Health system factors and caesarean sections in Kosovo: a cross-sectional study.
Adult
Case-Control Studies
Cesarean Section
/ statistics & numerical data
Cross-Sectional Studies
Female
Hospitals, Public
/ statistics & numerical data
Humans
Kosovo
/ epidemiology
Pregnancy
Prenatal Care
/ statistics & numerical data
Surveys and Questionnaires
Unnecessary Procedures
/ statistics & numerical data
antenatal care
caesarean section
health care reform
health systems
low and middle income
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
11 04 2019
11 04 2019
Historique:
entrez:
13
4
2019
pubmed:
13
4
2019
medline:
16
4
2020
Statut:
epublish
Résumé
To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo. Cross-sectional survey. Five largest public hospitals in Kosovo. 859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo. The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital. Women with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90). We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
Identifiants
pubmed: 30975683
pii: bmjopen-2018-026702
doi: 10.1136/bmjopen-2018-026702
pmc: PMC6500236
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e026702Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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