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Open Access Caesarean sections in rural Burundi: how well are mothers doing two years on?

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Setting: A caesarean section (C-section) is a life-saving emergency intervention. Avoiding pregnancies for at least 24 months after a C-section is important to prevent uterine rupture and maternal death.

Objectives: Two years following an emergency C-section, in rural Burundi, we assessed complications and maternal death during the post-natal period, uptake and compliance with family planning, subsequent pregnancies and their maternal and neonatal outcomes.

Methods: A household survey among women who underwent C-sections.

Results: Of 156 women who underwent a C-section, 116 (74%) were traced; 1 had died of cholera, 8 had migrated and 31 were untraceable. Of the 116 traced, there were no post-operative complications and no deaths. At hospital discharge, 83 (72%) women accepted family planning. At 24 months after hospital discharge (n = 116), 23 (20%) had delivered and 17 (15%) were pregnant. Of the remaining 76 women, 48 (63%) were not on family planning. The main reasons for this were religion or husband's non-agreement. Of the 23 women who delivered, there was one uterine rupture, no maternal deaths and three stillbirths.

Conclusions: Despite encouraging maternal outcomes, this study raises concerns around the effectiveness of current approaches to promote and sustain family planning for a minimum of 24 months following a C-section. Innovative ways of promoting family planning in this vulnerable group are urgently needed.
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Keywords: emergency obstetrics; family planning; inter-pregnancy interval; operational research; sub-Saharan Africa

Document Type: Research Article

Affiliations: 1: Médecins Sans Frontières (MSF), Operational Research Medical Department, Luxembourg City, Luxembourg 2: MSF, Brussels Operational Centre, Brussels, Belgium 3: MSF, Bujumbura, Burundi 4: Ministry of Health, Bujumbura, Burundi

Publication date: June 21, 2016

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