Evidence map›Paper›PMID 39898001›Full record

ArticleAJOG global reports2025

Disclosing possible nonmedically indicated cesarean sections in 5 high-volume urban maternity units in Tanzania: a criterion-based clinical audit.

Sarah Hansen, Monica Lauridsen Kujabi, Rikke Damkjær Maimburg, Anna Macha, Luzango Maembe, Idrissa Kabanda, Manyanga Hudson, Rukia Juma Msumi, Mtingele Sangalala, Natasha Housseine and 5 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in AJOG global reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04685668 (Enabling Best Post Possible Childbirth Care in Tanzania.), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04685668 nacompletednot on this map

Enabling Best Post Possible Childbirth Care in Tanzania.

TypeinterventionalSponsorUniversity of CopenhagenRan2021 to 2023Enrolled65,181ConditionsStillbirth, Delivery Complication, Delivery Delayed, ApgarArmsThe PartoMa guidelines and training
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Sarah HansenDepartment of Clinical Medicine, Occupational Medicine, Aarhus University, Aarhus, Denmark (Hansen and Maimburg).
Monica Lauridsen KujabiGlobal Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Kujabi, D'mello, Meyrowitsch, and Maaløe).
Rikke Damkjær MaimburgDepartment of Clinical Medicine, Occupational Medicine, Aarhus University, Aarhus, Denmark (Hansen and Maimburg).
Anna MachaMedical College East Africa, Aga Khan University, Dar es Salaam, Tanzania (Macha, Housseine).
Luzango MaembeDepartment of Gynecology and Obstetrics, Mwanyanamala Regional Referral Hospital, Dar es Salaam, Tanzania (Maembe).
Idrissa KabandaDepartment of Gynecology and Obstetrics, Sinza Regional Hospital, Dar es Salaam, Tanzania (Kabanda).
Manyanga HudsonDepartment of Gynecology and Obstetrics, Temeke Regional Referral Hospital, Dar es Salaam, Tanzania (Hudson).
Rukia Juma MsumiDepartment of Gynecology and Obstetrics, Rangi Tatu Maternity Hospital, Dar es Salaam, Tanzania (Msumi).
Mtingele SangalalaDepartment of Gynecology and Obstetrics, Amana Regional Referral Hospital, Dar es Salaam, Tanzania (Sangalala).
Natasha HousseineMedical College East Africa, Aga Khan University, Dar es Salaam, Tanzania (Macha, Housseine).
Brenda Sequeira D'melloGlobal Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Kujabi, D'mello, Meyrowitsch, and Maaløe).
Kidanto HusseinMedical College East Africa, Aga Khan University, Dar es Salaam, Tanzania (Macha, Housseine).
Thomas van den AkkerAthena Institute, VU University Amsterdam, Amsterdam, the Netherlands (Akker).
Dan Wolf MeyrowitschGlobal Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Kujabi, D'mello, Meyrowitsch, and Maaløe).
Nanna MaaløeGlobal Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Kujabi, D'mello, Meyrowitsch, and Maaløe).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Globally, the cesarean section rate has increased dramatically with many cesarean sections being performed on questionable medical indications. Particularly in urban areas of sub-Saharan Africa, the cesarean section rate is currently increasing rapidly. This potentially undermines the positive momentum of increased facility births and may be a central contributor to a growing "urban disadvantage" in maternal and perinatal health, which is seen in some settings. Objective: To assess to what extent cesarean section indications follow evidence-based, locally co-created audit criteria in five urban, high-volume maternity units in Dar es Salaam, Tanzania, and identify reasons contributing to nonmedically indicated cesarean sections. Study Design: This was a retrospective cross-sectional study conducted, from October 1st, 2021 to August 31st, 2022. A criterion-based audit with pre-defined, localized audit criteria was used to examine the clinical case-files of all women who gave birth by cesarean section during 3-month periods at the 5 maternity units. Primary outcomes were the cesarean section rate, indications for cesarean section, and proportion of nonmedically indicated cesarean sections. The PartoMa study is registered in ClinicalTrials.gov (NCT04685668). Results: Overall, the cesarean section rate was 31.5% (2949/9364), of which 2674/2949 (90.7%) cesarean sections had available data for analysis. Main indications were previous cesarean section (1133/2674; 42.4%), prolonged labor (746/2674; 27.9%), and fetal distress (554/2674; 20.7%). Overall, 1061/2674 (39.7%) did not comply with audit criteria at the time cesarean section was decided. Main reasons were one previous cesarean section with no trial of labor (526/1061; 49.6%); reported prolonged labor without actual slow progress (243/1061; 22.9%); and fetal distress with normal fetal heart rate at time of decision (211/1061; 19.9%). Conclusion: Two in 5 cesarean sections were categorized as nonmedically indicated at time of decision. Particularly, fear of poor outcomes and delay in accessing emergency surgery may cause resource-consuming "defensive decision-making" for cesarean section. Investments in conducive urban maternity units are crucial to ensure safe vaginal births and to reach a population-based approach that provides best possible timely care for all with the limited resources available.

Indexed as

fetal distresslow-income countriesPartoMasub-Saharan Africasub-standard careTanzaniatrial of laborurban disadvantage

Identifiers

PMID39898001
PMCPMC11786107

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.