The WHO surgical safety checklist for cesarean section in an Ethiopian teaching hospital: a prospective cross-sectional study

Background: Implementing the World Health Organization (WHO) Surgical Safety Checklist is crucial for preventing post-surgical complications, including surgical site infections, in low-resource settings such as Ethiopia. The country has the lowest measured rate of safe surgery worldwide, with a significant unmet need for safe and affordable surgical care. The WHO checklist can improve maternal health equity by enhancing surgical and obstetric care safety, ultimately improving maternal outcomes in low- and middle-income countries (LMICs). Objective: This study aimed to assess the compliance, completeness, and determinants of using the WHO’s Surgical Safety Checklist during cesarean section (CS). Methods: This prospective study was conducted in the Obstetrics and Gynecology Department of a large tertiary hospital in Addis Ababa, Ethiopia. Primary data were collected from observations of clinical interactions in the obstetrics operating room (OR) during CSs. The rates of performing the checklist and completing each section were analyzed. Results: Of 250 observed CSs, 26.4% were elective, and 73.6% were emergency procedures. Patient ages ranged from 18 to 45 years, with a median age of 28. The overall compliance rate for the WHO surgical safety checklist was 98%, with 100% compliance for elective procedures and 97.2% for emergency procedures. The completeness rates for sign-in, time-out, and sign-out were 80.1%, 66.4%, and 45.3%, respectively. Conclusion: The study revealed high compliance but low completeness rates for the surgical safety checklist during CS. A noticeable distinction was observed, with elective procedures exhibiting superior compliance and completeness rates compared to emergency procedures. This could be attributed to the sense of urgency and limitations in available time.