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

Souza, J; Betran, A; Dumont, A; de Mucio, B; Gibbs Pickens, C; Deneux-Tharaux, C; Ortiz-Panozo, E; Sullivan, E; Ota, E; Togoobaatar, G; +54 more...Carroli, G; Knight, H; Zhang, J; Cecatti, J; Vogel, J; Jayaratne, K; Leal, M; Gissler, M; Morisaki, N; Lack, N; Oladapo, O; Tunçalp, Ö; Lumbiganon, P; Mori, R; Quintana, S; Costa Passos, A; Marcolin, A; Zongo, A; Blondel, B; Hernández, B; Hogue, C; Prunet, C; Landman, C; Ochir, C; Cuesta, C; Pileggi-Castro, C; Walker, D; Alves, D; Abalos, E; Moises, E; Vieira, E; Duarte, G; Perdona, G; Gurol-Urganci, IORCID logo; Takahiko, K; Moscovici, L; Campodonico, L; Oliveira-Ciabati, L; Laopaiboon, M; Danansuriya, M; Nakamura-Pereira, M; Costa, M; Torloni, M; Kramer, M; Borges, P; Olkhanud, P; Pérez-Cuevas, R; Agampodi, S; Mittal, S; Serruya, S; Bataglia, V; Li, Z; Temmerman, M; Gülmezoglu, A and (2015) A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG, 123 (3). pp. 427-436. ISSN 1470-0328 DOI: 10.1111/1471-0528.13509
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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.


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