Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Abstract

Background: Quality control of care aims to reduce or eliminate \nunnecessary care and to improve the quality of those who are useful both in \ntheir indication and in their implementation. Objective: We conducted this study to assess the rate of \ncaesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management \nin order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the \ngynaeco-obstetrics department of the Laquintinie Hospital of Douala over a \nperiod of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and \nwho gave consent to our study as well as new-borns from these caesareans. We excluded caesarean \ndeliveries from other health structures and referred to Laquintinie Hospital \ndue to morbid operative follow-up. The variables collected were grouped under 3 main \nheadings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out \nof a total of 967 deliveries; a caesarean section rate of 29.06% in 4 months. After \ndata mining, 250 caesarean sections were included in the study because \n31 cases of caesarean deliveries were unusable. Referred pregnancies accounted \nfor 46.8% of the total population and the most common reason for referral was \nstationary labour (23% of cases). All caesareans were performed by the \ngynaeco-obstetricians. Women who had caesarean deliveries were informed by the \noperator of the surgical procedure in 28.4% of cases and 27.6% were notified of \nthe indication for surgery. The operative kit was present in 98% of cases. The \noperating room was available in 93% of cases. Caesareans were performed mostly \nin an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in \nour series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative \ncomplications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal \ndeaths out \nof which 8 were still births. Regarding the postoperative period, 78% of the \noperated patients did not have a good immediate postoperative monitoring. The \npost-operative protocol was not respected in 17% of cases. Postoperative \ncomplications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal \nsuppurations). Conclusion: The frequency of Caesarean sections at Laquintinie \nHospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time \nof emergency caesareans, far above the international standards despite the \nquasi-availability of operating kits and the operating theatre. The state of \nthe premises reveals a sub-workforce creating work overload and therefore a \ndemotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative \nfollow-up and significant neonatal morbidity and mortality. Hence the need to \ninitiate a staff satisfaction survey.