A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

OBJECTIVE: To generate a global reference for caesarean section (CS) rates at health facilities. DESIGN: Cross-sectional study. SETTING: Health facilities from 43 countries. POPULATION/SAMPLE: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. METHODS: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. MAIN OUTCOME MEASURES: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. RESULTS: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). CONCLUSIONS: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. TWEETABLE ABSTRACT: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.

A hospital based study on the usage pattern of Child Health Development Record as an information source on infant and young child feeding.

Objective: To assess the usage pattern of child health development record (CHDR) as an information source by the mothers of children aged 6-24 months admitted to a ward in Lady Ridgeway Hospital (LRH) and to assess their level of knowledge and practices on infant and young child feeding (IYCF). Method: A cross-sectional study was conducted in a paediatric ward in LRH from 1st February to 31st August 2009 on mothers with children aged 6-24 months. Feeding patterns, maternal knowledge on messages given in CHDR and selected socio-demographic factors were examined using a pre-tested interviewer-administered questionnaire. Association of feeding practices and socio-demographic characteristics were analyzed using non parametric tests. Ethical approval was granted by the ethical review committee of LRH. Results: Of the 300 mothers administered questionnaires 5 were excluded due to incomplete data. Of the 295 mothers included in study, 36% had passed GCE ordinary level. Of the children, 72% started complementary feeding after 6 months. Nearly 50% of children had satisfactory diet in terms of quality, quantity and frequency. Maternal IYCF knowledge was significantly associated with maternal educational level and reading of CHDR feeding instructions. Conclusion: Mothers have an acceptable level of knowledge on IYCF and satisfactory level of usage of CHDR as an information source. Reading CHDR has a significant impact on higher maternal IYCF knowledge and better IYCF practices.