Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings
Abstract Background Rising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of cae...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-022-05264-z |
| _version_ | 1811198326486335488 |
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| author | Zeina Jamaluddine Gloria Paolucci Ghada Ballout Hussam Al-Fudoli Louise T. Day Akihiro Seita Oona M. R. Campbell |
| author_facet | Zeina Jamaluddine Gloria Paolucci Ghada Ballout Hussam Al-Fudoli Louise T. Day Akihiro Seita Oona M. R. Campbell |
| author_sort | Zeina Jamaluddine |
| collection | DOAJ |
| description | Abstract Background Rising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of caesarean-section rates from conflict-affected settings is scarce. This study examines caesareans-section rates among Palestinian refugees by seven-group classification, compares to WHO guidelines, and to rates in the host settings, and estimates the costs of high rates. Methods Electronic medical records of 290,047 Palestinian refugee women using UNRWA’s (United Nations Relief and Works Agency for Palestine Refugees in the Near East) antenatal service from 2017–2020 in five settings (Jordan, Lebanon, Syria, West Bank, Gaza) were used. We modified Robson criteria to compare rates within each group with WHO guidelines. The host setting data were extracted from publicly available reports. Data on costs came from UNRWA’s accounts. Findings Palestinian refugees in Gaza had the lowest caesarean-section rates (22%), followed by those residing in Jordan (28%), West Bank (30%), Lebanon (50%) and Syria (64%). The seven groups caesarean section classification showed women with previous caesarean-sections contributed the most to overall rates. Caesarean-section rates were substantially higher than the WHO guidelines, and excess caesarean-sections (2017–2020) were modelled to cost up to 6.8 million USD. We documented a steady increase in caesarean-section rates in all five settings for refugee and host communities; refugee rates paralleled or were below those in their host country. Interpretation Caesarean-section rates exceed recommended guidance within most groups. The high rates in the nulliparous groups will drive future increases as they become multiparous women with a previous caesarean-section and in turn, face high caesarean rates. Our analysis helps suggest targeted and tailored strategies to reduce caesarean-section rates in priority groups (among low-risk women) organized by those aimed at national governments, and UNRWA, and those aimed at health-care providers. |
| first_indexed | 2024-04-12T01:29:31Z |
| format | Article |
| id | doaj.art-58a0bba16e9942d78f387ca7217c4a6e |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-12T01:29:31Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-58a0bba16e9942d78f387ca7217c4a6e2022-12-22T03:53:32ZengBMCBMC Pregnancy and Childbirth1471-23932022-12-0122111310.1186/s12884-022-05264-zClassifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settingsZeina Jamaluddine0Gloria Paolucci1Ghada Ballout2Hussam Al-Fudoli3Louise T. Day4Akihiro Seita5Oona M. R. Campbell6Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineUnited Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA HeadquartersUnited Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA HeadquartersUnited Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA HeadquartersFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineUnited Nations Relief and Works Agency for Palestinian Refugees in the Near East, UNRWA HeadquartersFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineAbstract Background Rising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of caesarean-section rates from conflict-affected settings is scarce. This study examines caesareans-section rates among Palestinian refugees by seven-group classification, compares to WHO guidelines, and to rates in the host settings, and estimates the costs of high rates. Methods Electronic medical records of 290,047 Palestinian refugee women using UNRWA’s (United Nations Relief and Works Agency for Palestine Refugees in the Near East) antenatal service from 2017–2020 in five settings (Jordan, Lebanon, Syria, West Bank, Gaza) were used. We modified Robson criteria to compare rates within each group with WHO guidelines. The host setting data were extracted from publicly available reports. Data on costs came from UNRWA’s accounts. Findings Palestinian refugees in Gaza had the lowest caesarean-section rates (22%), followed by those residing in Jordan (28%), West Bank (30%), Lebanon (50%) and Syria (64%). The seven groups caesarean section classification showed women with previous caesarean-sections contributed the most to overall rates. Caesarean-section rates were substantially higher than the WHO guidelines, and excess caesarean-sections (2017–2020) were modelled to cost up to 6.8 million USD. We documented a steady increase in caesarean-section rates in all five settings for refugee and host communities; refugee rates paralleled or were below those in their host country. Interpretation Caesarean-section rates exceed recommended guidance within most groups. The high rates in the nulliparous groups will drive future increases as they become multiparous women with a previous caesarean-section and in turn, face high caesarean rates. Our analysis helps suggest targeted and tailored strategies to reduce caesarean-section rates in priority groups (among low-risk women) organized by those aimed at national governments, and UNRWA, and those aimed at health-care providers.https://doi.org/10.1186/s12884-022-05264-zCaesarean-sectionDeliveryRefugeesObstetricsElectronic Medical RecordsRoutinely Collected Health Data |
| spellingShingle | Zeina Jamaluddine Gloria Paolucci Ghada Ballout Hussam Al-Fudoli Louise T. Day Akihiro Seita Oona M. R. Campbell Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings BMC Pregnancy and Childbirth Caesarean-section Delivery Refugees Obstetrics Electronic Medical Records Routinely Collected Health Data |
| title | Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings |
| title_full | Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings |
| title_fullStr | Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings |
| title_full_unstemmed | Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings |
| title_short | Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings |
| title_sort | classifying caesarean section to understand rising rates among palestinian refugees results from 290 047 electronic medical records across five settings |
| topic | Caesarean-section Delivery Refugees Obstetrics Electronic Medical Records Routinely Collected Health Data |
| url | https://doi.org/10.1186/s12884-022-05264-z |
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