{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:29:48Z","timestamp":1769149788440,"version":"3.49.0"},"reference-count":51,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T00:00:00Z","timestamp":1543449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["NCT00152204"],"award-info":[{"award-number":["NCT00152204"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["NCT01022788"],"award-info":[{"award-number":["NCT01022788"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe caesarean section rates and neonatal mortality to assess change in access to life\u2010saving interventions in a rural low\u2010resource setting between 2007 and 2013.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Population\u2010based cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Southern Tanzania.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 34\u00a0063 women from 384\u00a0549 households who gave birth in the previous year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data collected in two geo\u2010referenced household surveys conducted in 2007 and 2013 in the context of two cluster\u2010randomized controlled trials, we describe trends in caesarean section and neonatal mortality in obstetric risk groups inspired by the 10\u2010group Robson classification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Rates of self\u2010reported birth by caesarean section and neonatal mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Population\u2010based caesarean section rates increased from 4.0% in 2007 to 6.4% in 2013. In 2013, the lowest caesarean section rate was found in multipara whose labour was not induced or augmented [4.4%, 95% <jats:styled-content style=\"fixed-case\">confidence interval (CI)<\/jats:styled-content> 3.9\u20134.9], a group that showed a rate increase of over 50% from 2007 [adjusted prevalence ratio 1.57 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.34\u20131.82)]. Nullipara whose labour was not induced or augmented had rates of 6.2% in 2007 and 8.5% in 2013. Caesarean rates in multiple pregnancies were low at 8.1% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 5.6\u201310.5) in 2007, and 14.6% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 9.4\u201319.8) in 2013. Overall neonatal mortality was high: 3.5% in 2007 and 3.2% in 2013, with rates being lowest in multiparous women whose labour was not induced or augmented: 2.4% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.2\u20132.7) and 1.7% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.4\u20132.0) in 2007 and 2013, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although use of caesarean section remains insufficient, and higher rates do not necessarily imply better quality of care, our analysis highlights improvements in reaching women with caesarean section. Rates in multiple birth remained low compared with high\u2010income settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>In Southern Tanzania caesarean section rates increased over time, but the rate in high\u2010risk births remained alarmingly low.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15534","type":"journal-article","created":{"date-parts":[[2018,11,21]],"date-time":"2018-11-21T08:15:00Z","timestamp":1542788100000},"page":"690-700","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population\u2010based surveys in a low\u2010resource setting"],"prefix":"10.1111","volume":"126","author":[{"given":"C","family":"Hanson","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences Karolinska Institutet Stockholm Sweden"},{"name":"Department of Disease Control London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AP","family":"Betr\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction World Health Organization Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Opondo","sequence":"additional","affiliation":[{"name":"Department of Disease Control London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Mkumbo","sequence":"additional","affiliation":[{"name":"Ifakara Health Institute Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"Manzi","sequence":"additional","affiliation":[{"name":"Ifakara Health Institute Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Mbaruku","sequence":"additional","affiliation":[{"name":"Ifakara Health Institute Dar\u2010es\u2010Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Schellenberg","sequence":"additional","affiliation":[{"name":"Department of Disease Control London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,29]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Monitoring Emergency Obstetric Care: a Handbook","author":"WHO, UNFPA, UNICEF, AMMD","year":"2009"},{"key":"e_1_2_6_3_1","unstructured":"WHO.Strategies toward ending preventable maternal mortality (EPMM).2015[http:\/\/who.int\/reproductivehealth\/topics\/maternal_perinatal\/epmm\/en\/] Accessed 10 February 2018."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.038588"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00271-5"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.117598"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.15553"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0043-6"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13592"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12104"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31472-6"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13509"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k55"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-71"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30355-5"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.02.026"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2008.00241.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0014566"},{"key":"e_1_2_6_21_1","unstructured":"WHO.Robson classification: implementation manual.2017[http:\/\/www.who.int\/reproductivehealth\/publications\/maternal_perinatal_health\/robson-classification\/en\/] Accessed 20 December 2017."},{"key":"e_1_2_6_22_1","volume-title":"Tanzania Demographic and Health Survey","author":"National Bureau of Statistics, Tanzania; 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