Innovative Tools and Strategies | Prevention and Clinical Management | Health Systems and Workforce | Strengthening Quality of Care Room: 1.63-1.64 Oral Abstracts
May 10, 2023 09:10 - 10:25(Africa/Johannesburg)
20230510T0910 20230510T1025 Africa/Johannesburg Cesarean Birth at the Right Time and for the Right Patients

Interventions Targeting Health Care Providers to Optimise the Use of Caesarean Section: A Qualitative Comparative Analysis to Identify Important Intervention Features

Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population level have limited benefits for women and babies. Many interventions targeting health care providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting health care providers.

An Example of Too Much Too Soon? A Review of Caesarean Sections Performed in the First Stage of Labour in Kenya 

Caesarean section (CS) is the most commonly performed major surgical procedure, with global rates rising. When performed for appropriate indications, CS can be life-saving for mothers and babies. However, the procedure has potential short- and long-term complications, with reported rates of caesarean-associated death in sub-Saharan Africa at 10.9 per 1,000 procedures. In many health facilities, decisions to perform CS are made by nonspecialist doctors, without support from experienced obstetricians. This can result in suboptimal decision-making and inappropriate surgery. Our study assesses decision-making in CS performed in the first stage of labour.

ReJudge: Development and Testing of an Intervention to Reduce Cesarean Section (CS) Carried Out Due to Fear of Lit ...

Room: 1.63-1.64 International Maternal Newborn Health Conference 2023 information@imnhc.org
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Interventions Targeting Health Care Providers to Optimise the Use of Caesarean Section: A Qualitative Comparative Analysis to Identify Important Intervention Features

Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population level have limited benefits for women and babies. Many interventions targeting health care providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting health care providers.


An Example of Too Much Too Soon? A Review of Caesarean Sections Performed in the First Stage of Labour in Kenya 

Caesarean section (CS) is the most commonly performed major surgical procedure, with global rates rising. When performed for appropriate indications, CS can be life-saving for mothers and babies. However, the procedure has potential short- and long-term complications, with reported rates of caesarean-associated death in sub-Saharan Africa at 10.9 per 1,000 procedures. In many health facilities, decisions to perform CS are made by nonspecialist doctors, without support from experienced obstetricians. This can result in suboptimal decision-making and inappropriate surgery. Our study assesses decision-making in CS performed in the first stage of labour.


ReJudge: Development and Testing of an Intervention to Reduce Cesarean Section (CS) Carried Out Due to Fear of Litigation 

Obstetrics is a leading area for litigation worldwide, which can result in defensive health care practices including the use of interventions to protect against litigation. Caesarean section (CS) rates are over 80% in some regions of India, which is likely to result in medically generated harms. Existing interventions that aim to reduce unnecessary CS include educational interventions and clinical guidelines. Fear of litigation is recognised as a factor that stimulates unnecessary CS. We were unaware of an existing intervention specifically targeted to this driver of unnecessary CS. The ReJudge project was designed to develop an intervention to reduce CS carried out due to fear of litigation.


Implementing the Robson Ten Group Classification System (TGCS) to Monitor Hospital Cesarean Section Rates in Nepal: Some Early Lessons 

Nepal's population-based caesarean section (CS) rate has increased over the years but the (CS) rate of 9% (2016) is still within the World Health Organization (WHO) reference of 5–15%. Observed rates at the facility level vary due to case-mix, and their appropriateness is difficult to assess as they could reflect either overuse or unmet need for CS. Unsafe provision of CS quality of care endangers patient outcomes. The Family Welfare Division (FWD) adapted the WHO Robson Ten Group Classification System (TGCS) Guideline 2017, piloted it in four hospitals, and has recently rolled it out to 33 hospitals across the country.

Interventions Targeting Health Care Providers to Optimise the Use of Caesarean Section: A Qualitative Comparative Analysis to Identify Important Intervention Features
Single Abstract 09:10 AM - 10:25 AM (Africa/Johannesburg) 2023/05/10 07:10:00 UTC - 2023/05/10 08:25:00 UTC
Strengthening Quality of Care
Prevention and Clinical Management
Presenters Rana Islamiah Zahroh
PhD Candidate, Research Asisstant, The University Of Melbourne
Co-authors
DK
Dylan Kneale
Principal Research Fellow, University College Of London
KS
Katy Sutcliffe
Associate Professor, University Of College London
MV
Martha Vazquez Corona
Research Assistant , The University Of Melbourne
NO
Newton Opiyo
Researcher, World Health Organization
Caroline Homer
Co-Program Director, Maternal, Child And Adolescent Health, Burnet Institute
AB
Ana Pilar Betran
Medical Officer, World Health Organization
MB
Meghan Bohren
Associate Professor, University Of Melbourne
An Example of Too Much Too Soon? A Review of Caesarean Sections Performed in the First Stage of Labour in Kenya
Single Abstract 09:10 AM - 10:25 AM (Africa/Johannesburg) 2023/05/10 07:10:00 UTC - 2023/05/10 08:25:00 UTC
None
Strengthening Quality of Care
Presenters Helen Allott
Senior Specialist, Liverpool School Of Tropical Medicine
Co-authors
FD
Fiona Dickinson
M&E Data Manager, Liverpool School Of Tropical Medicine
NS
Nassir Shaban
Consultant Obstetrician And Gynaecologist, Msambweni County Referral Hospita
SS
Sheila Sawe
Resident In Obstetrics And Gynaecology, Moi University
EO
Evans Ogoti
Resident In Obstetrics And Gynaecology, Moi University
MO
Michael Odour
Consultant Obstetrician And Gynaecologist, Bondo Subcounty Hospital
SK
Stephen Karangau
Consultant Obstetrician And Gynaecologist, Muriranjas Sub County Hospital
EO
Ephraim Ochola
Consultant Obstetrician And Gynaecologist, Homa Bay Sub County Hospital
Charles A Ameh
HoD International Public Health/ Professor , Liverpool School Of Tropical Medicine
ReJudge: Development and Testing of an Intervention to Reduce Cesarean Section (CS) Carried Out Due to Fear of Litigation
Single Abstract 09:10 AM - 10:25 AM (Africa/Johannesburg) 2023/05/10 07:10:00 UTC - 2023/05/10 08:25:00 UTC
None
Innovative Tools and Strategies
Health Systems and Workforce
Presenters Soo Downe
University Of Central Lancashire, University Of Central Lancashire
Co-authors
GM
Gill Moncrieff
Research Associate, University Of Central Lancashire
BS
B.R. Shamanna
Professor, University Of Hyderabad
SM
Sunny Mannava
Student, University Of Hyderabad
IK
Indie Kaur
Director Of Midwifery, Fernandez Foundation
JE
Joanna Erdman
Professor Of Law, Dalhousie University, Halifax
MT
Maria Regina Torloni
Professor, São Paulo Federal University
AB
Ana Pilar Betran
Medical Officer, World Health Organization
Implementing the Robson Ten Group Classification System (TGCS) to Monitor Hospital Cesarean Section Rates in Nepal: Some Early Lessons
Single Abstract 09:10 AM - 10:25 AM (Africa/Johannesburg) 2023/05/10 07:10:00 UTC - 2023/05/10 08:25:00 UTC
Strengthening Quality of Care
Innovative Tools and Strategies
Presenters Shanti Mahendra
Team Leader, Nepal Health Sector Support Programme, Options Consultancy Services Ltd
Co-authors
PC
Paras Chipalu
Quality And Coverage Specialist, NHSSP, , Options Consultancy Service Ltd
AD
Alison Dembo-Rath
Team Leader, NHSSP, Options Consultancy Services Ltd.
Team Leader
,
Nepal Health Sector Support Programme, Options Consultancy Services Ltd
University of Central Lancashire
,
University of Central Lancashire
Senior Specialist
,
Liverpool School of Tropical Medicine
PhD Candidate, Research Asisstant
,
The University of Melbourne
Prof. Hadiza Galadanci
Director/ Professor
,
Africa Center of Excellence for Population Health and Policy, Bayero University, Kano
Dr. Enyi Etiaba
Lecturer/Researcher
,
University of Nigeria, College of Medicine, Faculty of Health Science and Technology
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