{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:11:58Z","timestamp":1782173518375,"version":"3.54.5"},"reference-count":44,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T00:00:00Z","timestamp":1578009600000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,10,18]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Surgical informed consent is essential prior to caesarean section, but potentially compromised by insufficient communication. We assessed the association between a multicomponent intervention and women\u2019s recollection of information pertaining to informed consent for caesarean section in a low-resource setting, thereby contributing to respectful maternity care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Pre-post implementation survey, conducted from January to June 2018, surveying women prior to discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Rural 150-bed mission hospital in Southern Malawi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 160 postoperative women were included: 80 preimplementation and 80 postimplementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Based on observed deficiencies and input from local stakeholders, a multicomponent intervention was developed, consisting of a standardised checklist, wall poster with a six-step guide and on-the-job communication training for health workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>\n                      Individual components of informed consent were: indication, explanation of procedure, common complications, implications for future pregnancies and verbal enquiry of consent, which were compared preintervention and postintervention using \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test. Generalised linear models were used to analyse incompleteness scores and recollection of the informed consent process.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The proportion of women who recollected being informed about procedure-related risks increased from 25\/80 to 47\/80 (OR 3.13 (95% CI 1.64 to 6.00)). Recollection of an explanation of the procedure changed from 44\/80 to 55\/80 (OR 1.80 (0.94 to 3.44)), implications for future pregnancy from 25\/80 to 47\/80 (1.69 (0.89 to 3.20)) and of consent enquiry from 67\/80 to 73\/80 (OR 2.02 (0.73 to 5.37)). After controlling for other variables, incompleteness scores postintervention were 26% lower (Exp(\u03b2)=0.74; 95% CI 0.57 to 0.96). Recollection of common complications increased with 0.25 complications (\u03b2=0.25; 95% CI 0.01 to 0.49). Recollection of the correct indication did not differ significantly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Recollection of informed consent for caesarean section changed significantly in the postintervention group. Obtaining informed consent for caesarean section is one of the essential components of respectful maternity care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030665","type":"journal-article","created":{"date-parts":[[2020,1,7]],"date-time":"2020-01-07T18:28:02Z","timestamp":1578421682000},"page":"e030665","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi"],"prefix":"10.1136","volume":"10","author":[{"given":"Siem","family":"Zethof","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Clinical Department, St. Luke's Hospital, Zomba, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"Bakker","sequence":"additional","affiliation":[{"name":"Clinical Department, St. Luke's Hospital, Zomba, Malawi"},{"name":"Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Nansongole","sequence":"additional","affiliation":[{"name":"Clinical Department, St. Luke's Hospital, Zomba, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Kilowe","sequence":"additional","affiliation":[{"name":"Nursing Department, St. Luke's Hospital, Zomba, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos","family":"van Roosmalen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,6]]},"reference":[{"key":"2025121602283768000_10.1.e030665.1","unstructured":"Jolivet R . 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