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Evaluation of a Strategy to Control the Epidemic of Cesarean Sections in Latin America

Objective

Main project:
To evaluate, within the framework of a randomized trial, the effect of an intervention aimed at reducing Caesarean section (CS) rates in Latin America. The intervention consists of the two following: (i) systematic second opinion before surgery (ii) practitioner education about decreasing CS rates through alternative guidelines for effective and safe management of childbirth.
Furthermore:
* Exploratory assessment of rates and needs of CS in Africa and Asia
* Dissemination of results of a study of maternal needs and demands concerning childbirth
Expected Outcome

The main project & appended proposals:
The main project will assess the effectiveness of a package of co-interventions aimed at curbing the excess rate of CS in Latin America. Should this prove effective, replicating the interventions should not be an issue, as they are mainly behavioural, and therefore their extension to routine care should be neither costly nor complicated. Should the interventions not be effective within the framework of this trial, further assessment of the determinants of the failure will be essential and further in-depth work along the Bradby study would be recommended.
Main project:
The efficacy of the intervention will be assessed in a multicenter cluster randomized controlled trial with two (three) further nested studies: (i) assessment of women's opinions (ii) care-giver's opinions (this survey is optional) and (iii) organisational and cost survey.
In maternity units randomized to the intervention arm, practitioners will systematically discuss the indication for caesarean section with a colleague before resorting to surgery (see a second opinion) and fill in a special form. Educational seminars on ways of decreasing CS will also be organised for the care-givers in the intervention arm maternity units. The trial will be conducted in six Latin American countries: Argentina, Brazil, Chile, Cuba, Guatemala and Mexico contributing a minimum of 17 pairs of maternity units.
The main outcome is CS rate, secondary outcomes include measures of maternal and perinatal morbidity. Satisfaction, acceptability and economic aspects will be assessed in the nested studies. Because of the risk of contamination between intervention and non-intervention units, CS levels will be assessed in all participating units prior to the study.
Furthermore:
* Prevalence and needs of CS in Africa and Asia will be assessed.
* Translation and dissemination of a related previous study will be performed.

Coordinator

Université Libre de Bruxelles
Address
Route De Lennik
1070 Bruxelles
Belgium

Participants (6)

America Arias Hospital
Cuba
Address
Calle Linea Y G, Vedado
10400 La Habana 4
CENTRO ROSARINO DE ESTUDIOS PERINATALES
Argentina
Address
2493,San Luis 2493
2000 Rosario
General Hospital "San Juan de Dios"
Guatemala
Address
10-50,1St Avenue
01001 Guatemala
INSTITUT NATIONAL DE LA SANTE ET DE LA RECHERCHE MEDICALE
France
Address
Boulevard De Port-royal 123 Adr 14 - Paris Ste. An
75014 Paris
The Population Council
Mexico
Address
110,Escondida
04000 Col.villa Coyoacan
Uppsala University
Sweden
Address
95-96,Akademiska Sjukhuset
751 85 Uppsala