■低剖腹产率(<10%)阻碍了资源匮乏地区最脆弱人群获得救生程序的机会,但是关于哪些因素对CD发病率的贡献最大的数据很少。
■我们旨在确定比哈尔邦的首次转诊单位(FRU)按设施级别分层的剖腹产率(区域,分区,区)。次要目的是确定与剖腹产率相关的设施水平因素。
■这项横断面研究使用了来自比哈尔邦政府FRU的开源国家数据集,印度,从2018年4月至2019年3月。多变量泊松回归分析了基础设施和劳动力因素与CD率的关联。
■在149FRU进行的546,444次交付,16961是CD,产生3.1%的全州FRUCD。有67家(45%)地区医院,45家(30%)街道医院,和37家(25%)地区医院。61%的FRU有资格拥有完整的基础设施,84%的人有一个正常运作的手术室,但只有7%获得了LaQshya(劳工室质量改善倡议)认证。考虑到劳动力,58%有妇产科医生(范围0-10),39%有麻醉师(范围0-5),35%的医疗服务提供者通过任务共享计划接受了急诊产科护理(EmOC)(范围0-4)的培训.大多数地区医院缺乏执行CD的必要劳动力和基础设施。包括所有进行分娩的FRU在内的多因素回归表明,手术室的功能正常(IRR=21.0,95CI7.9-55.8,p<0.001)以及妇产科医生的数量(IRR=1.3,95CI1.1-1.4,p=0.001)和EmOC(IRR=1.6,95CI1.3-1.9,p<0.001)与设施级CD率相关。
■在比哈尔邦的FRU中,只有3.1%的机构分娩是通过CD进行的。有一个功能手术室,产科医生,任务共享提供程序(EmOC)与CD密切相关。这些因素可能代表比哈尔邦提高CD费率的初始投资优先事项。
Low rates of caesarean delivery (CD) (<10%) hinder access to a lifesaving procedure for the most vulnerable populations in low-resource settings, but there is a paucity of data regarding which factors contribute most to CD rates.
We aimed to determine caesarean delivery rates at Bihar\'s first referral units (FRUs) stratified by facility level (regional, sub-district, district). The secondary aim was to identify facility-level factors associated with caesarean delivery rates.
This cross-sectional study used open-source national datasets from government FRUs in Bihar, India, from April 2018-March 2019. Multivariate Poisson regression analysed association of infrastructure and workforce factors with CD rates.
Of 546,444 deliveries conducted at 149 FRUs, 16961 were CDs, yielding a state-wide FRU CD of 3.1%. There were 67 (45%) regional hospitals, 45 (30%) sub-district hospitals, and 37 (25%) district hospitals. Sixty-one percent of FRUs qualified as having intact infrastructure, 84% had a functioning operating room, but only 7% were LaQshya (Labour Room Quality Improvement Initiative) certified. Considering workforce, 58% had an obstetrician-gynaecologist (range 0-10), 39% had an anaesthetist (range 0-5), and 35% had a provider trained in Emergency Obstetric Care (
EmOC) (range 0-4) through a task-sharing initiative. The majority of regional hospitals lack the essential workforce and infrastructure to perform CDs. Multivariate regression including all FRUs performing deliveries demonstrated that presence of a functioning operating room (IRR = 21.0, 95%CI 7.9-55.8, p < 0.001) and the number of obstetrician-gynaecologists (IRR = 1.3, 95%CI 1.1-1.4, p = 0.001) and EmOCs (IRR = 1.6, 95%CI 1.3-1.9, p < 0.001) were associated with facility-level CD rates.
Only 3.1% of the institutional childbirths in Bihar\'s FRUs were by CD. The presence of a functional operating room, obstetrician, and task-sharing provider (
EmOC) was strongly associated with CD. These factors may represent initial investment priorities for scaling up CD rates in Bihar.