title: Measuring coverage in MNCH: validating women's self-report of emergency cesarean sections in Ghana and the Dominican Republic.
abstract: BACKGROUND
  Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR).
  
  
  RESULTS
  This study compares hospital-based data, considered the reference standard, against women's self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic.
  
  
  CONCLUSIONS
  Questions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, United States of America. otuncalp@jhsph.edu
authors.forename: Ozge
authors.initials: O
authors.lastname: Tunçalp
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stanton
authors.forename: Arachu
authors.initials: A
authors.lastname: Castro
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
authors.forename: Marilyn
authors.initials: M
authors.lastname: Heymann
authors.forename: Kwame
authors.initials: K
authors.lastname: Adu-Bonsaffoh
authors.forename: Samantha R
authors.initials: SR
authors.lastname: Lattof
authors.forename: Ann
authors.initials: A
authors.lastname: Blanc
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000600:supply & distribution*; D004293:Dominican Republic; D004632:Emergency Medical Services / Q000600:supply & distribution*; D005260:Female; D005869:Ghana; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000600:supply & distribution*; D008875:Middle Aged; D011247:Pregnancy; D015203:Reproducibility of Results; D057566:Self Report; D055815:Young Adult