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. 2025 Aug 12;4(3):e70112.
doi: 10.1002/puh2.70112. eCollection 2025 Sep.

WHO Safe Surgery Checklist for Cesarean Section (CS) Delivery: Practice and Associated Factors Among Physicians in Rwanda

Rusagura Rwizigira Eric  1 , Diomede Ntasumbumuyange  2 , Abraham Fessehaye Sium  2
Affiliations

WHO Safe Surgery Checklist for Cesarean Section (CS) Delivery: Practice and Associated Factors Among Physicians in Rwanda

Rusagura Rwizigira Eric et al. Public Health Chall. .

Abstract

Background: Cesarean delivery (CD) is a life-saving intervention when vaginal delivery is not feasible. It is one of the most frequently performed procedures in obstetrics. This study examines the practice of adherence to the World Health Organization (WHO) safe surgery checklist for CD among doctors in Rwanda.

Methods: A cross-sectional survey was conducted among medical practitioners involved in Cesearan deliveries across Rwanda over 8 months in 2024. Data were collected on adherence to various pre-, intra-, and post-operative protocols that stick to the WHO safe surgery checklist for cesarean section (CS) delivery. The data were collected prospectively using a pre-tested questionnaire on Kobo Collect. Data were analyzed using STATA version 13 for analysis. Descriptive data are presented in frequencies and percentages in tables through univariate analysis. A p value ≤0.05 was considered statistically significant.

Results: Significant gaps were found in adherence to pre-operative protocols, with 78.26% of participants not conducting team handovers using the WHO surgical safety checklist. Additionally, 84.78% of practitioners did not ensure pre-cesarean patient bathing with soap or the use of chlorhexidine, contrary to WHO recommendations. Intraoperative practices showed some alignment with the standards, such as the use of chlorhexidine for abdominal skin preparation (97.8%), but revealed deficiencies in thromboprophylaxis measures. Variability in operative techniques was noted, with 71.7% using the Pfannenstiel incision and the same percentage correctly placing the hysterotomy site.

Conclusion: The study highlights critical gaps in adhering to pre-operative, intra-operative, and post-operative WHO safe surgery checklist for Cesearan delivery in Rwanda. There is a need for improved training, adherence to standardized safety protocols, and enhanced post-operative care practices to improve patient outcomes. Job title and clinical experience significantly influence adherence to best practices, underscoring the importance of specialized training.

Keywords: Rwanda; World Health Organization (WHO); cesarean delivery; global health; public health; safe surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

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