{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T03:44:49Z","timestamp":1774583089983,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T00:00:00Z","timestamp":1469145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"World Lung Foundation's"},{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Fondation H&B Agerup"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,9]]},"abstract":"Objective<\/jats:title>To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania.<\/jats:p><\/jats:sec>Design<\/jats:title>Before\u2010after intervention study design.<\/jats:p><\/jats:sec>Settings<\/jats:title>Rural Tanzania.<\/jats:p><\/jats:sec>Methods<\/jats:title>Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CE<\/jats:styled-content>mOC<\/jats:styled-content>) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CE<\/jats:styled-content>mOC<\/jats:styled-content>. Mentoring and audit of reasons for caesarean section (CS<\/jats:styled-content>) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA<\/jats:styled-content>) statistical tests.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Trends in CS<\/jats:styled-content> rates, proportion of unjustified CS<\/jats:styled-content>, use of spinal anaesthesia, and the risk of death from complications related to CS<\/jats:styled-content> and anaesthesia.<\/jats:p><\/jats:sec>Results<\/jats:title>During the audit period (2012\u20132014), 5868 of 58 751 deliveries were by CS<\/jats:styled-content> (10%). The proportion of CS<\/jats:styled-content> considered to be unjustified decreased from 30 to 17% in health centres (P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.02) and from 37 to 20% in hospitals (P\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.001). Practice of spinal anaesthesia for CS<\/jats:styled-content> increased from 10% to 64% in hospitals (P\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.001). Of 110 maternal deaths, 18 (16.4%) were associated with complications of CS<\/jats:styled-content>, giving a risk of 3.1 per 1000 CS<\/jats:styled-content>; three (2.7%) were judged to be anaesthetic\u2010associated deaths with a risk of 0.5 per 1000 caesarean deliveries.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Increasing availability and quality of CS<\/jats:styled-content> by improving infrastructure, training and audit of reasons for CS<\/jats:styled-content> is feasible, acceptable and required in low resource settings.<\/jats:p><\/jats:sec>Tweetable abstract<\/jats:title>Increasing availability and quality of CS<\/jats:styled-content> in rural Africa is feasible.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14223","type":"journal-article","created":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T10:06:54Z","timestamp":1469182014000},"page":"1676-1682","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Increasing the availability and quality of caesarean section in Tanzania"],"prefix":"10.1111","volume":"123","author":[{"given":"A","family":"Nyamtema","sequence":"first","affiliation":[{"name":"Tanzanian Training Centre for International Health Ifakara Tanzania"},{"name":"Saint Francis University College for Health and Allied Sciences Ifakara Tanzania"},{"name":"World Lung Foundation's Maternal Health Project Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Mwakatundu","sequence":"additional","affiliation":[{"name":"World Lung Foundation's Maternal Health Project Dar es Salaam 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