Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa.
OBJECTIVE
To assess the association between cesarean delivery rates and pregnancy outcomes in African health facilities.


METHODS
Data were obtained from all births over 2-3 months in 131 facilities. Outcomes included maternal deaths, severe maternal morbidity, fresh stillbirths, and neonatal deaths and morbidity.


RESULTS
Median cesarean delivery rate was 8.8% among 83439 births. Cesarean deliveries were performed in only 95 (73%) facilities. Facility-specific cesarean delivery rates were influenced by previous cesarean, pre-eclampsia, induced labor, referral status, and higher health facility classification scores. Pre-eclampsia increased the risks of maternal death, fresh stillbirths, and severe neonatal morbidity. Adjusted emergency cesarean delivery rate was associated with more fresh stillbirths, neonatal deaths, and severe neonatal morbidity--probably related to prolonged labor, asphyxia, and sepsis. Adjusted elective cesarean delivery rate was associated with fewer perinatal deaths.


CONCLUSIONS
Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.
Shah
Archana
A
Department of Making Pregnancy Safer, World Health Organization, Geneva, Switzerland. shaha@who.int
Fawole
Bukola
B
M'imunya
James Machoki
JM
Amokrane
Faouzi
F
Nafiou
Idi
I
Wolomby
Jean-José
JJ
Mugerwa
Kidza
K
Neves
Isilda
I
Nguti
Rosemary
R
Kublickas
Marius
M
Mathai
Matthews
M
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001942:Breast Feeding / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000401:mortality* / Q000706:statistics & numerical data*; D003906:Developing Countries; D017558:Elective Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D016896:Treatment Outcome; D014944:World Health Organization; D055815:Young Adult