ArticleBMJ global health2024
Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study.
Article in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- More than a lack of resources: a mixed-methods assessment of the barriers and facilitators to infection prevention practices in three low-resource maternity units in Malawi.BMJ global health · 2026Article
- Availability and readiness of health facilities to provide emergency obstetric care in eight low- and lower-middle-income countries: insights from nationally representative health facility surveys.BMJ global health · 2026Article
- Risk factors associated with maternal complications of caesarean delivery in Rwanda: a retrospective cross-sectional study.BMC pregnancy and childbirth · 2026Article
- Antenatal Care and Perinatal Mortality in Low- and Middle-Income Countries: Insights for Maternal and Newborn Health System.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026Article
- Urban-rural disparities in the trends and causes of maternal deaths in Jinan, 1991-2025: a longitudinal trend analysis.Frontiers in public health · 2026Article
- Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop.Global health action · 2025Article
- Informing Decision-Making About Caesarean Birth: A Delphi Study to Develop a Core Information Set.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- Prediction of caesarean section birth using machine learning algorithms among pregnant women in a district hospital in Ghana.BMC pregnancy and childbirth · 2025Article
- Prevalence of successful vaginal birth after caesarean section and its associated factors among women delivered in the university of Gondar comprehensive specialized referral hospital, Northwest Ethiopia.Contraception and reproductive medicine · 2025Article
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23 authors.
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Abstract
backgroundCaesarean section (CS) is the most common major surgery conducted globally, with rates rising. CS also contributes to maternal morbidity and mortality, with increased risks in low-resource settings. We conducted a detailed review of maternal deaths from 2020 to 2022 in Malawi to determine the burden of deaths related to CS, avoidable health system factors, and causes of death associated with this procedure.
methodsData were collected regarding every maternal death occurring across all district and central hospitals in Malawi, alongside facility-level aggregated birth data. Maternal deaths were reviewed by facility-based multidisciplinary teams with subsequent confirmation of cause of death by obstetricians according to international criteria. Logistic regression was applied to estimate the odds of associations of leading causes of death with CS while adjusting for potential confounders.
resultsDespite a low national CS rate, most deaths occurred following CS (51.8%, 276/533). Women who delivered by CS were five times (OR 5.60, 95% CI 4.74 to 6.67) more likely to die than women who delivered vaginally. The leading causes of death following CS were postpartum haemorrhage (26.0%, 68/277), eclampsia (15.6%, 41/277) and infection (14.1%, 37/277). Deaths from pregnancy-related infection were more often associated with CS (OR 2.03, 95% CI 1.12 to 3.72). Health system factors more frequently associated with deaths following CS than vaginal birth included 'prolonged abnormal observations without action' (p=0.006), 'delay in starting treatment' (p=0.006) and 'lack of blood transfusion' (p=0.03).
conclusionsWe found a high burden of maternal death following CS in this low-resource setting. Until now, international attention and many clinical trials have been focused on improving the safety of vaginal birth. Our findings highlight the need to ensure the safe and appropriate use of this potentially life-saving intervention to reduce maternal deaths. To avoid the high burden of death following CS we highlight, there is urgent need to develop and trial CS-specific interventions.
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