Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review
Bibliographic record
Abstract
Abstract Background: Advancement in medicine has improved birth assistance. As a result, caesarean section delivery (CSD) has become the most commonly performed surgical procedure. The exponential growth has now skewed toward low- and middle-income countries (LMICs) despite the well-established morbimortality risk and extra costs associated to this procedure. The expansion of private healthcare sector may be playing a significant role. The objective of this review synthesizes knowledge and investigates the difference in materno-fetal and neonatal outcomes of CSD in the perinatal period, between private and public hospitals. Methods: Medline, Embase, Cinhal, Cochrane Database, LILACS, and HINARI were screened for peer-reviewed published studies in English and French, from 1990 to 2019, in human subjects and supplemented by manual searches. The studies included were prospective and retrospective cohort studies, cross-sectional and Delphi studies comparing perinatal outcomes of women whose neonates were delivered by caesarean section and by vaginal delivery in public and private hospitals. In total, the searches yielded 7,762 studies, assessed independently by two assessors. Of these, 26 quantitative studies were included which risk of bias was considered fairly low.Results: Elective or not, CSD is associated with a variety of outcomes, including death for both the mother and the neonate. Low quality of life, postpartum depression, infections, and scars were burdens attributable to CSD in both sectors. CSD is associated with less urinary incontinence compared to vaginal delivery but no difference exists in early skin-to-skin contact or in early breastfeeding introduction. Finally, across continents, Africa leads in terms of adverse consequences.Discussion/Conclusion: Private facilities surpassed public ones in CSD rate but were associated with the least severe materno-neonatal outcomes. Countries like China are succeeding through robust policies interventions formulation to contain the CSD epidemic and the health issues associated thereto.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.006 |
| Bibliometrics | 0.010 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".