Caesarean section rates among referred and self-referred women in Tanzania
Author Information
Author(s): Sørbye Ingvil K, Vangen Siri, Oneko Olola, Sundby Johanne, Bergsjø Per
Primary Institution: National Resource Centre for Women's Health, Department of Obstetrics and Gynaecology, Oslo University Hospital HF, Rikshospitalet, Oslo, Norway
Hypothesis
What are the differences in Caesarean section rates and outcomes between formally referred and self-referred birthing women?
Conclusion
Formally referred women had higher Caesarean section rates and poorer neonatal outcomes, indicating the referral system identifies high-risk births but is underutilized.
Supporting Evidence
- 55% of formally referred women had a C-section compared to 27% of self-referred women.
- Low Apgar scores were significantly associated with formal referral.
- Neonatal death rates were higher in formally referred women but not statistically significant after adjustments.
Takeaway
The study looked at women giving birth in Tanzania and found that those who were referred to the hospital had more C-sections and worse outcomes for their babies than those who went directly to the hospital.
Methodology
Data from 21,011 deliveries were analyzed using the Ten-Group Classification System and multiple regression models to assess outcomes based on referral status.
Potential Biases
Potential selection bias due to the cost-sharing policy and the demographic profile of women accessing the tertiary facility.
Limitations
The study relied on registry data, which may have quality issues, and did not include community referral processes or data on women who did not reach care.
Participant Demographics
The study included 20,662 women, with 19% formally referred; demographics showed higher rates of teenage mothers and lower education among referred women.
Statistical Information
P-Value
<0.001
Confidence Interval
95% CI 1.09-1.86
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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