title: Audit of cesarean delivery in Burkina Faso.
abstract: OBJECTIVE
  To assess the level and determinants of unnecessary cesarean delivery.
  
  
  METHODS
  In a retrospective study, the medical charts were reviewed for 300 low-risk women who underwent intrapartum cesarean delivery at 10 referral hospitals in Burkina Faso between May 2009 and April 2010. In this context, cesarean deliveries were delegated to clinical officers who have less training than doctors.
  
  
  RESULTS
  Among the 300 study patients, 223 women (74.3%) were referred from primary healthcare facilities. The reason for referral was not medically justified for 35 women. Cesarean was performed by a gynecologist-obstetrician (46.0%), a trained doctor (35.0%), or a clinical officer (19.0%). Acute fetal distress and fetopelvic disproportion were the main indications recorded for intrapartum cesarean delivery. These diagnoses were not confirmed by an obstetrician-gynecologist in 12.0% of cases. Clinical officers were associated with a higher risk of unnecessary cesarean delivery compared with gynecologist-obstetricians by multivariate analysis (odds ratio, 4.46; 95% confidence interval, 1.44-13.77; P = 0.009).
  
  
  CONCLUSIONS
  Verification of cesarean indications by highly qualified personnel (i.e. second opinion), in-service training, and supervision of health workers in primary healthcare facilities might improve the performance of the referral system and help to reduce unnecessary cesarean deliveries in Burkina Faso.
authors.affiliation: Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso; Institut africain de santé publique (IASP), Ouagadougou, Burkina Faso. Electronic address: skouanda@irss.bf.
authors.forename: Seni
authors.initials: S
authors.lastname: Kouanda
authors.affiliation: Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso.
authors.forename: Abou
authors.initials: A
authors.lastname: Coulibaly
authors.affiliation: Unité de Formation et de Recherche en sciences de la santé, Université de Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso.
authors.forename: Ali
authors.initials: A
authors.lastname: Ouedraogo
authors.affiliation: Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso.
authors.forename: Tieba
authors.initials: T
authors.lastname: Millogo
authors.affiliation: Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso.
authors.forename: Bertrand I
authors.initials: BI
authors.lastname: Meda
authors.affiliation: Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumont
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Low-resource settings; Task shifting; Unnecessary cesarean delivery