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A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study
J P Souza1, A P Betran2, A Dumont3
1Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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.
