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What to scale first? A cross-sectional analysis of factors affecting cesarean delivery rates at first referral units in Bihar, India.
- Source :
-
Global health action [Glob Health Action] 2023 Dec 31; Vol. 16 (1), pp. 2202465. - Publication Year :
- 2023
-
Abstract
- 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.<br />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.<br />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.<br />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.<br />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.
Details
- Language :
- English
- ISSN :
- 1654-9880
- Volume :
- 16
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Global health action
- Publication Type :
- Academic Journal
- Accession number :
- 37133240
- Full Text :
- https://doi.org/10.1080/16549716.2023.2202465