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

• Authors: Carol Hogue, Emory University; Michael Kramer, Emory University; JP Souza, Univ Sao Paulo; AP Betran, WHO; A Dumont, Univ Paris 05; B de Mucio, WHO Reg Off Amer; CMG Pickens, Emory University; C Deneux-Tharaux, Paris Descartes Univ; E Ortiz-Panozo, Natl Inst Publ Hlth; E Sullivan, Univ Technol; E Ota, Natl Ctr Child Hlth & Dev; G Togoobaatar, Natl Ctr Child Hlth & Dev; G Carroli, Ctr Rosarino Estudios Perinat; H Knight, Lindsay Stewart R&D Ctr; J Zhang, Shanghai Jiao Tong University; JG Cecatti, Univ Estadual Campinas; JP Vogel, WHO; K Jayaratne, Family Hlth Bur; MC Leal, Fiocruz MS; M Gissler, Natl Inst Hlth & Welf; N Morisaki, Natl Ctr Child Hlth & Dev; N Lack, Bayer Krankenhausgesellschaft; OT Oladapo, WHO; O Tuncalp, WHO; P Lumbiganon, Khon Kaen University; R Mori, Natl Ctr Child Hlth & Dev; S Quintana, Univ Sao Paulo; ADC Passos, Univ Sao Paulo; AC Marcolin, Univ Sao Paulo; A Zongo, Univ Paris 05; B Blondel, Paris Descartes Univ; B Hernandez, University of Washington; C Prunet, Paris Descartes Univ; C Landman, Fiocruz MS; C Ochir, Univ Mongolia; C Cuesta, Ctr Rosarino Estudios Perinat; C Pileggi-Castro, GLIDE Tech Cooperat & Res; D Walker, University of California San Francisco; D Alves, Univ Sao Paulo; E Abalos, Ctr Rosarino Estudios Perinat; ECD Moises, Univ Sao Paulo; EM Vieira, Univ Sao Paulo; G Duarte, Univ Sao Paulo; G Perdona, Univ Sao Paulo; I Gurol-Urganci, Lindsay Stewart R&D Ctr; K Takahiko, Natl Ctr Child Hlth & Dev; L Moscovici, Univ Sao Paulo; L Campodonico, Ctr Rosarino Estudios Perinat; L Oliveira-Ciabati, Univ Sao Paulo; M Laopaiboon, Khon Kaen University; M Danansuriya, Family Hlth Bur; M Nakamura-Pereira, Fiocruz MS; ML Costa, Univ Estadual Campinas; MR Torloni, Univ Fed Sao Paulo; P Borges, Fiocruz MS; PB Olkhanud, Univ Mongolia; R Perez-Cuevas, Inter Amer Dev Bank; SB Agampodi, Family Hlth Bur; S Mittal, Emory University; S Serruya, WHO Reg Off Amer; V Bataglia, Paris Descartes Univ; Z Li, Univ Technol; M Temmerman, WHO; AM Guelmezoglu, WHO
• Journal Title: BJOG: An International Journal of Obstetrics and Gynaecology
• Volume: Volume 123, Number 3
• Publisher: Wiley Open Access | 2016-02-01, Pages 427-436
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1111/1471-0528.13509
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; Benchmarking; caesarean delivery rates; caesarean section rates; logistic regression; METAANALYSIS; DELIVERY

Abstract

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.