What to scale first? A cross-sectional analysis of factors affecting cesarean delivery rates at first referral units in Bihar, India
Bibliographic Data
| ID | 19529787 |
|---|---|
| Authors | Anna Alaska Pendleton (0000-0001-9800-0110, Massachusetts General Hospital), Rohini Dutta (0000-0002-9674-0067, World Health Organization - India), Minal Shukla (Care India), Anusha Jayaram (0000-0003-3776-7419, Tufts University), Anita Gadgil (0000-0002-9276-6649, World Health Organization - India), Sasmita Hembram (World Health Organization - India), Nobhojit Roy (0000-0003-2022-7416, Karolinska Institutet, corresponding author), Nakul Raykar (0000-0003-1825-7333, Brigham and Women's Hospital) |
| Year | 2023 |
| Volume | 16 |
| Issue | 1 |
| Pages | 2202465-2202465 |
| Publication date | 2023-12-31 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Global Health Action (JOURNAL) |
| Journal identifiers | ISSN: 1654-9716 • E-ISSN: 1654-9880 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/16549716.2023.2202465 |
| PMID | 37133240 |
| OpenAlex | W4367834289 |
| Language | EN |
| Citations received | 1 |
| References cited | 24 |
BACKGROUND: Low rates of caesarean delivery (CD) (<10%) hinder access to a lifesaving procedure for the most vulnerable populations in low-resource settings, but there is a paucity of data regarding which factors contribute most to CD rates. OBJECTIVES: We aimed to determine caesarean delivery rates at Bihar's first referral units (FRUs) stratified by facility level (regional, sub-district, district). The secondary aim was to identify facility-level factors associated with caesarean delivery rates. METHODS: This cross-sectional study used open-source national datasets from government FRUs in Bihar, India, from April 2018-March 2019. Multivariate Poisson regression analysed association of infrastructure and workforce factors with CD rates. RESULTS: Of 546,444 deliveries conducted at 149 FRUs, 16961 were CDs, yielding a state-wide FRU CD of 3.1%. There were 67 (45%) regional hospitals, 45 (30%) sub-district hospitals, and 37 (25%) district hospitals. Sixty-one percent of FRUs qualified as having intact infrastructure, 84% had a functioning operating room, but only 7% were LaQshya (Labour Room Quality Improvement Initiative) certified. Considering workforce, 58% had an obstetrician-gynaecologist (range 0-10), 39% had an anaesthetist (range 0-5), and 35% had a provider trained in Emergency Obstetric Care (EmOC) (range 0-4) through a task-sharing initiative. The majority of regional hospitals lack the essential workforce and infrastructure to perform CDs. Multivariate regression including all FRUs performing deliveries demonstrated that presence of a functioning operating room (IRR = 21.0, 95%CI 7.9-55.8, p < 0.001) and the number of obstetrician-gynaecologists (IRR = 1.3, 95%CI 1.1-1.4, p = 0.001) and EmOCs (IRR = 1.6, 95%CI 1.3-1.9, p < 0.001) were associated with facility-level CD rates. CONCLUSION: Only 3.1% of the institutional childbirths in Bihar's FRUs were by CD. The presence of a functional operating room, obstetrician, and task-sharing provider (EmOC) was strongly associated with CD. These factors may represent initial investment priorities for scaling up CD rates in Bihar
Cartography · Cross-sectional study · Environmental health · Family medicine · Geography · Referral · Global Health and Surgery · Global Maternal and Child Health · Maternal and Perinatal Health Interventions · Medicine
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State and socio-demographic group variation in out-of-pocket expenditure, borrowings and Janani Suraksha Yojana (JSY) programme use for birth deliveries in India
The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal
| Citations per year | 1 |
|---|---|
| Citation span | 2026 - 2026 (1) |
| Highly cited | No |