title: Cesarean sections among Syrian refugees in Lebanon from december 2012/january 2013 to june 2013: probable causes and recommendations.
abstract: BACKGROUND
  There are nearly 3 million Syrian refugees, with more than 1 million in Lebanon. We combined quantitative and qualitative methods to determine cesarean section (CS) rates among Syrian refugees accessing care through United Nations High Commissioner for Refugees (UNHCR)-contracted hospitals in Lebanon and possible driving factors.
  
  
  METHODS
  We analyzed hospital admission data from UNHCR's main partners from December 2012/January 1, 2013, to June 30, 2013. We collected qualitative data in a subset of hospitals through semi-structured informant interviews.
  
  
  RESULTS
  Deliveries accounted for almost 50 percent of hospitalizations. The average CS rate was 35 percent of 6,366 deliveries. Women expressed strong preference for female providers. Clinicians observed that refugees had high incidence of birth and health complications diagnosed at delivery time that often required emergent CS.
  
  
  CONCLUSIONS
  CS rates are high among Syrian refugee women in Lebanon. Limited access and utilization of antenatal care, privatized health care, and male obstetrical providers may be important drivers that need to be addressed.
authors.affiliation: University of Washington.
authors.forename: Karin M J
authors.initials: KM
authors.lastname: Huster
authors.affiliation: United Nations High Commissioner for Refugees Lebanon.
authors.forename: Njogu
authors.initials: N
authors.lastname: Patterson
authors.affiliation: United Nations High Commissioner for Refugees Switzerland.
authors.forename: Marian
authors.initials: M
authors.lastname: Schilperoord
authors.affiliation: United Nations High Commissioner for Refugees Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Spiegel
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006287:Health Planning Guidelines; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D012036:Refugees / Q000706:statistics & numerical data*; D013593:Syria / Q000453:epidemiology; D014480:United Nations
keywords: Lebanon; Syrian crisis; cesarean section; humanitarian emergency; refugee