RESUMEN
OBJECTIVE: To generate a global reference for caesarean section (CS) rates at health facilities. DESIGN: Cross-sectional study. SETTING: Health facilities from 43 countries. POPULATION/SAMPLE: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. METHODS: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. MAIN OUTCOME MEASURES: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. RESULTS: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). CONCLUSIONS: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. TWEETABLE ABSTRACT: The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.
Asunto(s)
Cesárea/estadística & datos numéricos , Modelos Estadísticos , Adulto , Estudios Transversales , Femenino , Humanos , Internacionalidad , Embarazo , Valores de ReferenciaRESUMEN
In the United States, infant mortality risks among Hispanics have not been previously evaluated at the national level. We used the 1983 and 1984 national Linked Birth and Infant Death data sets to compare infant mortality risks among single-delivery infants of Hispanic descent with those among single-delivery infants of non-Hispanic whites (the reference group). We also included the 1983 and 1984 linked birth cohort for single-delivery infants in Puerto Rico. Among all Hispanic groups, the neonatal (less than 28 days) mortality risk was higher among Puerto Rican islanders (relative risk [RR] = 2.3) and continental Puerto Ricans (RR = 1.5) and lower among Cuban-Americans (RR = 1.0) and Mexican-Americans (RR = 1.0). The postneonatal mortality risk (28 to 364 days) was highest among continental Puerto Ricans (RR = 1.2) and lowest among Cuban-Americans (RR = 0.6). Our study underscores the heterogeneity of the Hispanic population in the United States and suggests that interventions to prevent infant mortality be tailored to ethnic-specific risk factors and outcomes.