Quality of Caesarean Sections in Rural Sub-Saharan Africa: A Prospective Study in Cameroon

Introduction: Caesarean section (CS) is a major reproductive health intervention to improve maternal and foetal outcomes if appropriately performed. This study aimed to assess the quality of Caesarean sections (CS) in a rural setting in Cameroon. Materials and Methods: A prospective study conducted in 3 hospitals from February 1st 2020 to April 30th 2020. One hundred and twenty women who had a CS were included. Data were grouped into 5 categories: 1) Sociodemographic and obstetrical characteristics, 2) Geographic and financial access, 3) Diagnostic procedures, 4) Operative parameters and 5) Post-operative parameters. The Dujardin’s model and context-relevant criteria served to construct the quality score. The scale was 0 - 20 and scores ≤ 15 were considered as unacceptable quality while those >15 were considered as acceptable quality CS. Logistic regressions permitted to measure associations. Results: There were 538 deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6) weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification was predominant (35.0%). Motorbikes were the mode of transport to the maternity for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%) women had paid the full cost of the CS prior to surgery. In addition, 26 (21.6%) women had a complete clinical examination on admission. The surgical team was not complete (<6 staffs) in 56 (43.3%) cases. Anaesthesia was done by nurses in all cases. CS was done by a general practitioner and by nurses in 86 (71.7%) and 14 (11.7%) cases respectively. Overall, mean (SD) quality score (QS) was 16.33 (1.60). Sixty six of the 120 (55.3%) caesarean sections had unacceptable quality CS. Mean (SD) QS was significantly higher in faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59 (1.24);P < 0.001). Immediate postoperative clinical monitoring was effective only in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of which 6 freshes still births. No maternal death was recorded and maternal complications were recorded in 14 (11.7%) cases. Conclusion: The quality of CS is generally poor in rural settings in West-Cameroon. The quantity and quality of staffs required for Caesarean sections in the hospitals are sometimes insufficient. The poor quality of CS in this region could be addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a model.