Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.
Identifieur interne : 000548 ( Main/Exploration ); précédent : 000547; suivant : 000549Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.
Auteurs : David Bishop [Afrique du Sud] ; Robert A. Dyer [Afrique du Sud] ; Salome Maswime [Afrique du Sud] ; Reitze N. Rodseth [Afrique du Sud] ; Dominique Van Dyk [Afrique du Sud] ; Hyla-Louise Kluyts [Afrique du Sud] ; Janat T. Tumukunde [Ouganda] ; Farai D. Madzimbamuto [Zimbabwe] ; Abdulaziz M. Elkhogia [Libye] ; Andrew K N. Ndonga [Kenya] ; Zipporah W W. Ngumi [Kenya] ; Akinyinka O. Omigbodun [Nigeria] ; Simbo D. Amanor-Boadu [Nigeria] ; Eugene Zoumenou [Bénin] ; Apollo Basenero [Namibie] ; Dolly M. Munlemvo ; Coulibaly Youssouf [Mali] ; Gabriel Ndayisaba [Burundi] ; Akwasi Antwi-Kusi [Ghana] ; Veekash Gobin ; Patrice Forget [Belgique] ; Bernard Mbwele [Tanzanie] ; Henry Ndasi [Cameroun] ; Sylvia R. Rakotoarison [Madagascar] ; Ahmadou L. Samateh [Gambie] ; Ryad Mehyaoui [Algérie] ; Ushmaben Patel-Mujajati [Zambie] ; Chaibou M. Sani [Niger] ; Tonya M. Esterhuizen [Afrique du Sud] ; Thandinkosi E. Madiba [Afrique du Sud] ; Rupert M. Pearse [Royaume-Uni] ; Bruce M. Biccard [Afrique du Sud]Source :
- The Lancet. Global health [ 2214-109X ] ; 2019.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Complications de la grossesse (MeSH), Complications postopératoires (épidémiologie), Césarienne (effets indésirables), Césarienne (mortalité), Facteurs de risque (MeSH), Femelle (MeSH), Grossesse (MeSH), Humains (MeSH), Mortalité infantile (MeSH), Mortalité maternelle (MeSH), Nourrisson (MeSH), Nouveau-né (MeSH), République d'Afrique du Sud (épidémiologie), Résultat thérapeutique (MeSH), Études prospectives (MeSH).
- MESH :
- effets indésirables : Césarienne.
- mortalité : Césarienne.
- épidémiologie : Complications postopératoires, République d'Afrique du Sud.
- Adulte, Complications de la grossesse, Facteurs de risque, Femelle, Grossesse, Humains, Mortalité infantile, Mortalité maternelle, Nourrisson, Nouveau-né, Résultat thérapeutique, Études prospectives.
- Wicri :
- geographic : Afrique du Sud.
English descriptors
- KwdEn :
- Adult (MeSH), Cesarean Section (adverse effects), Cesarean Section (mortality), Female (MeSH), Humans (MeSH), Infant (MeSH), Infant Mortality (MeSH), Infant, Newborn (MeSH), Maternal Mortality (MeSH), Postoperative Complications (epidemiology), Pregnancy (MeSH), Pregnancy Complications (MeSH), Prospective Studies (MeSH), Risk Factors (MeSH), South Africa (epidemiology), Treatment Outcome (MeSH).
- MESH :
- geographic , epidemiology : South Africa.
- adverse effects : Cesarean Section.
- epidemiology : Postoperative Complications.
- mortality : Cesarean Section.
- Adult, Female, Humans, Infant, Infant Mortality, Infant, Newborn, Maternal Mortality, Pregnancy, Pregnancy Complications, Prospective Studies, Risk Factors, Treatment Outcome.
Abstract
BACKGROUND
Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes.
METHODS
A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899.
FINDINGS
Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0).
INTERPRETATION
Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.
FUNDING
Medical Research Council of South Africa.
DOI: 10.1016/S2214-109X(19)30036-1
PubMed: 30879511
Affiliations:
- Afrique du Sud, Algérie, Belgique, Burundi, Bénin, Cameroun, Gambie, Ghana, Kenya, Libye, Madagascar, Mali, Namibie, Niger, Nigeria, Ouganda, Royaume-Uni, Tanzanie, Zambie, Zimbabwe
- Angleterre, Gauteng, Grand Londres, Région de Bruxelles-Capitale, Wilaya d'Alger, État d'Oyo
- Alger, Bruxelles, Ibadan, Johannesbourg, Londres
- Université d'Ibadan, Université de Londres, Université du Witwatersrand
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Le document en format XML
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Tumukunde</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, Makerere University, Kampala, Uganda.</nlm:affiliation><country xml:lang="fr">Ouganda</country><wicri:regionArea>Department of Anaesthesiology, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Madzimbamuto, Farai D" sort="Madzimbamuto, Farai D" uniqKey="Madzimbamuto F" first="Farai D" last="Madzimbamuto">Farai D. Madzimbamuto</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare, Zimbabwe.</nlm:affiliation><country xml:lang="fr">Zimbabwe</country><wicri:regionArea>Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare</wicri:regionArea><wicri:noRegion>Harare</wicri:noRegion></affiliation></author><author><name sortKey="Elkhogia, Abdulaziz M" sort="Elkhogia, Abdulaziz M" uniqKey="Elkhogia A" first="Abdulaziz M" last="Elkhogia">Abdulaziz M. Elkhogia</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesia Department, Tripoli Medical Centre, Tripoli, Libya.</nlm:affiliation><country xml:lang="fr">Libye</country><wicri:regionArea>Anaesthesia Department, Tripoli Medical Centre, Tripoli</wicri:regionArea><wicri:noRegion>Tripoli</wicri:noRegion></affiliation></author><author><name sortKey="Ndonga, Andrew K N" sort="Ndonga, Andrew K N" uniqKey="Ndonga A" first="Andrew K N" last="Ndonga">Andrew K N. Ndonga</name><affiliation wicri:level="1"><nlm:affiliation>General and Gastrosurgery, Mater Hospital, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>General and Gastrosurgery, Mater Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Ngumi, Zipporah W W" sort="Ngumi, Zipporah W W" uniqKey="Ngumi Z" first="Zipporah W W" last="Ngumi">Zipporah W W. Ngumi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Omigbodun, Akinyinka O" sort="Omigbodun, Akinyinka O" uniqKey="Omigbodun A" first="Akinyinka O" last="Omigbodun">Akinyinka O. Omigbodun</name><affiliation wicri:level="4"><nlm:affiliation>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan</wicri:regionArea><orgName type="university">Université d'Ibadan</orgName><placeName><settlement type="city">Ibadan</settlement><region type="region">État d'Oyo</region></placeName></affiliation></author><author><name sortKey="Amanor Boadu, Simbo D" sort="Amanor Boadu, Simbo D" uniqKey="Amanor Boadu S" first="Simbo D" last="Amanor-Boadu">Simbo D. Amanor-Boadu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University College Hospital, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Department of Anaesthesia, University College Hospital, Ibadan</wicri:regionArea><wicri:noRegion>Ibadan</wicri:noRegion></affiliation></author><author><name sortKey="Zoumenou, Eugene" sort="Zoumenou, Eugene" uniqKey="Zoumenou E" first="Eugene" last="Zoumenou">Eugene Zoumenou</name><affiliation wicri:level="1"><nlm:affiliation>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou, Benin.</nlm:affiliation><country xml:lang="fr">Bénin</country><wicri:regionArea>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou</wicri:regionArea><wicri:noRegion>Lagune de Cotonou</wicri:noRegion></affiliation></author><author><name sortKey="Basenero, Apollo" sort="Basenero, Apollo" uniqKey="Basenero A" first="Apollo" last="Basenero">Apollo Basenero</name><affiliation wicri:level="1"><nlm:affiliation>Ministry of Health and Social Services Namibia, Windhoek, Namibia.</nlm:affiliation><country xml:lang="fr">Namibie</country><wicri:regionArea>Ministry of Health and Social Services Namibia, Windhoek</wicri:regionArea><wicri:noRegion>Windhoek</wicri:noRegion></affiliation></author><author><name sortKey="Munlemvo, Dolly M" sort="Munlemvo, Dolly M" uniqKey="Munlemvo D" first="Dolly M" last="Munlemvo">Dolly M. Munlemvo</name><affiliation><nlm:affiliation>Department of Anaesthesiology, University Hospital of Kinshasha, Kinshasha, Democratic Republic of Congo.</nlm:affiliation><wicri:noCountry code="subField">Democratic Republic of Congo</wicri:noCountry></affiliation></author><author><name sortKey="Youssouf, Coulibaly" sort="Youssouf, Coulibaly" uniqKey="Youssouf C" first="Coulibaly" last="Youssouf">Coulibaly Youssouf</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, Faculté de Médicine de Bamako, Bamako, Mali.</nlm:affiliation><country xml:lang="fr">Mali</country><wicri:regionArea>Department of Anaesthesiology, Faculté de Médicine de Bamako, Bamako</wicri:regionArea><wicri:noRegion>Bamako</wicri:noRegion></affiliation></author><author><name sortKey="Ndayisaba, Gabriel" sort="Ndayisaba, Gabriel" uniqKey="Ndayisaba G" first="Gabriel" last="Ndayisaba">Gabriel Ndayisaba</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Kamenge Teaching Hospital, Bujumbura, Burundi.</nlm:affiliation><country xml:lang="fr">Burundi</country><wicri:regionArea>Department of Surgery, Kamenge Teaching Hospital, Bujumbura</wicri:regionArea><wicri:noRegion>Bujumbura</wicri:noRegion></affiliation></author><author><name sortKey="Antwi Kusi, Akwasi" sort="Antwi Kusi, Akwasi" uniqKey="Antwi Kusi A" first="Akwasi" last="Antwi-Kusi">Akwasi Antwi-Kusi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.</nlm:affiliation><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Gobin, Veekash" sort="Gobin, Veekash" uniqKey="Gobin V" first="Veekash" last="Gobin">Veekash Gobin</name><affiliation><nlm:affiliation>Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius.</nlm:affiliation><wicri:noCountry code="subField">Mauritius</wicri:noCountry></affiliation></author><author><name sortKey="Forget, Patrice" sort="Forget, Patrice" uniqKey="Forget P" first="Patrice" last="Forget">Patrice Forget</name><affiliation wicri:level="3"><nlm:affiliation>Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, and Universitair Ziekenhuis Brussel, Brussels, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, and Universitair Ziekenhuis Brussel, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Mbwele, Bernard" sort="Mbwele, Bernard" uniqKey="Mbwele B" first="Bernard" last="Mbwele">Bernard Mbwele</name><affiliation wicri:level="1"><nlm:affiliation>Clinical Operations, HIV/AIDS Care and Treatment and Prevention of Mother-to-Child Transmission, Christian Social Service Commission, Mwanza, Tanzania.</nlm:affiliation><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Clinical Operations, HIV/AIDS Care and Treatment and Prevention of Mother-to-Child Transmission, Christian Social Service Commission, Mwanza</wicri:regionArea><wicri:noRegion>Mwanza</wicri:noRegion></affiliation></author><author><name sortKey="Ndasi, Henry" sort="Ndasi, Henry" uniqKey="Ndasi H" first="Henry" last="Ndasi">Henry Ndasi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene, Cameroon.</nlm:affiliation><country xml:lang="fr">Cameroun</country><wicri:regionArea>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene</wicri:regionArea><wicri:noRegion>Mutengene</wicri:noRegion></affiliation></author><author><name sortKey="Rakotoarison, Sylvia R" sort="Rakotoarison, Sylvia R" uniqKey="Rakotoarison S" first="Sylvia R" last="Rakotoarison">Sylvia R. Rakotoarison</name><affiliation wicri:level="1"><nlm:affiliation>Androhibe, Madagascar.</nlm:affiliation><country xml:lang="fr">Madagascar</country><wicri:regionArea>Androhibe</wicri:regionArea></affiliation></author><author><name sortKey="Samateh, Ahmadou L" sort="Samateh, Ahmadou L" uniqKey="Samateh A" first="Ahmadou L" last="Samateh">Ahmadou L. Samateh</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia.</nlm:affiliation><country xml:lang="fr">Gambie</country><wicri:regionArea>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul</wicri:regionArea><wicri:noRegion>Banjul</wicri:noRegion></affiliation></author><author><name sortKey="Mehyaoui, Ryad" sort="Mehyaoui, Ryad" uniqKey="Mehyaoui R" first="Ryad" last="Mehyaoui">Ryad Mehyaoui</name><affiliation wicri:level="3"><nlm:affiliation>Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algiers, Algeria.</nlm:affiliation><country xml:lang="fr">Algérie</country><wicri:regionArea>Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algiers</wicri:regionArea><placeName><settlement type="city">Alger</settlement><region nuts="2">Wilaya d'Alger</region></placeName></affiliation></author><author><name sortKey="Patel Mujajati, Ushmaben" sort="Patel Mujajati, Ushmaben" uniqKey="Patel Mujajati U" first="Ushmaben" last="Patel-Mujajati">Ushmaben Patel-Mujajati</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, University Teaching Hospital, Lusaka, Zambia.</nlm:affiliation><country xml:lang="fr">Zambie</country><wicri:regionArea>Department of Anaesthesiology, University Teaching Hospital, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Sani, Chaibou M" sort="Sani, Chaibou M" uniqKey="Sani C" first="Chaibou M" last="Sani">Chaibou M. Sani</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Niger.</nlm:affiliation><country xml:lang="fr">Niger</country><wicri:regionArea>Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey</wicri:regionArea><wicri:noRegion>Niamey</wicri:noRegion></affiliation></author><author><name sortKey="Esterhuizen, Tonya M" sort="Esterhuizen, Tonya M" uniqKey="Esterhuizen T" first="Tonya M" last="Esterhuizen">Tonya M. Esterhuizen</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch</wicri:regionArea><wicri:noRegion>Stellenbosch</wicri:noRegion></affiliation></author><author><name sortKey="Madiba, Thandinkosi E" sort="Madiba, Thandinkosi E" uniqKey="Madiba T" first="Thandinkosi E" last="Madiba">Thandinkosi E. Madiba</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Surgery, University of KwaZulu-Natal, Durban</wicri:regionArea><wicri:noRegion>Durban</wicri:noRegion></affiliation></author><author><name sortKey="Pearse, Rupert M" sort="Pearse, Rupert M" uniqKey="Pearse R" first="Rupert M" last="Pearse">Rupert M. Pearse</name><affiliation wicri:level="4"><nlm:affiliation>Intensive Care Medicine, Queen Mary University of London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Intensive Care Medicine, Queen Mary University of London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author><author><name sortKey="Biccard, Bruce M" sort="Biccard, Bruce M" uniqKey="Biccard B" first="Bruce M" last="Biccard">Bruce M. Biccard</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Electronic address: bruce.biccard@uct.ac.za.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2019">2019</date><idno type="RBID">pubmed:30879511</idno><idno type="pmid">30879511</idno><idno type="doi">10.1016/S2214-109X(19)30036-1</idno><idno type="wicri:Area/PubMed/Corpus">000270</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000270</idno><idno type="wicri:Area/PubMed/Curation">000269</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000269</idno><idno type="wicri:Area/PubMed/Checkpoint">000241</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000241</idno><idno type="wicri:Area/Main/Merge">000548</idno><idno type="wicri:Area/Main/Curation">000548</idno><idno type="wicri:Area/Main/Exploration">000548</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.</title><author><name sortKey="Bishop, David" sort="Bishop, David" uniqKey="Bishop D" first="David" last="Bishop">David Bishop</name><affiliation wicri:level="1"><nlm:affiliation>Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg</wicri:regionArea><wicri:noRegion>Pietermaritzburg</wicri:noRegion></affiliation></author><author><name sortKey="Dyer, Robert A" sort="Dyer, Robert A" uniqKey="Dyer R" first="Robert A" last="Dyer">Robert A. Dyer</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Maswime, Salome" sort="Maswime, Salome" uniqKey="Maswime S" first="Salome" last="Maswime">Salome Maswime</name><affiliation wicri:level="4"><nlm:affiliation>Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Rodseth, Reitze N" sort="Rodseth, Reitze N" uniqKey="Rodseth R" first="Reitze N" last="Rodseth">Reitze N. Rodseth</name><affiliation wicri:level="1"><nlm:affiliation>Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg</wicri:regionArea><wicri:noRegion>Pietermaritzburg</wicri:noRegion></affiliation></author><author><name sortKey="Van Dyk, Dominique" sort="Van Dyk, Dominique" uniqKey="Van Dyk D" first="Dominique" last="Van Dyk">Dominique Van Dyk</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Kluyts, Hyla Louise" sort="Kluyts, Hyla Louise" uniqKey="Kluyts H" first="Hyla-Louise" last="Kluyts">Hyla-Louise Kluyts</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria</wicri:regionArea><wicri:noRegion>Pretoria</wicri:noRegion></affiliation></author><author><name sortKey="Tumukunde, Janat T" sort="Tumukunde, Janat T" uniqKey="Tumukunde J" first="Janat T" last="Tumukunde">Janat T. Tumukunde</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, Makerere University, Kampala, Uganda.</nlm:affiliation><country xml:lang="fr">Ouganda</country><wicri:regionArea>Department of Anaesthesiology, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Madzimbamuto, Farai D" sort="Madzimbamuto, Farai D" uniqKey="Madzimbamuto F" first="Farai D" last="Madzimbamuto">Farai D. Madzimbamuto</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare, Zimbabwe.</nlm:affiliation><country xml:lang="fr">Zimbabwe</country><wicri:regionArea>Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare</wicri:regionArea><wicri:noRegion>Harare</wicri:noRegion></affiliation></author><author><name sortKey="Elkhogia, Abdulaziz M" sort="Elkhogia, Abdulaziz M" uniqKey="Elkhogia A" first="Abdulaziz M" last="Elkhogia">Abdulaziz M. Elkhogia</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesia Department, Tripoli Medical Centre, Tripoli, Libya.</nlm:affiliation><country xml:lang="fr">Libye</country><wicri:regionArea>Anaesthesia Department, Tripoli Medical Centre, Tripoli</wicri:regionArea><wicri:noRegion>Tripoli</wicri:noRegion></affiliation></author><author><name sortKey="Ndonga, Andrew K N" sort="Ndonga, Andrew K N" uniqKey="Ndonga A" first="Andrew K N" last="Ndonga">Andrew K N. Ndonga</name><affiliation wicri:level="1"><nlm:affiliation>General and Gastrosurgery, Mater Hospital, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>General and Gastrosurgery, Mater Hospital, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Ngumi, Zipporah W W" sort="Ngumi, Zipporah W W" uniqKey="Ngumi Z" first="Zipporah W W" last="Ngumi">Zipporah W W. Ngumi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Omigbodun, Akinyinka O" sort="Omigbodun, Akinyinka O" uniqKey="Omigbodun A" first="Akinyinka O" last="Omigbodun">Akinyinka O. Omigbodun</name><affiliation wicri:level="4"><nlm:affiliation>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan</wicri:regionArea><orgName type="university">Université d'Ibadan</orgName><placeName><settlement type="city">Ibadan</settlement><region type="region">État d'Oyo</region></placeName></affiliation></author><author><name sortKey="Amanor Boadu, Simbo D" sort="Amanor Boadu, Simbo D" uniqKey="Amanor Boadu S" first="Simbo D" last="Amanor-Boadu">Simbo D. Amanor-Boadu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University College Hospital, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Department of Anaesthesia, University College Hospital, Ibadan</wicri:regionArea><wicri:noRegion>Ibadan</wicri:noRegion></affiliation></author><author><name sortKey="Zoumenou, Eugene" sort="Zoumenou, Eugene" uniqKey="Zoumenou E" first="Eugene" last="Zoumenou">Eugene Zoumenou</name><affiliation wicri:level="1"><nlm:affiliation>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou, Benin.</nlm:affiliation><country xml:lang="fr">Bénin</country><wicri:regionArea>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou</wicri:regionArea><wicri:noRegion>Lagune de Cotonou</wicri:noRegion></affiliation></author><author><name sortKey="Basenero, Apollo" sort="Basenero, Apollo" uniqKey="Basenero A" first="Apollo" last="Basenero">Apollo Basenero</name><affiliation wicri:level="1"><nlm:affiliation>Ministry of Health and Social Services Namibia, Windhoek, Namibia.</nlm:affiliation><country xml:lang="fr">Namibie</country><wicri:regionArea>Ministry of Health and Social Services Namibia, Windhoek</wicri:regionArea><wicri:noRegion>Windhoek</wicri:noRegion></affiliation></author><author><name sortKey="Munlemvo, Dolly M" sort="Munlemvo, Dolly M" uniqKey="Munlemvo D" first="Dolly M" last="Munlemvo">Dolly M. Munlemvo</name><affiliation><nlm:affiliation>Department of Anaesthesiology, University Hospital of Kinshasha, Kinshasha, Democratic Republic of Congo.</nlm:affiliation><wicri:noCountry code="subField">Democratic Republic of Congo</wicri:noCountry></affiliation></author><author><name sortKey="Youssouf, Coulibaly" sort="Youssouf, Coulibaly" uniqKey="Youssouf C" first="Coulibaly" last="Youssouf">Coulibaly Youssouf</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, Faculté de Médicine de Bamako, Bamako, Mali.</nlm:affiliation><country xml:lang="fr">Mali</country><wicri:regionArea>Department of Anaesthesiology, Faculté de Médicine de Bamako, Bamako</wicri:regionArea><wicri:noRegion>Bamako</wicri:noRegion></affiliation></author><author><name sortKey="Ndayisaba, Gabriel" sort="Ndayisaba, Gabriel" uniqKey="Ndayisaba G" first="Gabriel" last="Ndayisaba">Gabriel Ndayisaba</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Kamenge Teaching Hospital, Bujumbura, Burundi.</nlm:affiliation><country xml:lang="fr">Burundi</country><wicri:regionArea>Department of Surgery, Kamenge Teaching Hospital, Bujumbura</wicri:regionArea><wicri:noRegion>Bujumbura</wicri:noRegion></affiliation></author><author><name sortKey="Antwi Kusi, Akwasi" sort="Antwi Kusi, Akwasi" uniqKey="Antwi Kusi A" first="Akwasi" last="Antwi-Kusi">Akwasi Antwi-Kusi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.</nlm:affiliation><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Gobin, Veekash" sort="Gobin, Veekash" uniqKey="Gobin V" first="Veekash" last="Gobin">Veekash Gobin</name><affiliation><nlm:affiliation>Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius.</nlm:affiliation><wicri:noCountry code="subField">Mauritius</wicri:noCountry></affiliation></author><author><name sortKey="Forget, Patrice" sort="Forget, Patrice" uniqKey="Forget P" first="Patrice" last="Forget">Patrice Forget</name><affiliation wicri:level="3"><nlm:affiliation>Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, and Universitair Ziekenhuis Brussel, Brussels, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, and Universitair Ziekenhuis Brussel, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Mbwele, Bernard" sort="Mbwele, Bernard" uniqKey="Mbwele B" first="Bernard" last="Mbwele">Bernard Mbwele</name><affiliation wicri:level="1"><nlm:affiliation>Clinical Operations, HIV/AIDS Care and Treatment and Prevention of Mother-to-Child Transmission, Christian Social Service Commission, Mwanza, Tanzania.</nlm:affiliation><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Clinical Operations, HIV/AIDS Care and Treatment and Prevention of Mother-to-Child Transmission, Christian Social Service Commission, Mwanza</wicri:regionArea><wicri:noRegion>Mwanza</wicri:noRegion></affiliation></author><author><name sortKey="Ndasi, Henry" sort="Ndasi, Henry" uniqKey="Ndasi H" first="Henry" last="Ndasi">Henry Ndasi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene, Cameroon.</nlm:affiliation><country xml:lang="fr">Cameroun</country><wicri:regionArea>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene</wicri:regionArea><wicri:noRegion>Mutengene</wicri:noRegion></affiliation></author><author><name sortKey="Rakotoarison, Sylvia R" sort="Rakotoarison, Sylvia R" uniqKey="Rakotoarison S" first="Sylvia R" last="Rakotoarison">Sylvia R. Rakotoarison</name><affiliation wicri:level="1"><nlm:affiliation>Androhibe, Madagascar.</nlm:affiliation><country xml:lang="fr">Madagascar</country><wicri:regionArea>Androhibe</wicri:regionArea></affiliation></author><author><name sortKey="Samateh, Ahmadou L" sort="Samateh, Ahmadou L" uniqKey="Samateh A" first="Ahmadou L" last="Samateh">Ahmadou L. Samateh</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia.</nlm:affiliation><country xml:lang="fr">Gambie</country><wicri:regionArea>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul</wicri:regionArea><wicri:noRegion>Banjul</wicri:noRegion></affiliation></author><author><name sortKey="Mehyaoui, Ryad" sort="Mehyaoui, Ryad" uniqKey="Mehyaoui R" first="Ryad" last="Mehyaoui">Ryad Mehyaoui</name><affiliation wicri:level="3"><nlm:affiliation>Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algiers, Algeria.</nlm:affiliation><country xml:lang="fr">Algérie</country><wicri:regionArea>Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algiers</wicri:regionArea><placeName><settlement type="city">Alger</settlement><region nuts="2">Wilaya d'Alger</region></placeName></affiliation></author><author><name sortKey="Patel Mujajati, Ushmaben" sort="Patel Mujajati, Ushmaben" uniqKey="Patel Mujajati U" first="Ushmaben" last="Patel-Mujajati">Ushmaben Patel-Mujajati</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, University Teaching Hospital, Lusaka, Zambia.</nlm:affiliation><country xml:lang="fr">Zambie</country><wicri:regionArea>Department of Anaesthesiology, University Teaching Hospital, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Sani, Chaibou M" sort="Sani, Chaibou M" uniqKey="Sani C" first="Chaibou M" last="Sani">Chaibou M. Sani</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Niger.</nlm:affiliation><country xml:lang="fr">Niger</country><wicri:regionArea>Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey</wicri:regionArea><wicri:noRegion>Niamey</wicri:noRegion></affiliation></author><author><name sortKey="Esterhuizen, Tonya M" sort="Esterhuizen, Tonya M" uniqKey="Esterhuizen T" first="Tonya M" last="Esterhuizen">Tonya M. Esterhuizen</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch</wicri:regionArea><wicri:noRegion>Stellenbosch</wicri:noRegion></affiliation></author><author><name sortKey="Madiba, Thandinkosi E" sort="Madiba, Thandinkosi E" uniqKey="Madiba T" first="Thandinkosi E" last="Madiba">Thandinkosi E. Madiba</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Surgery, University of KwaZulu-Natal, Durban</wicri:regionArea><wicri:noRegion>Durban</wicri:noRegion></affiliation></author><author><name sortKey="Pearse, Rupert M" sort="Pearse, Rupert M" uniqKey="Pearse R" first="Rupert M" last="Pearse">Rupert M. Pearse</name><affiliation wicri:level="4"><nlm:affiliation>Intensive Care Medicine, Queen Mary University of London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Intensive Care Medicine, Queen Mary University of London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author><author><name sortKey="Biccard, Bruce M" sort="Biccard, Bruce M" uniqKey="Biccard B" first="Bruce M" last="Biccard">Bruce M. Biccard</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Electronic address: bruce.biccard@uct.ac.za.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author></analytic><series><title level="j">The Lancet. Global health</title><idno type="eISSN">2214-109X</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Cesarean Section (adverse effects)</term><term>Cesarean Section (mortality)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Infant (MeSH)</term><term>Infant Mortality (MeSH)</term><term>Infant, Newborn (MeSH)</term><term>Maternal Mortality (MeSH)</term><term>Postoperative Complications (epidemiology)</term><term>Pregnancy (MeSH)</term><term>Pregnancy Complications (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Risk Factors (MeSH)</term><term>South Africa (epidemiology)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Complications de la grossesse (MeSH)</term><term>Complications postopératoires (épidémiologie)</term><term>Césarienne (effets indésirables)</term><term>Césarienne (mortalité)</term><term>Facteurs de risque (MeSH)</term><term>Femelle (MeSH)</term><term>Grossesse (MeSH)</term><term>Humains (MeSH)</term><term>Mortalité infantile (MeSH)</term><term>Mortalité maternelle (MeSH)</term><term>Nourrisson (MeSH)</term><term>Nouveau-né (MeSH)</term><term>République d'Afrique du Sud (épidémiologie)</term><term>Résultat thérapeutique (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>South Africa</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Cesarean Section</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Césarienne</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Cesarean Section</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Césarienne</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Complications postopératoires</term><term>République d'Afrique du Sud</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Female</term><term>Humans</term><term>Infant</term><term>Infant Mortality</term><term>Infant, Newborn</term><term>Maternal Mortality</term><term>Pregnancy</term><term>Pregnancy Complications</term><term>Prospective Studies</term><term>Risk Factors</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Complications de la grossesse</term><term>Facteurs de risque</term><term>Femelle</term><term>Grossesse</term><term>Humains</term><term>Mortalité infantile</term><term>Mortalité maternelle</term><term>Nourrisson</term><term>Nouveau-né</term><term>Résultat thérapeutique</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Afrique du Sud</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899.</p></div><div type="abstract" xml:lang="en"><p><b>FINDINGS</b></p><p>Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0).</p></div><div type="abstract" xml:lang="en"><p><b>INTERPRETATION</b></p><p>Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.</p></div><div type="abstract" xml:lang="en"><p><b>FUNDING</b></p><p>Medical Research Council of South Africa.</p></div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Algérie</li><li>Belgique</li><li>Burundi</li><li>Bénin</li><li>Cameroun</li><li>Gambie</li><li>Ghana</li><li>Kenya</li><li>Libye</li><li>Madagascar</li><li>Mali</li><li>Namibie</li><li>Niger</li><li>Nigeria</li><li>Ouganda</li><li>Royaume-Uni</li><li>Tanzanie</li><li>Zambie</li><li>Zimbabwe</li></country><region><li>Angleterre</li><li>Gauteng</li><li>Grand Londres</li><li>Région de Bruxelles-Capitale</li><li>Wilaya d'Alger</li><li>État d'Oyo</li></region><settlement><li>Alger</li><li>Bruxelles</li><li>Ibadan</li><li>Johannesbourg</li><li>Londres</li></settlement><orgName><li>Université d'Ibadan</li><li>Université de Londres</li><li>Université du Witwatersrand</li></orgName></list><tree><noCountry><name sortKey="Gobin, Veekash" sort="Gobin, Veekash" uniqKey="Gobin V" first="Veekash" last="Gobin">Veekash Gobin</name><name sortKey="Munlemvo, Dolly M" sort="Munlemvo, Dolly M" uniqKey="Munlemvo D" first="Dolly M" last="Munlemvo">Dolly M. 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Rakotoarison</name></noRegion></country><country name="Gambie"><noRegion><name sortKey="Samateh, Ahmadou L" sort="Samateh, Ahmadou L" uniqKey="Samateh A" first="Ahmadou L" last="Samateh">Ahmadou L. Samateh</name></noRegion></country><country name="Algérie"><region name="Wilaya d'Alger"><name sortKey="Mehyaoui, Ryad" sort="Mehyaoui, Ryad" uniqKey="Mehyaoui R" first="Ryad" last="Mehyaoui">Ryad Mehyaoui</name></region></country><country name="Zambie"><noRegion><name sortKey="Patel Mujajati, Ushmaben" sort="Patel Mujajati, Ushmaben" uniqKey="Patel Mujajati U" first="Ushmaben" last="Patel-Mujajati">Ushmaben Patel-Mujajati</name></noRegion></country><country name="Niger"><noRegion><name sortKey="Sani, Chaibou M" sort="Sani, Chaibou M" uniqKey="Sani C" first="Chaibou M" last="Sani">Chaibou M. Sani</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Pearse, Rupert M" sort="Pearse, Rupert M" uniqKey="Pearse R" first="Rupert M" last="Pearse">Rupert M. 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