The highest rates of this procedure were among women who reported a complication during delivery (OR: 4.21; 95%CI: 3.66-4.84), between the ages of 35 and 49 at the time of their last child birth (OR: 2.54; 95%CI: 2.02-3.20) and women receiving care through private healthcare providers during delivery (OR: 2.36; 95%CI: 1.84-3.03). CONCLUSIONS The existence of different socio-demographic and obstetric profiles among women who receive care for vaginal or cesarean delivery, are supported by the findings of the present study. The frequency of vaginal delivery is higher in indigenous women, when the care provider is public and, in women with two or more children at time of the most recent child birth. Planned cesarean deliveries are positively associated with years of schooling, a higher socioeconomic level, and higher age. The occurrence of emergency cesarean sections is elevated in women with a diagnosis of a health issue during pregnancy or delivery, and it is reduced in highly marginalized settings.
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Affiliation(s)
| | | | - Veronika J. Wirtz
- Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America
| | | | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
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Al-Hussaini A, Owens D, Tomkinson A. Health costs and consequences: have UK national guidelines had any effect on tonsillectomy rates and hospital admissions for tonsillitis? Eur Arch Otorhinolaryngol 2013; 270:1959-65. [DOI: 10.1007/s00405-013-2345-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Barber SL. Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor. Eur J Public Health 2010; 20:383-8. [PMID: 19933778 PMCID: PMC2908155 DOI: 10.1093/eurpub/ckp184] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 10/14/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Caesarean section rates are increasing in Mexico and Latin America. This study evaluates the impact of a large-scale, conditional cash transfer programme in Mexico on caesarean section rates. The programme provides cash transfers to participating low income, rural households in Mexico conditional on accepting health care and nutrition supplements. METHODS The primary analyses uses retrospective reports from 979 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Using multivariate and instrumental variable analyses, we estimate the impact of the programme on caesarean sections and predict the adjusted mean rates by clinical setting. Programme participation is measured by beneficiary status, programme months and cash transfers. RESULTS More than two-thirds of poor rural women delivered in a health facility. Beneficiary status is associated with a 5.1 percentage point increase in caesarean rates; this impact increases to 7.5 percentage points for beneficiaries enrolled in the programme for >or=6 months before delivery. Beneficiaries had significantly higher caesarean delivery rates in social security facilities (24.0 compared with 5.6% among non-beneficiaries) and in other government facilities (19.3 compared with 9.5%). CONCLUSION The Oportunidades conditional cash transfer programme is associated with higher caesarean section rates in social security and government health facilities. This effect appears to be driven by the increases in disposable income from the cash transfer. These findings are relevant to other countries implementing conditional cash transfer programmes and health care requirements.
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Affiliation(s)
- Sarah L Barber
- Institute of Business and Economic Research, University of California, Berkeley, CA, USA.
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Abdul-Rahim HF, Abu-Rmeileh NME, Wick L. Cesarean section deliveries in the occupied Palestinian territory (oPt): an analysis of the 2006 Palestinian Family Health Survey. Health Policy 2009; 93:151-6. [PMID: 19674810 PMCID: PMC2789246 DOI: 10.1016/j.healthpol.2009.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 07/04/2009] [Accepted: 07/12/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory. METHODS Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15-49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable. RESULTS Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector. CONCLUSIONS There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.
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Affiliation(s)
- Hanan F Abdul-Rahim
- International Affairs Program, Qatar University, P.O. Box 2713, Doha, Qatar.
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Khawaja NP, Yousaf T, Tayyeb R. Analysis of caesarean delivery at a tertiary care hospital in Pakistan. J OBSTET GYNAECOL 2009. [DOI: 10.1080/jog.24.2.139.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Okezie AO, Oyefara B, Chigbu CO. A 4-year analysis of caesarean delivery in a Nigerian teaching hospital: One-quarter of babies born surgically. J OBSTET GYNAECOL 2009; 27:470-4. [PMID: 17701792 DOI: 10.1080/01443610701405945] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Between January 2001 and December 2004, a total of 2,922 deliveries were conducted at the University of Nigeria Teaching Hospital , Enugu. Caesarean section accounted for 740 deliveries, an incidence of 25.3%. A total of 62.2% of caesarean sections were done as emergencies, while 37.8% were done as elective procedures and 64.8% were booked patients. Repeat caesarean sections accounted for 59.2% of elective cases and 18.7% of emergency cases. Fetal distress was responsible for 11. 6% of emergency cases, however 35.6% of babies delivered for clinically diagnosed fetal distress had Apgar scores 7 and above. A total of 85.6% of patients were between 25 - 29 years of age; 31% were primigravida, while 54.4% were Gravida 2 - 4. There were seven (0.6%) maternal deaths and 73 (9.2%) stillbirths. It was concluded that reduction of primary caesarean section rate and repeat caesarean rates should be the main target of any strategy to reduce caesarean section rate. Other measures to reduce the caesarean section rate and recommendations are discussed.
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Affiliation(s)
- A O Okezie
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Freitas PF, Sakae TM, Jacomino ;MEMLP. Fatores médicos e não-médicos associados às taxas de cesariana em um hospital universitário no Sul do Brasil. CAD SAUDE PUBLICA 2008; 24:1051-61. [DOI: 10.1590/s0102-311x2008000500012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 10/08/2007] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi descrever fatores associados ao aumento nas taxas de cesariana em um hospital universitário de 2002 e 2004, explorando a contribuição de fatores médicos e não-médicos para este aumento. Um estudo transversal investigou 2.905 partos ocorridos nos anos de 2002 (1.441) e 2004 (1.464). Diferenças nas razões de prevalência ajustadas pela regressão de Poisson e risco atribuível percentual foram estimados para a associação de cesariana com fatores sócio-demográficos; clínicos e reprodutivos; e do parto, institucionais e da prática obstétrica. As taxas de cesariana aumentaram de 28,4% em 2002 para 36,7% em 2004. Escolaridade materna elevada, hora do parto, presença de patologia e maior freqüência ao pré-natal foram os fatores que representaram a contribuição mais expressiva para o excesso em 2004, quando comparado a 2002. O aumento nas taxas de cesariana ao se comparar os dois anos pode ser atribuído, pelo menos em parte, a um crescimento nas indicações relativas e condições não-médicas.
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Affiliation(s)
- Paulo Fontoura Freitas
- Universidade Federal de Santa Catarina, Brasil; Universidade do Sul de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
| | - Thiago Mamôru Sakae
- Universidade Federal de Santa Catarina, Brasil; Universidade do Sul de Santa Catarina, Brasil
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Kabakian-Khasholian T, Kaddour A, Dejong J, Shayboub R, Nassar A. The policy environment encouraging C-section in Lebanon. Health Policy 2006; 83:37-49. [PMID: 17178426 DOI: 10.1016/j.healthpol.2006.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 11/03/2006] [Accepted: 11/14/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to analyse the environment encouraging C-section in Lebanon and to reveal approaches that could be adopted for the reduction of this practice, by considering the attitudes, opinions and actions of different stakeholders. METHODS Semi-structured interviews were conducted with 20 selected key players, including hospital directors, midwives, insurance bodies, syndicates and scientific societies, ministries, international agencies, medical schools, media representatives and women's groups. In addition, a group discussion was conducted with 10 obstetricians. Semi-structured interviews were conducted with a convenience sample of 36 women who had a C-section within 4 months preceding the study. Data was analysed using the Policy Maker software version 2.3. RESULTS Findings of the study point to the role of multiple factors in shaping the current practices related to C-section deliveries, among which are the organisation of the health care system, the dominance of the private sector, the lack of physician accountability, the minimisation of midwives' roles in the process and women's misconceptions about C-sections. CONCLUSIONS Involvement of the diversity of players is important to change practices in maternity care in Lebanon, after considering their position and power. Different strategies making use of available opportunities to improve the current situation are discussed.
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Affiliation(s)
- Tamar Kabakian-Khasholian
- Health Behavior and Education Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Abstract
Evidence suggests that cesarean birth rates are high and increasing in some developing countries. The objectives of this study are to compile the best current estimate of cesarean birth rates for developing countries, to estimate regional rates, and to document trends nationally and by urban/rural residence where data permit. A database of cesarean birth rates was compiled representing 90 percent of births in the developing world, resulting in an estimated cesarean birth rate for the developing world of 12 percent, with regional rates ranging from 3 to 26 percent. Data representing 45 percent of births in the developing world show that a majority of countries experienced increases in cesarean birth rates during the 1990s, except in sub-Saharan African countries, where little if any change occurred. Cesarean birth rates must be monitored routinely to call attention to rapidly changing practices. These data can, in turn, trigger investigation into the appropriateness of the rate in a given context.
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Affiliation(s)
- Cynthia K Stanton
- Department of Population and Family Health Sciences, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Mennella JA, Turnbull B, Ziegler PJ, Martinez H. Infant feeding practices and early flavor experiences in Mexican infants: an intra-cultural study. ACTA ACUST UNITED AC 2005; 105:908-15. [PMID: 15942540 DOI: 10.1016/j.jada.2005.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The study explored the maternal beliefs and practices related to pregnancy, breastfeeding, and infant feeding among women living in several regions in Mexico. We hypothesized that, despite the culinary diversity within Mexico, there would be similar patterns in the types of flavors and foods eaten by mothers and fed to infants. DESIGN A structured interview was conducted through personal interviews with mothers during routine visits to their local family medical units. The units were located in four regions in Mexico that represent the diversity of culinary practices characteristic of the country. SUBJECTS A random sample of 101 women whose infants ranged in age from 6 days to 9 months. RESULTS Although the vast majority of mothers knew of its benefits and nursed their infants, breastfeeding during the first week of life was not exclusive; approximately one third of the infants were also fed teas, water, and/or formula. The feeding of teas continued throughout infancy in three of the regions, but the flavor of the tea differed. There were also regional similarities in the foods chosen and avoided during pregnancy and lactation and the type of first foods offered to the infants. CONCLUSIONS The similarities in the types of foods fed to infants and eaten more of by mothers during pregnancy suggest that these cultural and regional practices contribute to the development of strong preferences for regional cuisines. The foods eaten by the mother during pregnancy and lactation form the basis of the child's weaning patterns.
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Mossialos E, Allin S, Karras K, Davaki K. An investigation of Caesarean sections in three Greek hospitals: the impact of financial incentives and convenience. Eur J Public Health 2005; 15:288-95. [PMID: 15923214 DOI: 10.1093/eurpub/cki002] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates have been increasing dramatically in the past decades around the world. The objective of our study was to investigate the factors increasing the likelihood of undergoing CS in two public hospitals and one private hospital in Athens, Greece. Specifically, the purpose was primarily to assess the impact of non-medical factors such as private health insurance, potential for making informal payments, physician convenience and socio-economic status on the rate of CS deliveries. METHODS All available demographic, socio-economic and medical information from the medical records of all deliveries in the three hospitals in January 2002 were analysed. The relative importance of the variables in predicting delivery with CS rather than normal vaginal delivery was calculated in multiple logistic regression models to generate odds ratios (OR). RESULTS The CS rate in the public hospitals was 41.6% (52.5% for Greeks and 26% for immigrants), while the CS rate in the private hospital was 53% (65.2% for women with private insurance and 23.9% for women who paid directly). In the public hospitals, after controlling for demographic and medical factors, Greek ethnic background, delivery between 8 a.m. and 4 p.m., between 4 p.m. and midnight, and on Monday, Wednesday and Friday were found to increase the likelihood of CS delivery. In the private hospital, having private health insurance is the strongest predictor of CS delivery, followed by delivery between 8 a.m. and 4 p.m., between 4 p.m. and midnight, delivery on a Saturday and being a housewife. CONCLUSION The results of this study lend support to the hypothesis that physicians are motivated to perform CS for financial and convenience incentives. The recent commercialization of gynaecology services in Greece is discussed, along with its implications on physicians' decisions to perform CS.
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Affiliation(s)
- E Mossialos
- LSE Health and Social Care, Cowdray House, London School of Economics and Political Science, London, UK.
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Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. Multiple cesarean section morbidity. Int J Gynaecol Obstet 2005; 87:227-32. [PMID: 15548394 DOI: 10.1016/j.ijgo.2004.08.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 08/09/2004] [Accepted: 08/13/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify maternal risk associated with multiple cesarean sections (CSs) and determine whether the third CS defines a threshold for increased morbidity. METHODS From January 1997 to January 2002, the clinical records of 3191 women who were delivered by CS at our referral maternity center were examined for selected indicators of maternal morbidity. The women were assigned to groups based on number of CSs and the frequency of each indicator was determined. A composite score for each indicator among women grouped by number of consecutive CSs was then derived to compare risk between groups and against the third CS. RESULTS By all indicators studied, morbidity increased with successive CSs before and through the third CS. However, compared with the third, the risk of major morbidity was significantly increased with the fifth, and much worse at the sixth CS for placenta previa (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.9-7.4), placenta accreta (OR=6.1, 95% CI=2.0-18.4) and hysterectomy (OR=5.9, 95% CI=1.5-24.4). But the third and fourth CSs had the same risk of major morbidity for placenta previa (OR=1.4, 95% CI=0.8-2.2), placenta accreta (OR=1.0, 95% CI=0.3-2.9) and hysterectomy (OR=0.3, 95% CI=0.0-2.7). CONCLUSIONS The third CS does not define a threshold for increased risk to the mother. Instead, overall morbidity rises continually with each successive CS. However, specifically for major morbidity from the triad of placenta previa, placenta accreta and hysterectomy during CS, the fourth CS carries the same risk as the third.
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Affiliation(s)
- F W Makoha
- Department of Obstetrics and Gynecology, Maternity and Children's Hospital, Jeddah, Saudi Arabia.
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