Background and importance The setting up of the free policy in caesarean sections is spreading in sub-Saharan Africa. In our country, since 2009, a free kit as a guideline, containing the required materials and antibiotics, has been available.¹ An agency was set up to manage the policy. Unfortunately, some contradictions were noted in antibiotic prophylaxis practices.

Aim and objectives We aimed to identify bottlenecks for appropriate antibiotic prophylaxis practices.

Material and methods Using a semi-structured interview guide, we explored in the stakeholders involved their opinions on the mechanism used in the setting up with a focus on the choice of the antibiotics. The data were analysed by content analysis.

Results From the emerged themes, the stakeholders expressed positive opinions about the kit, intended for the patient’s safety and protection, and good practices in caesarean sections. The choice of the antibiotics in the kit was based on pharmacological and non-pharmacological criteria. However, the non-involvement of certain socioprofessional categories such as microbiologists in the decision-making and the top-down approach showed that the engagement and opinions of all stakeholders has been little considered. Moreover, there appeared to be a low evidence-base and mixed-consensual opinions, which revealed a poor relevance in the choice of the antibiotics. These aspects that have received little consideration in this decision-making are contrary to the two important principles described by Formoso et al in the methodology of guidelines. In effect, they emphasised that healthcare decisions can and should be made through the participation and balanced judgment of specific stakeholders, and scientific evidence should be highly relevant, be gathered systematically and be appraised critically at the patient and policy levels.²

Conclusion and relevance The inappropriate practices in prophylaxis can be explained by the bottlenecks found in our study. Local stakeholders’ opinions and engagement coupled with evidence-based decision-making are essential to ameliorate antibiotic prophylaxis in caesarean sections.

References and/or acknowledgements 1. Dossou J-P et al. Opening the ‘implementation black-box’ of the user fee exemption policy for caesarean section in Benin: a realist evaluation. Health Policy Plan 2020;35(2):153–166.

2. Formoso G, Liberati A, Magrini N. Practice guidelines: useful and “participative” method? Survey of Italian physicians by professional setting. Arch Intern Med 2001;161(16):2037–2042.

Conflict of interest No conflict of interest