Assessing the Effect of the Labour Care Guide on Urgent Caesarean Sections at a Tertiary Level Health Facility in Uganda: An Interrupted Time Series Study.

Background: The Labour Care Guide (LCG) has numerous benefits, including providing respectful care during labour and childbirth, and reducing the rate of urgent caesarean sections. However, there is limited literature on the effects of the LCG in low- and middle-income settings in Africa. This study aimed to evaluate the impact of implementing the LCG on urgent caesarean section rates in a low-resource, tertiary health facility in Uganda. Methods: This Interrupted Time Series study (ITS) involved a retrospective review of medical records of pregnant women between July 1st 2021, and June 30th 2023. Data was collected from pregnant women admitted in labour and monitored using the modified WHO Partograph or the WHO Labour Care Guide at St. Francis Hospital Nsambya. Analysis was done using STATA 17/MP, with Continuous variables presented as means ± SD and proportions for categorical variables. Linear segmental regression was used to analyse the outcome data, with a significance level set at ? 0.05. Results: A total of 2451 pregnant women were included in the study, with no significant differences between the two groups monitored during labour. The ITS model showed a significant decrease in urgent caesarean section rates (0.80, p-value 0.016) immediately after the introduction of the LCG, with no significant change in the slope post-intervention (0.015, p-value 0.053). From the aggregated data, the LCG accounted for a 14.0% [95% CI: 17.2 – 10.8] risk difference in urgent caesarean section deliveries and an odds ratio (OR = 0.44 [95% CI: 0.36-0.53], p-value <0.00. However, the study found no statistically significant difference in maternal complications or newborn outcomes immediately after delivery between the two labour monitoring tools (p-value > 0.05). Conclusion and Recommendation: This study highlights a significant reduction in urgent caesarean section rates following the implementation of the WHO Labour Care Guide. The adoption of the labour care guide is recommended as a reliable method for decreasing urgent caesarean sections in Uganda.