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Institutional capacity for obstetric care and its association with cesarean section rates in Mexico: a risk model evaluation approach.

Conzuelo Rodriguez, Gabriel (2016) Institutional capacity for obstetric care and its association with cesarean section rates in Mexico: a risk model evaluation approach. Master Essay, University of Pittsburgh.

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Abstract

Background/Objective: Worldwide, cesarean section (CS) rates have increased in the last decades, particularly the number of elective procedures. Although CS contribute to reduce maternal and fetal morbidity and mortality under appropriate medical indications, risks overpass the benefits when done indiscriminately. In Mexico, CS rates are higher than those recommended by the WHO. Institutional factors such as infrastructure and availability of services have been recognized as predictors of CS, yet they have not been widely explored. The aim of this study is to evaluate the association between obstetric institutional capacity and CS rate in a Mexican setting. Methods: Data comes from 14 hospitals included in the 2010-2012 waves of the WHO Multi-Country Survey (WHOMCS). The primary analysis included 12,720 obstetric events. CS rate was the outcome variable and Facility Capacity Index (FCI) score the main predictor. FCI comprised six service categories: standard of building/basic, medical, emergency obstetric, laboratory tests, hospital practices and human resources, ranging from 12 to 59 points. We also considered type of hospital: public or private, teaching facility and maternity exclusive as secondary predictive variables. Two generalized estimating equations (GEE) models were fit using a modified Poisson approach for binary outcomes. Both models examined the relationship between FCI score and CS rates, the first was adjusted for sociodemographic characteristics of the mother and fetus; the second was also adjusted for institutional factors other than FCI score. Results: CS rate in the sample was 47.3%, among which, 34.1% had no evidence of labor. FCI score lied within 31 and 57 points. Hospitals with lower scores were mostly private. In the adjusted model, we found a positive association for CS across categories of the FCI score. However, we found that the majority of no-labor CS was performed among low capacity institutions. Conclusion: Reduction of CS rates must be a priority for public health officials given its potential drawbacks in morbidity and increased burden in costs for the health system. It is imperative to consider and address institutional factors associated with this practice, since women and physician’s practice style share common characteristics within facility, thus opening a window of opportunity to target better and more effective interventions.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Conzuelo Rodriguez, Gabrielgabriel.conzuelo@pitt.eduGAC49
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBondad, Lisabodnar@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberNaimi, Ashleyashley.naimi@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberJarlenski, Marianmarian.jarlenski@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: 23 November 2016
Date Type: Submission
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 23 May 2017 13:36
Last Modified: 30 Oct 2018 13:58
URI: http://d-scholarship.pitt.edu/id/eprint/30578

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