title: [Quality of caesarean delivery: A cross-sectional study in 12 hospitals in Benin].
abstract: BACKGROUND
  Caesarean section (CS) is a major obstetric intervention, widely recognized as an effective means to reduce maternal and perinatal mortality, when appropriately performed. CS numbers and rates are regularly published but quality is rarely taken into account. This study aims to describe the quality of caesarean delivery in selected hospitals in Benin.
  
  
  METHODS
  A cross-sectional study was performed among women who had undergone a CS between 18 December 2013 and 8 February 2014 in one randomly selected hospital in each of the 12 administrative districts of Benin. The quality of CS was defined according to the analytical framework of Dujardin and Delvaux (1998) with its four pillars (access, diagnosis, procedure, postoperative care). Data were collected from hospital files and questionnaires from women and hospital directors. Data analysis was performed using Epi Info 3.5.1.
  
  
  RESULTS
  Six hundred and thirty-two women delivered by CS during the period and 579 were eligible for the study. They were aged 26.5±6.3 years, 73.2% living more than 5km from the hospital, 63.0% referred to a health facility of whom 46.0% and 21.8% were transported by motorcycle and by ambulance respectively. The median expenditure by family was FCFA 30 000, ranging from 0 to FCFA 200 000. The admission examination was complete in 12.6% of women and the partograph used in 32.6%. The average CS rate was 37.6%, the average response time, 124minutes. Emergency CS was performed in 80.7%, for absolute maternal indications in 48.0% and under spinal anesthesia in 84.2% (98.3% of which were conducted by a nurse or midwife anesthetist). Maternal mortality was 2000 maternal deaths per 100 000 deliveries, while perinatal mortality was 7.4% (88.4% due to stillbirths).
  
  
  CONCLUSIONS
  CS in Benin hospitals partially fulfilled quality criteria. However access to CS remains difficult and errors of diagnosis or excessive delay are too frequent. Quality CS is not yet a reality in Benin hospitals.
authors.affiliation: Département politiques et systèmes de santé, institut régional de santé publique de Ouidah, université d'Abomey-Calavi, BP 384, Ouidah, Bénin. Electronic address: vmongade@yahoo.com.
authors.forename: V
authors.initials: V
authors.lastname: Mongbo
authors.affiliation: Département politiques et systèmes de santé, institut régional de santé publique de Ouidah, université d'Abomey-Calavi, BP 384, Ouidah, Bénin.
authors.forename: E-M
authors.initials: EM
authors.lastname: Ouendo
authors.affiliation: Département de santé publique, institut de médecine tropicale (IMT) , 155, Nationalestraat, 2000 Anvers, Belgique.
authors.forename: V
authors.initials: V
authors.lastname: De Brouwere
authors.affiliation: Département politiques et systèmes de santé, École de santé publique, université libre de Bruxelles, 808, route de Lennik, 1070 Bruxelles, Belgique.
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.affiliation: Département politiques et systèmes de santé, École de santé publique, université libre de Bruxelles, 808, route de Lennik, 1070 Bruxelles, Belgique.
authors.forename: B
authors.initials: B
authors.lastname: Dujardin
authors.affiliation: Département santé et environnement, institut régional de santé publique de Ouidah, université d'Abomey-Calavi, BP 384, Ouidah, Bénin.
authors.forename: M
authors.initials: M
authors.lastname: Makoutodé
authors.affiliation: Département politiques et systèmes de santé, École de santé publique, université libre de Bruxelles, 808, route de Lennik, 1070 Bruxelles, Belgique.
authors.forename: W-H
authors.initials: WH
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000592:standards / Q000706:statistics & numerical data; D001541:Benin / Q000453:epidemiology; D002585:Cesarean Section / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Benin; Bénin; Caesarean section; Césarienne; Quality; Qualité