Introduction Emergency caesarean sections (CS) are crucial for preventing life-threatening complications. The Decision-to-Delivery Interval (DDI), the time between decision and actual delivery, impacts maternal and neonatal outcomes. While the World Health Organization recommends a DDI of < 30 minutes, achieving this in low-resource settings remains challenging. This study examines the impact of surgeon’s cadre, operating theatre location, and presence of intern healthcare professionals on DDI and whether these associations vary by CS indication. Methods This historical cohort study was conducted at St. Mary’s Hospital Lacor, a tertiary hospital in Northern Uganda, involving 760 women who underwent emergency CS between 6th September 2022 and 1st June 2024. We assessed the association of prolonged DDI (>=60 minutes) with surgeon cadre, operating theatre location, and intern presence using logistic regression, adjusting for key confounders and investigated interaction with the indication for emergency CS. Results The median DDI was 51 minutes (IQR: 36-67), with 36.0% of cases classified as prolonged (>= 60 minutes). Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to senior doctors (adjusted OR: 2.07; 95% CI: 1.38-3.10). Theatre location showed no effect on DDI (OR: 0.89; 95% CI: 0.61-1.28). The presence of interns was weakly associated, with slightly lower odds of prolonged DDI when interns were absent (OR: 0.71; 95% CI: 0.51-1.02). No significant variations were found based on the indication for emergency CS. Conclusion Surgeon’s cadre is a key factor in reducing prolonged DDI, highlighting the importance of training and supervision for junior doctors. While theatre location did not significantly impact DDI, improving theatre readiness and coordination remains essential. The weak association with intern presence suggests further investigation into their role in emergency CS. These findings highlight the importance of addressing system-level delays to improve timely emergency obstetric care in resource-limited settings.

The authors have declared no competing interest.

This study did not receive any external funding. The resources and support for this work were provided by St. Mary’s Hospital Lacor, where the research was conducted. The authors declare no commercial funding related to this study.

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St. Mary’s Hospital Lacor Research Ethics Committee

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