TITLE:
Quality of Caesarean Sections in Rural Sub-Saharan Africa: A Prospective Study in Cameroon
AUTHORS:
Jean Dupont Ngowa Kemfang, Jovanny Tsuala Fouogue, Adeline Christel Gwet, Arouna Ngapagna Njayou, Bruno Kenfack, Loic Meukem Tatsipie, Christiane Nsahlai, Henri Donald Mutarambirwa, Pamela Leonie Fouogue Nzogning Manebou, Pierre Marie Tebeu
KEYWORDS:
Childbirth, Caesarean Section, Robson’s Classification, Apgar Score
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.10,
October
20,
2021
ABSTRACT: Introduction: Caesarean section (CS) is a
major reproductive health intervention to improve maternal and foetal outcomes
if appropriately performed. This study aimed
to assess the quality of Caesarean sections (CS) in a rural setting in Cameroon. Materials and Methods: A
prospective study conducted in 3 hospitals from February 1st 2020 to April 30th 2020. One hundred and twenty women who had a CS
were included. Data were grouped into 5 categories: 1) Sociodemographic and obstetrical characteristics, 2) Geographic and financial access, 3) Diagnostic procedures, 4) Operative parameters and 5) Post-operative parameters.
The Dujardin’s model and context-relevant criteria served to construct the quality score. The
scale was 0 - 20 and scores ≤ 15 were considered as unacceptable
quality while those >15 were considered as acceptable quality CS. Logistic
regressions permitted to measure associations. Results: There were 538
deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6)
weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification
was predominant (35.0%). Motorbikes were the mode of transport to the maternity
for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%)
women had paid the full cost of the CS prior to surgery. In addition, 26
(21.6%) women had a complete clinical examination on admission. The surgical
team was not complete ( Sixty six of the 120 (55.3%) caesarean sections
had unacceptable quality CS. Mean (SD) QS was significantly higher in
faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59
(1.24); P 0.001). Immediate postoperative clinical monitoring was effective only
in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of
which 6 freshes still births. No maternal death was recorded and maternal
complications were recorded in 14 (11.7%) cases. Conclusion: The quality
of CS is generally poor in rural settings in West-Cameroon. The quantity and
quality of staffs required for Caesarean sections in the hospitals are
sometimes insufficient. The poor quality of CS in this region could be
addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a
model.