Study on experiences with cesarean postpartum care in Rwanda published in BMC Health Services Research

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Theoneste Nkurunziza, PhD student at the Chair of Epidemiology at TUM, in collaboration with the Department of Global Health and Social Medicine at Harvard Medical School, has published results of a study on facilitators and barriers to women's cesarean follow-up in Rwanda. The study shows that phone calls or notifications are important influences that help prompt women to seek follow-up care. The article appears in issue 22 of BMC Health Services Research in issue 22 (impact factor: 2.655).

BMC Health Services Research is an open access health services journal that focuses on research related to health services
Theoneste Nkurunziza has been researching how to improve health care after a c-section in Rwanda
Prof. Dr. Stefanie Klug, head of the Chair of Epidemiology

Rwanda data information

Cesarean sections account for about one-third of all surgical procedures in low-income countries. Because there is a lack of standardized protocols and practices for post-discharge follow-up, most data is collected during hospitalization and are therefore not ideal for answering questions about post-discharge outcomes.

Aims and results of the study

The study, with the participation of the Chair of Epidemiology, therefore examined what prompts women who have undergone cesarean section in a rural district hospital in Rwanda to return to the hospital after discharge and what hinders them from doing so.

"About 90 percent of the study participants returned for follow-up. The key factors influencing return were being counseled by a female data collector and receiving a reminder call. Furthermore, the likelihood of returning for follow-up was negatively influenced by high transportation costs as well as not having insurance", Theoneste Nkurunziza explains the study's findings.

Since travel costs discourage patients from returning for follow-up, the researchers recommend the introduction of decentralized follow-up services. In addition, patients from rural communities who do not have health insurance need more financial support for follow-up care after a cesarean section.

Prof. Dr. Stefanie Klug, head of the Chair of Epidemiology, offers an outlook: "The study is one mosaic piece in a series of findings that can shape the future of follow-up care for women after a cesarean section. We now need to work with other stakeholders, such as the government and aid organizations in the field, to derive strategies to improve their care."


To the article "Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda"

To the hompage of the Chair of Epidemiology



Prof. Dr. Stefanie Klug
Chair of Epidemiology
Georg-Brauchle Ring 56
80992 Munich

phone: 089 289 24950
e-Mail: stefanie.klug(at)

Theoneste Nkurunziza
Chair of Epidemiology
Georg-Brauchle Ring 56
80992 Munich

E-Mail: theoneste.nkurunziza(at)


Text: Jessica Flaster
Photos: "BMC Health Services Research"/private