Determinants of non-medically indicated cesarean deliveries in Burkina Faso.
OBJECTIVE
To identify the factors associated with non-medically indicated cesarean deliveries (NMIC) in Burkina Faso in centers where user fees for cesarean delivery were partially removed.


METHODS
We carried out a criteria-based audit in 22 referral hospitals, using data from a 6-month prospective observational study, to assess the proportion of NMIC. Multivariate logistic regression analyses were used to identify factors associated with NMIC.


RESULTS
The decision of cesarean delivery was not medically indicated in 24% of cases. The factors independently associated with NMIC were urban residence (adjusted OR 1.55; 95% CI, 1.12-2.12; P=0.006), spouse's occupation other than breeder or farmer (aOR varying from 1.77 [95% CI, 1.19-2.62] to 2.15 [95% CI, 1.38-3.32] according to the profession), and cesarean decided by a general practitioner (aOR 1.61; 95% CI, 1.13-2.30; P=0.009).


CONCLUSIONS
The high percentage of unnecessary cesarean deliveries is in contrast to the unmet needs of women who still deliver outside health facilities. NMIC is associated with both socioeconomic determinants and medical factors. Hence, interventions are needed to improve the skills of healthcare professionals and awareness of women concerning the risks associated with unnecessary cesarean delivery.
Institute for Development Research, University Paris Descartes, UMR 216 MERIT, Paris, France; Research Institute of Health Sciences, Ouagadougou, Burkina Faso. Electronic address: kaborewendyam@yahoo.fr.
Charles
C
Kaboré
Department of Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada; Public Health Research Institute, University of Montreal, Montreal, Canada.
Valéry
V
Ridde
Research Institute of Health Sciences, Ouagadougou, Burkina Faso.
Seni
S
Kouanda
Department of Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
Isabelle
I
Agier
Department of Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada; Public Health Research Institute, University of Montreal, Montreal, Canada.
Ludovic
L
Queuille
Institute for Development Research, University Paris Descartes, UMR 216 MERIT, Paris, France.
Alexandre
A
Dumont
D002050:Burkina Faso; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
Burkina Faso; Criterion-based audit; Low-income country; Non-medically indicated cesarean delivery