Increasing the availability and quality of caesarean section in Tanzania

Objective: To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. Design: Before-after intervention study design. Settings: Rural Tanzania. Methods: Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CEmOC. Mentoring and audit of reasons for caesarean section (CS) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA) statistical tests. Main outcome measures: Trends in CS rates, proportion of unjustified CS, use of spinal anaesthesia, and the risk of death from complications related to CS and anaesthesia. Results: During the audit period (2012–2014), 5868 of 58 751 deliveries were by CS (10%). The proportion of CS considered to be unjustified decreased from 30 to 17% in health centres (P�=�0.02) and from 37 to 20% in hospitals (P�<�0.001). Practice of spinal anaesthesia for CS increased from 10% to 64% in hospitals (P�<�0.001). Of 110 maternal deaths, 18 (16.4%) were associated with complications of CS, giving a risk of 3.1 per 1000 CS; three (2.7%) were judged to be anaesthetic-associated deaths with a risk of 0.5 per 1000 caesarean deliveries. Conclusions: Increasing availability and quality of CS by improving infrastructure, training and audit of reasons for CS is feasible, acceptable and required in low resource settings. Tweetable abstract: Increasing availability and quality of CS in rural Africa is feasible.