Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi

BMJ Open, vol. 10, pp. e030665

Abstract

OBJECTIVE: Surgical informed consent is essential prior to caesarean section, but potentially compromised by insufficient communication. We assessed the association between a multicomponent 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 preimplementation and 80 postimplementation. INTERVENTION: Based on observed deficiencies and input from local stakeholders, a multicomponent 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: test. Generalised 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% CI 1.64 to 6.00)). Recollection of an explanation of the procedure changed from 44/80 to 55/80 (OR 1.80 (0.94 to 3.44)), implications for future pregnancy from 25/80 to 47/80 (1.69 (0.89 to 3.20)) and of consent enquiry from 67/80 to 73/80 (OR 2.02 (0.73 to 5.37)). After controlling for other variables, incompleteness scores postintervention were 26% lower (Exp(β)=0.74; 95% CI 0.57 to 0.96). Recollection of common complications increased with 0.25 complications (β=0.25; 95% CI 0.01 to 0.49). Recollection of the correct indication did not differ significantly. CONCLUSION: Recollection of informed consent for caesarean section changed significantly in the postintervention group. Obtaining informed consent for caesarean section is one of the essential components of respectful maternity care.

Authors 6

1. Siem Zethof Aachen Department of Obstetrics and Gynaecology

   Leiden University Medical Center · St. Luke's Hospital · St. Luke's Hospital

   Affiliation as printed

   Clinical Department, St. Luke's Hospital, Zomba, Malawi

   Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands

   Clinical Department

   Department of Obstetrics and Gynaecology

   Leiden University Medical Center

   St. Luke's Hospital

2. Wouter Bakker corresponding

   Athena Sustainable Materials Institute · St. Luke's Hospital · St. Luke's Hospital · Vrije Universiteit Amsterdam

   Affiliation as printed

   Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands

   Clinical Department, St. Luke's Hospital, Zomba, Malawi

   Athena Institute, Faculty of Science

   Clinical Department

   St. Luke's Hospital

   VU University

3. Felix Nansongole

   St. Luke's Hospital · St. Luke's Hospital

   Affiliation as printed

   Clinical Department, St. Luke's Hospital, Zomba, Malawi

   Clinical Department

   St. Luke's Hospital

4. Kelvin Kilowe

   St. Luke's Hospital · St. Luke's Hospital

   Affiliation as printed

   Nursing Department, St. Luke's Hospital, Zomba, Malawi

   Nursing Department

   St. Luke's Hospital

5. Jos van Roosmalen Aachen Department of Obstetrics and Gynaecology

   Leiden University Medical Center · Athena Sustainable Materials Institute · Vrije Universiteit Amsterdam

   Affiliation as printed

   Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands

   Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands

   Athena Institute, Faculty of Science

   Department of Obstetrics and Gynaecology

   Leiden University Medical Center

   VU University

6. Thomas van den Akker Aachen Department of Obstetrics and Gynaecology

   Leiden University Medical Center · Athena Sustainable Materials Institute · Vrije Universiteit Amsterdam

   Affiliation as printed

   Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands

   Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands

   Athena Institute, Faculty of Science

   Department of Obstetrics and Gynaecology

   Leiden University Medical Center

   VU University