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Objective Surgical informed consent is essential prior to caesarean
section, but potentially compromised by insufficient communication. We
assessed the association between a multi-component intervention and
women's recollection of information pertaining to informed consent
for caesarean section in a low-resource setting, thereby contributing to
respectful maternity care. Design Pre-post implementation survey,
conducted from January to June 2018, surveying women prior to discharge.
Setting Rural 150-bed mission hospital in Southern Malawi. Participants A
total of 160 postoperative women were included: 80 pre- and 80
post-implementation. Intervention Based on observed deficiencies and input
from local stakeholders a multi-component intervention was developed,
consisting of a standardised checklist, wall poster with a six-step guide
and on-the-job communication training for health workers. Primary and
secondary outcome measures Individual components of informed consent were:
indication, explanation of procedure, common complications, implications
for future pregnancies and verbal enquiry of consent, which were compared
pre- and post-intervention using χ2 test. Generalized linear models were
used to analyse incompleteness scores and recollection of the informed
consent process. Results The proportion of women who recollected being
informed about procedure-related risks increased from 25/80 to 47/80 (OR
3.13 [95% Confidence Interval 1.64-6.00]). Recollection of an explanation
of the procedure changed from 44/80 to 55/80 (OR 1.80[0.94-3.44]),
implications for future pregnancy from 25/80 to 47/80 (1.69[0.89-3.20])
and of consent enquiry from 67/80 to 73/80 (OR 2.02 [0.73-5.37]). After
controlling for other variables, incompleteness scores post-intervention
were 26% lower (Exp(β)=0.74; 95% CI 0.57 – 0.96). Recollection of common
complications increased by 29% (Exp(β)=1.29; 95% CI 1.01 – 1.64).
Recollection of the correct indication did not differ significantly.
Conclusion Recollection of informed consent for caesarean section changed
significantly in the post-intervention group. Obtaining informed consent
for caesarean section is one of the essential components of respectful
maternity care.
182 views reported since publication in 2019.