Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Feb;26(1):101199.
doi: 10.1016/j.siny.2021.101199. Epub 2021 Jan 27.

Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement

Adeline A Boatin  1 , Joseph Ngonzi  2 , Gabriel Ganyaglo  3 , Magatte Mbaye  4 , Blair J Wylie  5 , Khady Diouf  6
Affiliations
Review

Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement

Adeline A Boatin et al. Semin Fetal Neonatal Med. 2021 Feb.

Abstract

Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.

Keywords: Cesarean delivery; Childbirth; Low-and middle-income countries; Quality of care; Safety.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests

AAB provides consulting services to Microchips Biotech on contraceptive technology in low- and middle-income countries and is on the scientific advisory board for RHIA Ventures, a US based company investing in technology for reproductive health. There are no conflicts of interest with the work presented in this manuscript.

References

    1. World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. World Health Organization; 2019.
    1. United Nations Inter-agency Group for Child Mortality. A Neglected Tragedy: The global burden of stillbirths. Report of the UN Inter-agency Group for Child Mortality Estimation, 2020. n.d.
    1. National Academies of Sciences E, Medicine. Crossing the global quality chasm: Improving health care worldwide. National Academies Press; 2018. - PubMed
    1. Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet 2018;392:2203–12. 10.1016/S0140-6736(18)31668-4. - DOI - PMC - PubMed
    1. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018;6:e1196–252. 10.1016/S2214-109X(18)30386-3. - DOI - PMC - PubMed

Publication types