Assessment of cesarean delivery availability in 26 low- and middle-income countries: a cross-sectional study.
OBJECTIVE
We sought to assess the capacity to provide cesarean delivery (CD) in health facilities in low- and middle-income countries.


METHODS
We conducted secondary analysis of 719 health facilities, in 26 countries in Africa, the Pacific, Asia, and the Mediterranean, using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care.


RESULTS
A total of 531 (73.8%) facilities reported performing CD. In all, 126 (17.5%) facilities did not perform but referred CD; the most common reasons for doing so were lack of skills (53.2%) and nonfunctioning equipment (42.9%). All health facilities surveyed had at least 1 operating room. Of the facilities performing CD, 47.3% did not report the presence of any type of anesthesia provider and 17.9% did not report the presence of any type of obstetric/gynecological or surgical care provider. In facilities reporting a lack of functioning equipment, 26.4% had no access to an oxygen supply, 60.8% had no access to an anesthesia machine, and 65.9% had no access to a blood bank.


CONCLUSIONS
Provision of CD in facilities in low- and middle-income countries is hindered by a lack of an adequate anesthetic and surgical workforce and availability of oxygen, anesthesia, and blood banks.
Faculty of Medicine, School of Public Health, Imperial College London, St Mary's Hospital, London, United Kingdom; Emergency and Essential Surgical Care Program, Health Systems and Innovation. Electronic address: Rele.ologunde09@imperial.ac.uk.
Rele
R
Ologunde
Department of Reproductive Health and Research, United Nations Development Programme/United Nations Fund for Population Activities/United Nations International Children's Emergency Fund/World Health Organization (WHO)/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction; Faculty of Medicine, Dentistry and Health Sciences, School of Population Health, University of Western Australia, Crawley, Australia.
Joshua P
JP
Vogel
Emergency and Essential Surgical Care Program, Health Systems and Innovation.
Meena N
MN
Cherian
Faculty of Medicine, School of Public Health, Imperial College London, St Mary's Hospital, London, United Kingdom.
Mariam
M
Sbaiti
Department of Reproductive Health and Research, United Nations Development Programme/United Nations Fund for Population Activities/United Nations International Children's Emergency Fund/World Health Organization (WHO)/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction.
Mario
M
Merialdi
Faculty of Medicine, School of Public Health, Imperial College London, St Mary's Hospital, London, United Kingdom.
James
J
Yeats
D000776:Anesthesiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D014943:Global Health; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006280:Health Workforce; D006801:Humans; D008427:Maternal Health Services / Q000600:supply & distribution*; D009774:Obstetrics; D011247:Pregnancy
cesarean delivery; low- and middle-income countries; obstetric services; surgery