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2019

DECIDE : a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso

Kaboré Charles, Ridde Valéry, Chaillet Nils, Yaya Bocoum Fadima, Betrán Ana Pilar, Dumont Alexandre



Kaboré Charles, Ridde Valéry, Chaillet Nils, Yaya Bocoum Fadima, Betrán Ana Pilar et Dumont Alexandre (2019) « DECIDE: a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso », BMC Medicine, 17 (1) (décembre), p. 87. DOI : 10.1186/s12916-019-1320-y. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1320-y.
itemfields keyHWPLJPD4
Version12627
TypeArticle de revue
TitreDECIDE: a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso
AuteurKaboré, Charles
AuteurRidde, Valéry
AuteurChaillet, Nils
AuteurYaya Bocoum, Fadima
AuteurBetrán, Ana Pilar
AuteurDumont, Alexandre
RésuméBackground In Burkina Faso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. Effective and safe strategies are needed to prevent unnecessary caesarean deliveries. Methods We conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in Burkina Faso. The evidence-based intervention was designed to promote the use of clinical algorithms for caesarean decision-making using in-site training, audits and feedback of caesarean indications and SMS reminders. The primary outcome was the change in the percentage of unnecessary caesarean deliveries. Unnecessary caesareans were defined on the basis of the literature review and expert consensus. Data were collected daily using a standardized questionnaire, in the same way at both the intervention and control hospitals. Caesareans were classified as necessary or unnecessary in the same way, in both arms of the trial using a standardized computer algorithm.ResultsA total of 2138 and 2036 women who delivered by caesarean section were analysed in the pre and post-intervention periods, respectively. A significant reduction in the percentage of unnecessary caesarean deliveries was evident from the pre- to post-intervention period in the intervention group compared with the control group (18.96 to 6.56% and 18.27 to 23.30% in the intervention and control groups, respectively; odds ratio [OR] for incremental change over time, adjusted for hospital and patient characteristics, 0.22; 95% confidence interval [CI], 0.14 to 0.34; P<0.001; adjusted risk difference, -17.02%; 95% CI, -19.20 to -13.20%).The intervention did not significantly affect the rate of maternal death (0.75 to 0.19% and 0.92 to 0.40% in the intervention and control groups, respectively; adjusted OR 0.32; 95% CI 0.04 to 2.23; P=0.253) or intrapartum-related neonatal death (4.95 to 6.32% and 5.80 to 4.29% in the intervention and control groups, respectively, adjusted OR 1.73; 95% CI 0.82 to 3.66; P=0.149). The overall perinatal mortality data were not available.Conclusion Promotion and training on clinical algorithms for decision-making, audit and feedback and SMS reminders reduced unnecessary caesarean deliveries, compared with usual care in a low-resource setting.
PublicationBMC Medicine
Volume17
Numéro1
Pages87
Date2019-12
Abrév. de revueBMC Med
Langueen
DOI10.1186/s12916-019-1320-y
ISSN1741-7015
Titre abrégéDECIDE
URLhttps://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1320-y
Consulté le2019-05-06T13:21:28Z
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Modifié le2019-06-06T15:25:10Z
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