title: A national review of cesarean delivery in Ethiopia.
abstract: OBJECTIVE
  To describe Ethiopian national population-based and institutional cesarean delivery rates by sector, and to describe indications for cesarean delivery, fetal and maternal outcomes, and aspects of quality of care.
  
  
  METHODS
  The data source was the national baseline assessment of emergency obstetric and newborn care--a cross-sectional, facility-based survey of 797 facilities. Two instruments were used to collect the data for the present paper: a retrospective record review of 267 cesarean deliveries based on the last 3 performed in each facility; and a 12-month summary of each facility's statistics on vaginal and abdominal deliveries.
  
  
  RESULTS
  The national population-based cesarean delivery rate was 0.6%, with regional rates varying from 0.2% to 9%. The overall institutional rate was 18%, which varied between 46% in the private for- profit sector and 15% in the public sector. Maternal indications accounted for 66% of the cesareans reviewed, and fetal indications for 34%. Three-quarters of the cesareans were recorded as emergencies, but only 12% of these had their labor monitored with a partograph. The interval between decision and delivery was within 30 minutes for 36% of the women, 31-60 minutes for 23%, and more than 5 hours for 19%. Antibiotics were given in 94% of the reviewed cases; nevertheless, 12% of the cases reported wound infection. There were 2 maternal deaths and 14% of the newborns were stillbirths or died shortly after birth.
  
  
  CONCLUSIONS
  The study showed little progress in the proportion of all births delivered by cesarean and a high rate of cesarean among women attended in the private sector--indicating a need to monitor the appropriateness of obstetric care in all sectors and to increase access in rural areas. Clinical management protocols for obstetric and newborn care are needed, and audits of cesareans should be performed at all institutions, especially in the private sector. The importance of improving record keeping is crucial for informed local decision-making.
authors.affiliation: World Health Organization, Addis Ababa, Ethiopia. nebreedf@et.afro.who.int
authors.forename: Nebreed
authors.initials: N
authors.lastname: Fesseha
authors.forename: Atnafu
authors.initials: A
authors.lastname: Getachew
authors.forename: Mihret
authors.initials: M
authors.lastname: Hiluf
authors.forename: Yirgu
authors.initials: Y
authors.lastname: Gebrehiwot
authors.forename: Patricia
authors.initials: P
authors.lastname: Bailey
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D003625:Data Collection; D003657:Decision Making; D004632:Emergency Medical Services / Q000592:standards; D005002:Ethiopia; D005260:Female; D006801:Humans; D007224:Infant Care / Q000592:standards; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D017149:Private Sector / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents