Health Management and Economics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Health Economics and Management Department, Health Information Management Research Centre, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
East Mediterr Health J. 2021 Aug 26;27(8):826-849. doi: 10.26719/emhj.21.046.
The increasing trend in unnecessary caesarean sections has caused maternal and neonatal health concerns worldwide. Various medical and non-medical interventions have been designed and implemented to reduce caesarian section overuse. However, their efficacy is questionable.
This study aimed to identify and classify effective interventions to reduce unnecessary caesarian sections.
We searched EMBASE, MEDLINE, Web of Knowledge and Scopus databases for articles, using appropriate search strategies, up to 2 June 2020. Overall, 7951 identified articles were screened and assessed using a valid quality assessment checklist. Finally, 109 eligible studies were included in this review. Thematic content analysis was used to identify and classify the effective interventions.
Overall, 188 effective caesarian section reduction measures were identified. They were categorized into 45 actions, 16 intervention groups and 6 WHO building blocks, including "governance and leadership", "financing", "health workforce", "medical products and technologies", "information" and "service delivery". Using qualified and competent staff, intra-partum services, and oversight were the most commonly applied interventions to reduce unnecessary caesarian sections.
A taxonomy of effective strategies to reduce unnecessary caesarian sections was developed in this study. A holistic approach is crucial to addressing the new epidemic of unnecessary caesarian section. Multiple interventions based on the underlying causes of caesarian section overuse should be designed and implemented at local and global levels.
全球范围内，剖宫产率不断上升，导致母婴健康问题日益受到关注。为了减少不必要的剖宫产，人们设计并实施了各种医疗和非医疗干预措施。然而，这些干预措施的效果尚存在争议。
本研究旨在确定并分类可有效减少不必要剖宫产的干预措施。
我们检索了 EMBASE、MEDLINE、Web of Knowledge 和 Scopus 数据库，检索时间截至 2020 年 6 月 2 日，使用了适当的检索策略。共筛选出 7951 篇文章，采用有效的质量评估清单进行评估，最终纳入了 109 项符合条件的研究。使用主题内容分析法识别并分类有效的干预措施。
共确定了 188 项有效的剖宫产减少措施，可分为 45 项行动、16 个干预组和 6 个世卫组织构建模块，包括“治理和领导力”、“筹资”、“卫生人力”、“医疗产品和技术”、“信息”和“服务提供”。使用合格且有能力的工作人员、产时服务和监督是减少不必要剖宫产最常用的干预措施。
本研究制定了减少不必要剖宫产的有效策略分类法。解决不必要剖宫产这一新的流行问题需要采取整体方法。应在地方和全球层面设计并实施基于剖宫产过度使用根本原因的多种干预措施。
