{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:45:20Z","timestamp":1792176320200,"version":"4.4.0"},"reference-count":51,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation for Acute Medicine","doi-asserted-by":"publisher","award":["40495"],"award-info":[{"award-number":["40495"]}],"id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Maternal and neonatal mortality remain high in Sierra Leone despite significant decline in the last decade. The aim of the present study was to evaluate obstetric care delivery using the Robson Ten Group Classification System (TGCS), focusing on caesarean delivery (CD) and task\u2010sharing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study analyzed maternity and surgical registry data from nine governmental hospitals, collected over 4\u2009months in 2021 or 2022. Variables included mode and outcome of delivery, TGCS parameters, and provider cadre: associate clinician (AC) or medical doctor (MD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 5748 women included in the study, 3806 (66.2%) delivered vaginally, 156 (2.7%) by assisted vaginal delivery and 1786 (31.1%) by CD. The largest TGCS groups were low risk primipara (28.8%) and multipara (47.0%). In the low risk primipara group, 450\/1656 (27.2%) underwent CD; in the low risk multipara group, 604\/2702 (22.4%) underwent CD. MDs performed 876 (49.1%) of the total CDs and ACs 830 (46.5%). ACs performed more CDs with the indication of twin pregnancy, previous CD, or malpresentation, whereas MDs performed more with the indication of breech, uterine rupture, and fetal distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Facility\u2010based CD rates in Sierra Leone are high, particularly among low risk primi\u2010 and multipara\u2010Robson groups, while assisted vaginal delivery rates remain low. Nearly half of all CDs are performed by ACs, highlighting the importance of task\u2010sharing in this context. Further in\u2010depth analysis is warranted to understand the factors influencing CD decision making and the collaborative processes between ACs and MDs to improve maternal and neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71072","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T13:25:22Z","timestamp":1780147522000},"page":"865-876","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A cross\u2010sectional study of caesarean deliveries performed by medical doctors and associate clinicians in nine district and regional hospitals in Sierra Leone using the Robson Ten Group Classification System"],"prefix":"10.1002","volume":"175","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9151-5584","authenticated-orcid":false,"given":"Josien","family":"Westendorp","sequence":"first","affiliation":[{"name":"Institute of Public Health and Nursing The Norwegian University of Science and Technology  Trondheim Norway"},{"name":"CapaCare  Masanga Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rugiatu","family":"Jalloh","sequence":"additional","affiliation":[{"name":"College of Medicine and Allied Health Sciences University of Sierra Leone  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarrah","family":"Sheriff","sequence":"additional","affiliation":[{"name":"Masanga Medical Research Unit  Masanga Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4575-5277","authenticated-orcid":false,"given":"Jenny","family":"Wussow","sequence":"additional","affiliation":[{"name":"Global Health Section, Department of Public Health University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guro","family":"Stamland","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences The Norwegian University of Science and Technology  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid\u2010Anne","family":"Bjor\u00f8y","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences The Norwegian University of Science and Technology  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Moses","sequence":"additional","affiliation":[{"name":"Government of Sierra Leone: Ministry of Health Director of Reproductive Health  Freetown Western Area Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0914-5508","authenticated-orcid":false,"given":"Marcus J.","family":"Rijken","sequence":"additional","affiliation":[{"name":"The Julius Center for Health Sciences and Primary Care Utrecht  The Netherlands"},{"name":"Netherlands Cancer Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7851-5376","authenticated-orcid":false,"given":"Risa","family":"Hoffmann\u2010Lonnee","sequence":"additional","affiliation":[{"name":"Institute of Public Health and Nursing The Norwegian University of Science and Technology  Trondheim Norway"},{"name":"Department of Obstetrics and Gynecology, St. Olavs Hospital HF Trondheim University Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9609-4093","authenticated-orcid":false,"given":"H\u00e5kon A.","family":"Bolkan","sequence":"additional","affiliation":[{"name":"Institute of Public Health and Nursing The Norwegian University of Science and Technology  Trondheim Norway"},{"name":"CapaCare  Masanga Sierra Leone"},{"name":"Department of Surgery, St. Olavs Hospital HF Trondheim University Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6943-0100","authenticated-orcid":false,"given":"Alex J.","family":"van Duinen","sequence":"additional","affiliation":[{"name":"Institute of Public Health and Nursing The Norwegian University of Science and Technology  Trondheim Norway"},{"name":"CapaCare  Masanga Sierra Leone"},{"name":"Department of Surgery, St. Olavs Hospital HF Trondheim University Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13592"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k55"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31927-5"},{"key":"e_1_2_11_6_1","first-page":"1973","article-title":"Maternal and perinatal mortality and complications associated with caesarean section in low\u2010income and middle\u2010income countries: a systematic review and meta\u2010analysis","volume":"393","author":"Bernocchi P","year":"2018","journal-title":"Lancet"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)70111-7"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31930-5"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002494"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aog.0000219750.79480.84"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0200941"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)70094-X"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13267"},{"key":"e_1_2_11_14_1","unstructured":"ICF SSL and.Sierra Leone Demographic and Health Survey 2019. Freetown Sierra Leone and Rockville Maryland USA2020."},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005671"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","unstructured":"AlkireBC VincentJR MearaJG.Benefit\u2010cost analysis for selected surgical interventions in low\u2010 and middle\u2010income countries. Disease Control Priorities Third Edition (Volume 1): Essential Surgery.2015. doi:10.1596\/978-1-4648-0346-8_ch21","DOI":"10.1596\/978-1-4648-0346-8_ch21"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-001605"},{"key":"e_1_2_11_18_1","volume-title":"Sierra Leone Demographic and Health Survey 2019","author":"Statistics Sierra Leone\u2014StatsSL and ICF","year":"2020"},{"key":"e_1_2_11_19_1","unstructured":"PreSTrack will revolutionize maternal health in Sierra Leone.Dr. Austin Demby\u2014Ministry of Health and Sanitation.https:\/\/mohs.gov.sl\/prestrack\u2010will\u2010revolutionize\u2010maternal\u2010health\u2010in\u2010sierra\u2010leone\u2010dr\u2010austin\u2010demby\/"},{"key":"e_1_2_11_20_1","unstructured":"Sierra Leone National Reproductive Maternal Newborn Child and Adolescent Health Strategy 2017\u20132021|WHO|Regional Office for Africa.https:\/\/www.afro.who.int\/publications\/sierra\u2010leone\u2010national\u2010reproductive\u2010maternal\u2010newborn\u2010child\u2010and\u2010adolescent\u2010health"},{"key":"e_1_2_11_21_1","unstructured":"WHO.Estimates by WHO UNICEF UNFPA World Bank Group and UNDESA\/Population Division in Maternal Mortality 2000\u20132023 by Department of Sexual and Reproductive Health and Research World Health Organization.2023."},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2484"},{"key":"e_1_2_11_23_1","unstructured":"UNFPA Sierra Leone|Improving maternal health in Sierra Leone.https:\/\/sierraleone.unfpa.org\/en\/video\/improving\u2010maternal\u2010health\u2010sierra\u2010leone"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/IJERPH18189546"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10552"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-5-17"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01489.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-018423"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11076"},{"key":"e_1_2_11_30_1","unstructured":"The World Bank Group.World Bank Open Data 2023.https:\/\/data.worldbank.org\/country\/sierra\u2010leone"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/IJGO.15996"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60160-X"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3417-1"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.02.043"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14243"},{"key":"e_1_2_11_36_1","unstructured":"World Health Organization.The Robson classification implementation manual 2017.https:\/\/www.who.int\/news\/item\/30\u201011\u20102017\u2010the\u2010robson\u2010classification\u2010implementation\u2010manual"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/BMJOPEN-2023-081143"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033348"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-07009-6"},{"key":"e_1_2_11_40_1","first-page":"4","article-title":"Impact of cesarean section in a private health service in Brazil: indications and neonatal morbidity and mortality rates","volume":"1","author":"Almeida MA","year":"2018","journal-title":"Cesk Gynekol"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/26334941251339710"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14774"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-060773"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.5334\/AOGH.3970"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005528.pub3"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.XAGR.2025.100586"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13172"},{"key":"e_1_2_11_48_1","first-page":"123","article-title":"M. H\u2010L. Robson's clasification of C\u2010section\u2010comparation, interpretation and improvement of perinatal results","volume":"45","year":"2017","journal-title":"J Perinat Med"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30043-9"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.XAGR.2024.100404"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12884-016-1052-3"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10552"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71072","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.71072","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71072","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:50:47Z","timestamp":1792173047000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.71072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,30]]},"references-count":51,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1002\/ijgo.71072"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.71072","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,30]]},"assertion":[{"value":"2026-01-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}