A pre-post implementation survey of a multi-component intervention to improve informed consent for caesarean section in Southern Malawi

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. Exit-interviews with women postoperatively, entered anounymously into database.  Database has been adjusted and all sensitive information has been removed to ensure information is not traceable to individuals.  Not all variables are included to prevent traceability