Richard F, Ouédraogo C, De Brouwere V
Quality and Human Resources Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Int J Gynaecol Obstet. 2008 Dec;103(3):283-90. doi: 10.1016/j.ijgo.2008.08.008. Epub 2008 Nov 6.
To assess the effects of a comprehensive intervention (staff training, equipment, internal clinical audits, cost sharing system, patients-providers meetings) in improving cesarean delivery access and quality in an urban district of Burkina Faso.
We conducted a before-after study in the health district sector 30 in Ouagadougou between 2003 and 2006. We measured cesarean delivery quality (accessibility, diagnosis, procedure, postoperative follow-up) and maternal and neonatal health in 1371 sections.
The number of cesarean deliveries performed increased each year, from 42 in 2003 to 630 in 2006. This increase happened without increase in maternal and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006). The cesarean delivery rate for women of the district increased from 1.9% to 3.3% of expected births between 2003 and 2005.
To improve access to quality cesarean delivery, we have shown that it was necessary to have a systemic approach combining technical, operational, sociocultural, and political factors.
评估综合干预措施（人员培训、设备、内部临床审计、费用分担系统、医患会议）对改善布基纳法索一个城市地区剖宫产可及性和质量的效果。
2003年至2006年期间，我们在瓦加杜古的第30个卫生区开展了一项前后对照研究。我们对1371例剖宫产手术的质量（可及性、诊断、手术过程、术后随访）以及孕产妇和新生儿健康状况进行了测量。
剖宫产手术数量逐年增加，从2003年的42例增至2006年的630例。这一增长并未导致剖宫产术后孕产妇和围产儿死亡率上升（2006年分别为1.1%和3.6%）。2003年至2005年期间，该地区妇女的剖宫产率从预期出生数的1.9%升至3.3%。
为了改善优质剖宫产的可及性，我们证明有必要采用一种综合技术、操作、社会文化和政治因素的系统方法。
