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BJOG. 2016 Feb;123(3):427-36. doi: 10.1111/1471-0528.13509. Epub 2015 Aug 10.

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

Author information

1
Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
2
Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland.
3
Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France.
4
Latin American Center for Perinatology, Women and Reproductive Health, (CLAP/WR), WHO Regional Office for the Americas, Montevideo, Uruguay.
5
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
6
Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris Descartes University, Paris, France.
7
Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
8
Faculty of Health, University of Technology, Sydney, NSW, Australia.
9
Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
10
Centro Rosarino de Estudios Perinatales, Rosario, Argentina.
11
Royal College of Obstetricians and Gynaecologists, Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, London, UK.
12
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
13
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
14
Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
15
Family Health Bureau, Ministry of Health, Colombo, Sri Lanka.
16
Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
17
National Institute for Health and Welfare, Helsinki, Finland.
18
Department of Paediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
19
Bayerische Arbeitsgemeinschaft für Qualitätssicherung in der Stationären Versorgung (BAQ), Bayerische Krankenhausgesellschaft, Munich, Germany.
20
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
21
Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
22
Direction de la santé de la famille, Ministère de la Santé, Ouagadougou, Burkina Faso.
23
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
24
School of Public Health, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia.
25
GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil.
26
Department of Paediatrics, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, SP, Brazil.
27
Departments of Obstetrics & Gynaecology and Global Health Sciences, University of California, San Francisco, CA, USA.
28
Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
29
Department of Obstetrics, School of Medicine of São Paulo, São Paulo Federal University, São Paulo, Brazil.
30
Social Protection and Health Division, Inter-American Development Bank, Mexico City, Mexico.
31
Fortis Memorial Research Institute, Gurgaon, Haryana, India.
32
Hospital Nacional de Itauguá, Itauguá, Paraguay.

Abstract

OBJECTIVE:

To generate a global reference for caesarean section (CS) rates at health facilities.

DESIGN:

Cross-sectional study.

SETTING:

Health facilities from 43 countries.

POPULATION/SAMPLE:

Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing.

METHODS:

We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models.

MAIN OUTCOME MEASURES:

Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate.

RESULTS:

According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/).

CONCLUSIONS:

This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.

TWEETABLE ABSTRACT:

The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.

KEYWORDS:

Benchmarking; caesarean delivery rates; caesarean section rates; logistic regression

PMID:
26259689
PMCID:
PMC4873961
DOI:
10.1111/1471-0528.13509
[Indexed for MEDLINE]
Free PMC Article

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