Predictors of prolonged decision-to-delivery interval in emergency caesarean section in Northern Uganda: a historical cohort study

Abstract

Delays in decision-to-delivery interval (DDI) during emergency caesarean section (CS) may increase the risk of adverse maternal and neonatal outcomes. Evidence on health-system and provider-related factors influencing DDI in low-resource settings remains limited. We examined whether surgeon cadre, operating theatre location, and the presence of intern healthcare professionals were associated with prolonged DDI in a tertiary hospital in Northern Uganda.BACKGROUNDDelays in decision-to-delivery interval (DDI) during emergency caesarean section (CS) may increase the risk of adverse maternal and neonatal outcomes. Evidence on health-system and provider-related factors influencing DDI in low-resource settings remains limited. We examined whether surgeon cadre, operating theatre location, and the presence of intern healthcare professionals were associated with prolonged DDI in a tertiary hospital in Northern Uganda.We conducted a historical cohort study at St. Mary's Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. Effect modification by emergency CS indication was assessed.METHODSWe conducted a historical cohort study at St. Mary's Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. Effect modification by emergency CS indication was assessed.Of the 760 participants enrolled (median DDI was 51 minutes [IQR: 36-67]), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to fully-licensed doctors (adjusted odds ratio [aOR]: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (aOR: 0.89; 95% CI: 0.61-1.28) and (aOR: 0.71; 95% CI: 0.50-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication.RESULTSOf the 760 participants enrolled (median DDI was 51 minutes [IQR: 36-67]), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to fully-licensed doctors (adjusted odds ratio [aOR]: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (aOR: 0.89; 95% CI: 0.61-1.28) and (aOR: 0.71; 95% CI: 0.50-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication.Emergency CS performed by junior doctors was associated with increased odds of prolonged DDI compared with procedures performed by fully-licensed doctors. These findings highlight the importance of strengthening supervision, mentorship and emergency obstetric training for junior doctors in resource-limited settings. Operating theatre location and the presence of intern healthcare professionals were not significantly associated with prolonged DDI.CONCLUSIONSEmergency CS performed by junior doctors was associated with increased odds of prolonged DDI compared with procedures performed by fully-licensed doctors. These findings highlight the importance of strengthening supervision, mentorship and emergency obstetric training for junior doctors in resource-limited settings. Operating theatre location and the presence of intern healthcare professionals were not significantly associated with prolonged DDI.

MEDLINE - Academic