title: Quality cesarean delivery in Ouagadougou, Burkina Faso: a comprehensive approach.
abstract: OBJECTIVE
  To assess the effects of a comprehensive intervention (staff training, equipment, internal clinical audits, cost sharing system, patients-providers meetings) in improving cesarean delivery access and quality in an urban district of Burkina Faso.
  
  
  METHODS
  We conducted a before-after study in the health district sector 30 in Ouagadougou between 2003 and 2006. We measured cesarean delivery quality (accessibility, diagnosis, procedure, postoperative follow-up) and maternal and neonatal health in 1371 sections.
  
  
  RESULTS
  The number of cesarean deliveries performed increased each year, from 42 in 2003 to 630 in 2006. This increase happened without increase in maternal and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006). The cesarean delivery rate for women of the district increased from 1.9% to 3.3% of expected births between 2003 and 2005.
  
  
  CONCLUSIONS
  To improve access to quality cesarean delivery, we have shown that it was necessary to have a systemic approach combining technical, operational, sociocultural, and political factors.
authors.affiliation: Quality and Human Resources Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. frichard@itg.be
authors.forename: F
authors.initials: F
authors.lastname: Richard
authors.forename: C
authors.initials: C
authors.lastname: Ouédraogo
authors.forename: V
authors.initials: V
authors.lastname: De Brouwere
mesh_terms: D002050:Burkina Faso; D002585:Cesarean Section / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D017047:Cost Sharing; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008485:Medical Audit; D010353:Patient Education as Topic; D054238:Perinatal Mortality; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards; D012307:Risk Factors; D012959:Socioeconomic Factors; D013192:Staff Development