title: Increasing the availability and quality of caesarean section in Tanzania.
abstract: OBJECTIVE
  To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania.
  
  
  METHODS
  Before-after intervention study design.
  
  
  METHODS
  Rural Tanzania.
  
  
  METHODS
  Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CEmOC. Mentoring and audit of reasons for caesarean section (CS) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA) statistical tests.
  
  
  METHODS
  Trends in CS rates, proportion of unjustified CS, use of spinal anaesthesia, and the risk of death from complications related to CS and anaesthesia.
  
  
  RESULTS
  During the audit period (2012-2014), 5868 of 58 751 deliveries were by CS (10%). The proportion of CS considered to be unjustified decreased from 30 to 17% in health centres (P = 0.02) and from 37 to 20% in hospitals (P < 0.001). Practice of spinal anaesthesia for CS increased from 10% to 64% in hospitals (P < 0.001). Of 110 maternal deaths, 18 (16.4%) were associated with complications of CS, giving a risk of 3.1 per 1000 CS; three (2.7%) were judged to be anaesthetic-associated deaths with a risk of 0.5 per 1000 caesarean deliveries.
  
  
  CONCLUSIONS
  Increasing availability and quality of CS by improving infrastructure, training and audit of reasons for CS is feasible, acceptable and required in low resource settings.
  
  
  CONCLUSIONS
  Increasing availability and quality of CS in rural Africa is feasible.
authors.affiliation: Tanzanian Training Centre for International Health, Ifakara, Tanzania.|Saint Francis University College for Health and Allied Sciences, Ifakara, Tanzania.|World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: A
authors.initials: A
authors.lastname: Nyamtema
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: N
authors.initials: N
authors.lastname: Mwakatundu
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: S
authors.initials: S
authors.lastname: Dominico
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: H
authors.initials: H
authors.lastname: Mohamed
authors.affiliation: Tanzanian Training Centre for International Health, Ifakara, Tanzania.|World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: A
authors.initials: A
authors.lastname: Shayo
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.|Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: R
authors.initials: R
authors.lastname: Rumanyika
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.|Hubert Kairuki Memorial University, Dar es Salaam, Tanzania.
authors.forename: C
authors.initials: C
authors.lastname: Kairuki
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.|Maweni Regional Referral Hospital, Kigoma, Tanzania.
authors.forename: C
authors.initials: C
authors.lastname: Nzabuhakwa
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.|Sinza Hospital, Kinondoni Municipal Council, Dar es Salaam, Tanzania.
authors.forename: O
authors.initials: O
authors.lastname: Issa
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: C
authors.initials: C
authors.lastname: Lyimo
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.
authors.forename: I
authors.initials: I
authors.lastname: Kasiga
authors.affiliation: World Lung Foundation's Maternal Health Project, Dar es Salaam, Tanzania.|Leiden University Medical Centre and VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000592:standards* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008485:Medical Audit; D011247:Pregnancy; D011256:Pregnancy Outcome; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania / Q000453:epidemiology
keywords: Anaesthesia; caesarean section; risk of death from anaesthestic complications; risk of death from caesarean section complications; unjustified caesarean section