title: Caesarean sections in rural Burundi: how well are mothers doing two years on?
abstract: METHODS
  A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.
  
  
  OBJECTIVE
  Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes.
  
  
  METHODS
  A household survey among women who underwent C-sections.
  
  
  RESULTS
  Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths.
  
  
  CONCLUSIONS
  Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.
authors.affiliation: Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg.
authors.forename: W
authors.initials: W
authors.lastname: van den Boogaard
authors.affiliation: Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.affiliation: MSF, Brussels Operational Centre, Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: De Plecker
authors.affiliation: MSF, Brussels Operational Centre, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Caluwaerts
authors.affiliation: MSF, Bujumbura, Burundi.
authors.forename: K
authors.initials: K
authors.lastname: Nanan-N'zeth
authors.affiliation: MSF, Bujumbura, Burundi.
authors.forename: B
authors.initials: B
authors.lastname: Duchenne
authors.affiliation: MSF, Brussels Operational Centre, Brussels, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Etienne
authors.affiliation: Ministry of Health, Bujumbura, Burundi.
authors.forename: N
authors.initials: N
authors.lastname: Juma
authors.affiliation: Ministry of Health, Bujumbura, Burundi.
authors.forename: B
authors.initials: B
authors.lastname: Ndelema
authors.affiliation: Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
keywords: emergency obstetrics; family planning; inter-pregnancy interval; operational research; sub-Saharan Africa