Rate of and factors associated with indications for cesarean deliveries: Results of a national review in Burkina Faso.

OBJECTIVE: To determine the prevalence of cesarean deliveries in Burkina Faso, analyze the indications for them and the outcomes, and identify factors associated with non-absolute maternal indications for the procedure, as opposed to major obstetric interventions performed to save a woman's life. METHODS: In a cross-sectional study, we selected and analyzed cesarean deliveries among those most recently performed between May 2009 and April 2010 in all facilities in Burkina Faso. To identify the factors associated with non-absolute maternal indications, we used generalized estimating equations to take into account the clustering of data at the hospital level. RESULTS: The proportion of births by cesarean delivery was 1.5%, with regional variations ranging from 0.8% to 4.5%. They were performed mainly for absolute maternal indications (54.8%). Cesarean deliveries for non-absolute maternal indications were statistically more frequent in private hospitals (OR 2.2; 95% CI, 1.2-4.0), among women in urban areas (OR 1.6; 95% CI, 1.0-2.4), during scheduled cesareans, and in the absence of use of the partogram. CONCLUSION: This study confirms the small proportion of cesarean deliveries in Burkina, the disparity between urban and rural areas, and the relative preponderance of absolute maternal indications for cesarean delivery.

Indicators of availability, use, and quality of emergency obstetric and neonatal care in Togo in 2012.

OBJECTIVE: To assess the availability, utilization, and quality of emergency obstetric and neonatal care (EmONC) in Togo. METHODS: A cross-sectional study of EmONC services in all public and private health facilities in the territory of Togo conducted from July to December, 2012. The generic tools developed by the Averting Maternal Death and Disability program were used as the basic tools for this evaluation. RESULTS: The survey involved 1019 health facilities including 864 potential EmONC facilities that constituted the final sample. The results showed that there was low availability of functional EmONC health facilities (8 basic EmONC and 24 comprehensive EmONC) with a large urban/rural variation. Among the 24 current CEmONC, 22 were in urban areas and half were from the private sector. The national ratio of availability was 3 EmONC health facilities per 500 000 inhabitants. Nationally, the cesarean delivery rate was 3.5%. The lethality rate of direct obstetric causes was estimated at 1.3%. CONCLUSION: Needs assessment for EmONC showed low availability of EmONC services and underutilization of the available services.