ArticleBMJ open2019
Health system factors and caesarean sections in Kosovo: a cross-sectional study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries.BMJ open · 2021Pooled it
- Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany.The European journal of health economics : HEPAC : health economics in prevention and care · 2025Article
- Prevalence and associated factors of caesarean section delivery: analysis from the Nepal Demographic and Health Survey 2022.BMJ open · 2025Article
- The influence of emotional labor and emotional intelligence on cesarean section decision-making among midwives and obstetricians in Kosovo: A cross-sectional study using conjoint analysis.European journal of midwifery · 2025Article
- Low-Value Surgical Procedures in Low- and Middle-Income Countries: A Systematic Scoping Review.JAMA network open · 2023Article
- Management of Non-Communicable Diseases in Kosovo: A Scoping Review.International journal of environmental research and public health · 2023Article
- Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2022Observational
- Office hours and caesarean section: systematic review and Meta-analysis.Research in health services & regions · 2022Review
- Caesarean sections and health financing: a global analysis.BMJ open · 2021Article
- Trends and correlates of cesarean section rates over two decades in Nepal.BMC pregnancy and childbirth · 2020Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo.
designCross-sectional survey.
settingFive largest public hospitals in Kosovo.
participants859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo. OUTCOME MEASURES: The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital.
resultsWomen with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90).
conclusionsWe found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
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