Quality cesarean delivery in Ouagadougou, Burkina Faso: A comprehensive approach

ObjectiveTo 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.MethodsWe 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.ResultsThe 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.ConclusionTo 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.