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Sarker AR, Zabeen I, Hossain Z, Ali N, Khan JAM. Increasing rates of cesarean birth in Bangladesh: A household-level pooled analysis. Birth 2024; 51:326-342. [PMID: 37994253 DOI: 10.1111/birt.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/24/2022] [Accepted: 10/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in Bangladesh. METHODS We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever-married women aged 15-49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables. RESULTS The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003-04; this rate increased to 33.22% in 2017-18. The annual percentage change in CB rate was 16.34% from 2004 to 2017-18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh. CONCLUSIONS This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Irfat Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Zakir Hossain
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nausad Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Jahangir A M Khan
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Razzaque A, Chowdhury R, Mustafa AG, Billah MA, Naima S, Shafique S, Sarker BK, Islam MZ, Kim M, Jahangir MA, Matin Z, Ferdous J, Vandenent M, Rahman A. Caesarean delivery and neonatal mortality: evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:69. [PMID: 38762527 PMCID: PMC11102622 DOI: 10.1186/s41043-024-00563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND This study examined the neonatal mortality for newborn of women who delivered by caesarean section or vaginally using a prospective cohort. METHODS A total of 6,989 live births registered from 2016 to 2018, were followed for neonatal survival from the selected slums of Dhaka (North and South) and Gazipur city corporations, where icddr,b maintained the Health and Demographic Surveillance System (HDSS). Neonatal mortality was compared by maternal and newborn characteristics and mode of delivery using z-test. Logistic regression model performed for neonatal mortality by mode of delivery controlling selected covariates and reported adjusted odd ratios (aOR) with 95% confidence interval (CI). RESULTS Out of 6,989 live births registered, 27.7% were caesarean and the rest were vaginal delivery; of these births, 265 neonatal deaths occurred during the follow-up. The neonatal mortality rate was 2.7 times higher (46 vs. 17 per 1,000 births) for vaginal than caesarean delivered. Until 3rd day of life, the mortality rate was very high for both vaginal and caesarean delivered newborn; however, the rate was 24.8 for vaginal and 6.3 per 1,000 live births for caesarean delivered on the 1st day of life. After adjusting the covariates, the odds of neonatal mortality were higher for vaginal than caesarean delivered (aOR: 2.63; 95% CI: 1.82, 3.85). Additionally, the odds were higher for adolescent than elderly adult mother (aOR: 1.60; 95% CI: 1.03, 2.48), for multiple than singleton birth (aOR: 5.40; 95% CI: 2.82, 10.33), for very/moderate (aOR: 5.13; 95% CI: 3.68, 7.15), and late preterm birth (aOR: 1.48; 95% CI: 1.05, 2.08) than term birth; while the odds were lower for girl than boy (aOR: 0.74; 95% CI: 0.58, 0.96), and for 5th wealth quintile than 1st quintile (aOR: 0.59, 95% CI: 0.38, 0.91). CONCLUSION Our study found that caesarean delivered babies had significantly lower neonatal mortality than vaginal delivered. Therefore, a comprehensive delivery and postnatal care for vaginal births needed a special attention for the slum mothers to ensure the reduction of neonatal mortality.
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Affiliation(s)
- Abdur Razzaque
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Razib Chowdhury
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Ahm Golam Mustafa
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Arif Billah
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shakera Naima
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sohana Shafique
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Minjoon Kim
- Maternal Newborn Health, UNICEF, New York, USA
| | | | | | | | | | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Kundu S, Sharif AB, Chowdhury SSA, Afroz S, Dey R, Hossain A. Socioeconomic and geographical inequalities in delivery by cesarean section among women in Bangladesh, 2004-2017. BMC Pregnancy Childbirth 2024; 24:131. [PMID: 38350916 PMCID: PMC10863140 DOI: 10.1186/s12884-024-06327-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017. METHODS Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported. RESULTS An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69-30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26-35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19-11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66-42.30). CONCLUSION We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.
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Affiliation(s)
- Satyajit Kundu
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
| | - Azaz Bin Sharif
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Syed Sharaf Ahmed Chowdhury
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Sadia Afroz
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Rakhi Dey
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
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Zewudu L, Keshaun F, Silesh M, Tefera M, Ketema Bogale E, Demis A, Tekle ZY. Preference of cesarean delivery and its associated factors among pregnant women attending ante natal care at public health facilities of Debrebrehan City, Ethiopia: Cross-sectional study. PLoS One 2024; 19:e0296990. [PMID: 38295110 PMCID: PMC10829985 DOI: 10.1371/journal.pone.0296990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/24/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND A Caesarean section is a surgical procedure used to prevent or treat life-threatening maternal or fetal complications. Women's delivery preferences have become a global issue of interest to many researchers and clinicians, especially given the ever-increasing rate of cesarean sections. There is limited data on the preference for cesarean delivery and its associated factors for Ethiopian women, particularly in the study area. The aim of the study is to assess the preference for cesarean delivery and its associated factors among pregnant women attending antenatal care at public health facilities in Debre Berhan, Ethiopia, in 2023. METHODS An institution-based cross-sectional study design was done from May 5-20, 2023, among 512 participants, and a multi-stage sampling technique was used. The data were collected by using interviewer-administered semi-structured questionnaires. The data were entered by Epi Data version 4.6 and then transferred to SPSS version 25 for analysis. With logistic regression, those variables with a p-value <0.25 in the bivariate analysis were candidates for multivariate logistic regression, and variables with a p-value <0.05 were considered statistically significant. RESULT The preference for a cesarean section was 26%, with a CI of 22.3% to 29.9%. Pregnant mothers who were not satisfied with their previous intrapartum care (AOR; 6.3 CI = (3.5-11), P = 0.01), had no knowledge about cesarean delivery (AOR; 2.9; 95% CI = 1.6-5.3), P = 0.01), had a previous history of spontaneous abortion (AOR; 3.1; 95% CI = (1.5-6.3), P = 0.001), lived in an urban area (AOR; 1.9; 95% CI = (1.0-3.5), P = 0.038), and had a current pregnancy-related problem (AOR; 4.8; 95% CI = 1.9-10), P = 0.001) were significantly associated with the preference for cesarean delivery. CONCLUSION In this study, the preference for cesarean delivery was high as compared to the World Health Organization recommendation. Pregnant mothers who were not satisfied with their previous intrapartum care, had no knowledge about cesarean delivery, had a previous history of spontaneous abortion, had an urban residence, and had a current pregnancy-related problem were significantly associated with a preference for caesarean delivery. Clinicians who are working in the delivery room should improve their service provision by using patient-centered care to increase patient satisfaction.
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Affiliation(s)
- Lemlem Zewudu
- Debre Berhan compressive specialized Hospital Amhara Region, Debre Berhan, Ethiopia
| | - Fetene Keshaun
- Department of Midwifery School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mulualem Silesh
- Department of Midwifery School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mitiku Tefera
- Department of Midwifery School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral Sciences Department, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aberham Demis
- Department of Midwifery, Deber-Berehan Health Science College, Debre Berhan, Amhara, Ethiopia
| | - Zewedie Yeshaw Tekle
- Department of Midwifery, Deber-Berehan Health Center, Debre Berhan, Amhara, Ethiopia
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Etcheverry C, Betrán AP, de Loenzien M, Robson M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project. BMC Pregnancy Childbirth 2024; 24:67. [PMID: 38233792 PMCID: PMC10792793 DOI: 10.1186/s12884-024-06257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Improving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso. METHODS A cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women's characteristics. RESULTS A total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%. CONCLUSION Our results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women's preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care. TRIAL REGISTRATION The QUALI-DEC trial is registered on the Current Controlled Trials website ( https://www.isrctn.com/ ) under the number ISRCTN67214403.
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Affiliation(s)
- Camille Etcheverry
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
| | | | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
- Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
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Nantume S, Baluku EM, Kwesiga D, Waiswa P. Factors Associated with High Rates of Caesarean Deliveries: A Cross Sectional Study Classifying Deliveries According to Robson in Mengo Hospital Kampala. Risk Manag Healthc Policy 2023; 16:2339-2356. [PMID: 37965117 PMCID: PMC10641024 DOI: 10.2147/rmhp.s422705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction The number of caesarean section (CS) continues to rise worldwide. CS can improve outcomes in infants and mothers. However, if used improperly, the potential harm can outweigh the potential benefits. Aim The study was to determine the factors associated with high cesarean section rates at Mengo Hospital. Methods This cross-sectional study used a mixed-method approach that included a retrospective review of 1276 casebooks using the Robson Ten Group Classification System (RTGCS) for births that occurred at Mengo Hospital in December 2018, January, and February 2019. Questionnaire was used for data collection from 200 mothers on second day after birth from 24th May to 19th July 2019. Eight key informants were interviewed within the same period. Quantitative data were analyzed using STATA V.14, thematic analysis for qualitative data. Univariate, bivariate, and multivariate analyses were performed to determine the association between predisposing factors and outcome variables using chi-square and modified Poisson. Results Caesarean section rate (CSR) from casebooks was 49% and 64% from the primary data. Group 5(Previous CS, single cephalic, >37 weeks) had (35.4%) to the total number of cesarean deliveries, followed by Group 1 (Nulliparous, single cesarean deliveries, >37 weeks in spontaneous labour), with 18.4%. Group 3 (ultiparous (excluding previous CS), single cephalic, >37 weeks of spontaneous labor) with (13.7%). The common indications from casebooks were a previous scar (32%), obstructed labor (18%), and previous scar (97.6%). Presence of an obstetric indication, influence of husband, friends, relatives, and mother's desire for a CS were closely associated with caesarean delivery. Mothers said that occurrence of CS was due to health workers reducing the stress of monitoring labour and financial benefits from CS deliveries by the hospital. Conclusion Repeat CS made the highest CSR contribution; therefore, strategies to reduce the frequency of the procedure should include avoiding medically unnecessary primary CS and encouraging vaginal birth after previous CS where applicable.
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Affiliation(s)
- Susan Nantume
- College of Health Science, Makerere University, Kampala, Uganda
| | - Eric Murungi Baluku
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Doris Kwesiga
- College of Health Science, Makerere University, Kampala, Uganda
| | - Peter Waiswa
- College of Health Science, Makerere University, Kampala, Uganda
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Kumar P, Srivastava S, Chaudhary P, Muhammad T. Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey. PLoS One 2023; 18:e0291485. [PMID: 37703256 PMCID: PMC10499255 DOI: 10.1371/journal.pone.0291485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Most of the existing literature in developing countries focused on either the rising trend of CS or its determinants. There is a paucity of population-based studies on existing socioeconomic inequalities in availing CS services by women in Indonesia. This study aimed to assess the factors associated with caesarian section (CS) delivery and explore the various factors contributing to inequalities in CS delivery rates in Indonesia. METHODS The study utilized nationally representative cross-sectional data from the Indonesia Demographic and Health Survey (IDHS), 2017. We conducted multivariable logistic regression to find the factors associated with CS delivery. Concentration index and Wagstaff's decomposition analysis were used to examine the socioeconomic inequalities in CS delivery among women and associated factors. RESULTS About 17% of women in Indonesia delivered babies through CS. A concentration index of 0.31 in CS delivery rate showed a higher CS delivery rate among women belonging to rich households. About 44.7% of socioeconomic status inequality in CS delivery was explained by educational status among women who went for CS delivery. Women's place of residence explained 30.1% of socioeconomic inequality, and women's age at first birth explained about 11.9% and reporting ANC visits explained 8.4% of the observed inequality. Highest socioeconomic inequality was witnessed in central Sulawesi (0.529), followed by Maluku (0.488) and West Kalimantan (0.457), whereas the lowest was recorded in Yogyakarta (0.021) followed by north Sulawesi (0.047) and east Kalimantan (0.171). Education (44.7%) followed by rural-urban place of residence (30.1%) and age of first birth (11.9%) contributed most to explain the gap in CS delivery among rich and poor women. CONCLUSION The study highlighted the higher CS delivery rates among women from higher socioeconomic groups and thus, it is important to frame policies after identifying the population subgroups with potential underuse or overuse of CS method of delivery.
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Affiliation(s)
- Pradeep Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | | | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Singh RR, Sharma A, Mohanty SK. Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5. BMC Health Serv Res 2023; 23:966. [PMID: 37679706 PMCID: PMC10485997 DOI: 10.1186/s12913-023-09980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Though over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India. METHODS We used data from the latest round of the National Family Health Survey conducted during 2019-21. The survey covered 636,699 households, and 724,115 women in the age group 15-49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis. RESULT Cesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96% in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35-10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata. CONCLUSION High OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India.
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Affiliation(s)
| | - Anjali Sharma
- International Institute for Population Sciences, Mumbai, 400088, India
| | - Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India
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Neethi Mohan V, Shirisha P, Vaidyanathan G, Muraleedharan VR. Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh. BMC Pregnancy Childbirth 2023; 23:622. [PMID: 37649006 PMCID: PMC10466745 DOI: 10.1186/s12884-023-05928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The prevalence of C-sections in India increased from 17.2% to 2006 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG). METHODS Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions. RESULTS The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95-2.29; NFHS-5) those for underweight women. Women aged 35-49 were also twice (OR = 2.10; 95% CI 1.92-2.29; NFHS-5) as likely as those aged 15-24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74-4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor. CONCLUSION The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges.
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Affiliation(s)
- Varshini Neethi Mohan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India.
| | - P Shirisha
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - Girija Vaidyanathan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - V R Muraleedharan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
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Lee KH, Chowdhury AI, Rahman QSU, Cunningham SA, Parveen S, Bari S, El Arifeen S, Gurley ES. Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: Findings from a health and demographic surveillance system. PLoS One 2023; 18:e0288746. [PMID: 37467226 DOI: 10.1371/journal.pone.0288746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
Adolescent pregnancies, a risk factor for obstetric complications and perinatal mortality, are driven by child marriage in many regions of South Asia. We used data collected between 2017-2019 from 56,155 married adolescents and women in a health and demographic surveillance system to present a population-level description of historical trends in child marriage from 1990-2019 as well as epidemiologic associations between maternal age and pregnancy outcomes in Baliakandi, a rural sub-district of Bangladesh. For pregnancies identified between 2017-2019, we used Kaplan-Meier estimates to examine timing of first pregnancies after first marriage and multinomial logistic regression to estimate associations between maternal age and perinatal death. We described the frequency of self-reported obstetric complications at labor and delivery by maternal age. In 1990, 71% of all marriages were to female residents under 18 years of age. This decreased to 57% in 2010, with the largest reduction among females aged 10-12 years (22% to 3%), and to 53% in 2019. Half of all newly married females were pregnant within a year of marriage, including adolescent brides. Although we observed a decline in child marriages since 1990, over half of all marriages in 2019 were to child brides in Baliakandi. In this same population, adolescent pregnancies were more likely to result in obstetric complications (13-15 years: 36%, 16-17 years: 32%, 18-34 years: 23%; χ2 test, p<0.001) and perinatal deaths (13-15 years: stillbirth OR 2.23, 95% CI 1.01-2.42; 16-17 years: early neonatal death OR 1.57, 95% CI: 1.01-2.42) compared to adult pregnancies. Preventing child marriage can improve the health of girls and contribute to Bangladesh's commitment to reducing child mortality.
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Affiliation(s)
- Kyu Han Lee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - Solveig A Cunningham
- Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Sanwarul Bari
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Kumar P, Sharma H. Prevalence and determinants of socioeconomic inequality in caesarean section deliveries in Bangladesh: an analysis of cross-sectional data from Bangladesh Demographic Health Survey, 2017-18. BMC Pregnancy Childbirth 2023; 23:492. [PMID: 37403091 DOI: 10.1186/s12884-023-05782-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Caesarean section deliveries, which involve incisions in the abdomen and uterus of the mother, have been a widespread event among women with obstructed labour. The current study not only estimated the socioeconomic and demographic factors of caesarean deliveries in Bangladesh but also decomposed the existing socioeconomic inequality in caesarean deliveries. DATA AND METHODS 2017-18 Bangladesh Demographic and Health Survey (BDHS) data was used for this study. The adequate sample size for the analysis was 5,338 women aged 15-49 years who had given birth at a health facility for three years preceding the survey. Explanatory variables included women's age, women's educational level, women's working status, mass media exposure, body mass index (BMI), birth order, Ante Natal Care (ANC) visits, place of delivery, partner's education and occupation, religion, wealth index, place of residence, and divisions. Descriptive statistics along with bivariate and multivariate logistic regression analysis was performed to identify the factors associated with the outcome variable. Concentration index and concentration curve were made to measure the socioeconomic inequality in caesarean births in Bangladesh. Further, Wagstaff decomposition analysis was used to decompose the inequalities in the study. RESULTS About one-third of the deliveries in Bangladesh were caesarean. Education of the women and the family's wealth had a positive relationship with caesarean delivery. The likelihood of caesarean delivery was 33% less among working women than those who were not working [AOR: 0.77; CI: 0.62-0.97]. Women who had mass media exposure [AOR: 1.27; CI: 0.97-1.65], overweight/obese [AOR: 1.43; CI: 1.11-1.84], first birth order, received four or more Antenatal check-ups (ANC) [AOR: 2.39; CI: 1.12-5.1], and delivered in a private health facility [AOR: 6.69; CI: 5.38-8.31] had significantly higher likelihood of caesarean delivery compared to their counterparts. About 65% of inequality was explained by place of delivery followed by wealth status of the household (about 13%). ANC visits explained about 5% of the inequality. Furthermore, the BMI status of the women had a significant contribution to caesarean births-related inequality (4%). CONCLUSION Socioeconomic inequality prevails in the caesarean deliveries in Bangladesh. The place of delivery, household wealth status, ANC visits, body mass index, women's education and mass media have been the highest contributors to the inequality. The study, through its findings, suggests that the health authorities should intervene, formulate specialized programs and spread awareness about the ill effects of caesarean deliveries amongst the most vulnerable groups of women in Bangladesh.
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Affiliation(s)
- Pradeep Kumar
- Monitoring & Evaluation, Health Action Trust, Lucknow, India
| | - Himani Sharma
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
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Ahamed F, Rehman T, Kaur A. Why do Mothers from Remote Rural Areas opt for Cesarean Delivery: An Observational Analytical Study from West Bengal, India. Indian J Community Med 2023; 48:573-578. [PMID: 37662136 PMCID: PMC10470558 DOI: 10.4103/ijcm.ijcm_911_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background The percentage of cesarean section (C-section) deliveries has doubled in the last two decades in India. Although C-section delivery is a life-saving intervention, multiple maternal and neonatal morbidities are often associated with this procedure, adversely affecting the quality of life of both the mother and child. Material and Methods This community-based cross-sectional study was conducted to assess the point of view of mothers who delivered from January 2020 to June 2021. Results The mean (standard deviation (SD)) age of the 866 study participants at delivery was 24.5 (4.8) years, and 60.2% were primigravidas. A total of 613 (70.8%; 95% CI: 67.8-73.8) C-sections were conducted, of which 65.9% (n = 404) were planned and 21.9% were done on maternal request. C-sections were significantly associated with private institutes (adjusted prevalence ratio (aPR) 1.90; 95% CI: 1.70-2.11), at-risk pregnancy (aPR 1.37; 95% CI: 1.26-1.49), and primigravida (aPR 1.16; 95% CI: 1.05-1.29). About 55.3%, 29.8%, and 14.9% of women considered vaginal delivery to be risky, painful, and inconvenient, respectively. Conclusion It is imperative to generate awareness regarding modes of delivery during antenatal care (ANC) so that mothers can make better-informed choices.
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Affiliation(s)
- Farhad Ahamed
- Department of Community Medicine and Family Medicine, AIIMS Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, West Bengal, India
| | - Tanveer Rehman
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Amandeep Kaur
- Department of Community Medicine and Family Medicine, AIIMS Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, West Bengal, India
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Khan MN, Islam MM, Akter S. Spatial distribution of caesarean deliveries and their determinants in Bangladesh: evidence from linked data of population and health facility survey. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 14:100153. [PMID: 37492410 PMCID: PMC10363500 DOI: 10.1016/j.lansea.2023.100153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/18/2022] [Accepted: 01/11/2023] [Indexed: 07/27/2023]
Abstract
Background Health facility-level factors play a crucial role in women's access to and use of caesarean section (CS) services, but lacks relevant evidence. The study aimed to understand the effects of health facility-level factors on CS delivery in Bangladesh. Methods The 2017-18 Bangladesh Demographic and Health Survey (2017-18 BDHS) and the 2017 Bangladesh Health Facility Survey (2017 BHFS) were linked and analysed in this study. The sample comprised of 4954 women gave at least one live birth within three years preceding the survey. The outcome variable was delivery through CS (yes, no) and the explanatory variables were health facility-level, individual-level, household-level, and community-level factors. Moran's I and Getis-Ord General G statistic were used to identify the hotspots of delivery through CS. Mixed-effect multilevel logistic regression was used to examine the association of the outcome variable with explanatory variables. Findings Around 33% of women in Bangladesh underwent CS in their most recent pregnancies. The hotspots of delivery through CS are located primarily in Rajshahi, Dhaka, and Khulna divisions. The likelihood of delivered through CS increased with the rising scores of the management (Adjusted Odds Ratio (AOR), 1.83; 95% CI 1.04-2.07) and infrastructure (AOR, 3.14; 95% CI 1.40-5.12) of the nearest health facility. The readiness of health facilities to provide comprehensive obstetric care was significantly associated with an increased likelihood of delivery through CS (AOR, 2.18; 95% CI 1.15-3.28). These relationships were strong for private than non-government and government health facilities. Interpretation The proximity of comprehensive obstetric care facilities to women's residences and their readiness to provide services play critical roles in the access to and use of CS in Bangladesh. The findings highlight the importance of necessary healthcare personnel, including midwives, availability of government hospitals where undue CS are avoided, and awareness-building programmes about the adverse effects of CS delivery. Funding None.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh 2220, Bangladesh
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Shahinoor Akter
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
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Sayed G, Salama H, Abumhara S, Al Obaidly S, Al-Qubaisi M, Al-Rifai H. Review of socioeconomic risk factors for cesarean births: a population-based study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023082. [PMID: 37326277 PMCID: PMC10308481 DOI: 10.23750/abm.v94i3.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/09/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The reasons for increased cesarean section (CS) rates are complex and multifactorial. The goal of this study was to look at different social and economic factors that might be causing more cases of CS in the population. STUDY DESIGN A retrospective population-based cohort study. Data was taken from the Perinatal Neonatal Outcomes Research study in the Arabian Gulf (PEARL study) registry. Data from 60,728 live births ≥ 24 weeks of gestation were analyzed. In this study, various socioeconomic factors, such as maternal nationality, religion, educational level, employment status, parental income, consanguinity, housing, preterm birth, and tall stature, were examined for women undergoing cesarean section (CS) and their economic outcomes. Women who underwent vaginal delivery (VD) were compared. There are risks associated with pregnancy, smoking, assisted conception, and prenatal care. RESULTS 60,728 births ≥ 24 weeks gestation were included in the analysis. 17,535 women delivered by CS (28.9%). Women with university-level -education and above were more likely to deliver by CS (61%), as compared to illiterate women or women with basic education at elementary or secondary levels (OR 0.73, CI 95%: P: <0.0001). Working women were more likely to deliver by CS (OR 1.40, CI 95%, P value <0.0001). Women living in rented houses were less likely to achieve a normal delivery (71.8%) (OR 1.40, CI 95%; P: <0.0001) as compared to women living in owned houses (74.7%). Women over 20 years old tended to achieve more VD compared to women less than 20 years old. P value <0.0001. Smoking was associated with lower chances of VD, with 42.4% of smokers delivered by CS compared to 28.3% of non-smokers (OR 1.87, CI 95%; P: <0.0001). Assisted conception was associated with higher CS rates as compared to spontaneous conceptions (OR 0.39; P: <0.0001). We found no statistically significant differences in how babies were born based on the mother's nationality, the father's job, or the mother's income. CONCLUSIONS Higher education, employed mothers, smoking, and living in rented houses were socioeconomic factors associated with a higher rate of CS in our population. Furthermore, women who had regular antenatal care were more at risk for delivery by cesarean section, which could be related to other comorbidities increasing the likelihood of cesarean birth rather than antenatal care itself. In our population, assisted reproduction was associated with a higher probability of cesarean delivery.
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Affiliation(s)
- Gamal Sayed
- Department of Obstetrics and Gynecology. women's wellness and research center. Hamad Medical City Hamad Medical corporation WWRC.
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Vu PH, Sepehri A, Tran LTT. Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam's Household Living Standard Survey 2006-2018. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:237-254. [PMID: 35419672 DOI: 10.1007/s10754-022-09330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/22/2022] [Indexed: 05/05/2023]
Abstract
Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.
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Affiliation(s)
- Phuong Hung Vu
- School of Banking & Finance, National Economics University, Hanoi, Vietnam
| | - Ardeshir Sepehri
- Department of Economics, University of Manitoba, Winnipeg, MB, R3T 5V5, Canada.
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Jean Simon D, Jean-Baptiste S, Nazaire R, Joseph G, Carmil JA, Joseph F, Kondo Tokpovi VC. Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey. Trop Med Health 2023; 51:21. [PMID: 37069696 PMCID: PMC10108480 DOI: 10.1186/s41182-023-00513-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. METHODS Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. RESULTS The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight. CONCLUSIONS While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.
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Affiliation(s)
- David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
| | | | - Roodjmie Nazaire
- Université d'Etat d'Haïti (UEH), Faculté de Médecine et de Pharmacie (FMP), Port-au-Prince, Haiti
| | - Ghislaine Joseph
- Centre de Recherche Cultures Arts Sociétés (CELAT), University of Laval, Quebec City, Canada
| | | | - Fanor Joseph
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
- University of Antananarivo, Doctoral School of Social and Human Sciences, Antananarivo, Madagascar
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Chauhan BG, Radkar A. Trends and inequalities in caesarean section delivery in India, 1992–2021. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Long Q, Zhang Y, Zhang J, Tang X, Kingdon C. Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys. BMJ Open 2022; 12:e059208. [PMID: 35418438 PMCID: PMC9014066 DOI: 10.1136/bmjopen-2021-059208] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Since 2009, China has introduced policies, principally targeting health professionals, to reduce caesarean section (CS) overuse. In 2016, China endorsed a universal two-child policy. Advanced maternal age and previous CS may indicate changes in obstetric risks, which raise concerns on the need for and safety of CS. This study investigated changes in CS rates in 2008-2018, and factors associated with CS use during the period of transition from the one-child to two-child policy era. DESIGN We used births data from the cross-sectional National Household Health Services Surveys in 2013 and 2018. SETTING Population-based national survey. PARTICIPANTS Women who had the last live birth within 5 years before the survey. PRIMARY OUTCOME MEASURE CS rate. RESULTS Overall CS use increased from 40.9% in 2008 to 47.2% in 2014 with significant increase in rural areas and the western region, and slightly decreased to 45.2% in 2018 with the greatest decrease among nulliparous women. Maternal request for CS by urban nulliparous women decreased from 36.8% in 2008-2009 to 22.2% in 2016-2018, but this change was not statistically significant in rural areas. Maternal age over 35 years old (OR 2.40, 95% CI 1.72 to 3.35) and births that occurred at a private hospital (OR 1.52, 95% CI 1.25 to 1.86) were associated with CS use among nulliparous women in 2016-2018. The CS rate among multiparous women increased over time. Individual socioeconomic factors associated with CS use among multiparous women. CONCLUSIONS The CS rate rise in China in 2008-2018 is attributable to increased use in rural areas and the less developed western region. The population policy shift, alongside facility policies for unnecessary CS reduction, are likely factors in CS reduction in urban areas. The challenge remains to reduce unnecessary CS, at the same time as providing safe, universal access to CS for women in need.
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Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yaoguang Zhang
- Centre for Health Statistics and Information, National Health Commission of the People's Republic of China, Beijing, China
| | - Jing Zhang
- Nursing School, Hangzhou Normal University, Hangzhou, China
| | - Xiaojun Tang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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Chavan S, Malwade SD, Kumari S, Garud BP, Agarkhedkar S. Incidence, Clinical Features, and Outcomes of Transient Tachypnea of the Newborn at a Tertiary Care Center in Western India. Cureus 2022; 14:e23939. [PMID: 35535295 PMCID: PMC9079322 DOI: 10.7759/cureus.23939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Transient tachypnea of the newborn (TTN) is a self-limiting, benign condition leading to respiratory distress shortly after birth. It is among the leading cause of respiratory distress in term and late preterm neonates. The disease is transient and resolves by three to four days in most neonates. Objective The objective of this study was to study the incidence of TTN, its clinical features, predictors of outcomes and duration of hospital stay in these neonates suffering from it. Methods This was a prospective study done at a tertiary care center carried out between August 2019 to July 2021. The study subjects were late pre-term (34 to 36 weeks of gestation) and term neonates with respiratory distress who were admitted to the neonatal intensive care unit (NICU). The diagnosis was based on clinical features, radiological features, and clinical course in NICU. Results The total number of cases with TTN was 74. The incidence of TTN was 16 per 1000 live births. 63.5% were male, 75.7% were term births, 70.3% were born via lower section cesarean section (LSCS), and 66.2% were normal birth weight (≥2.5 kg) infants. A high incidence of TTN was found in late pre-term babies, babies born via LSCS, and male sex. None of the neonates required ventilatory support, either noninvasive or invasive. Conclusion Delivery by LSCS and male sex were risk factors for the development of TTN. The distress in TTN is usually mild to moderate, and in most cases, oxygen supplementation suffices. Higher Downes’ score at presentation, low birth weight, preterm, and delivery by LSCS were found to be predictors for a longer duration of distress and thus the longer duration of NICU stay. Although severe complications for TTN have been reported in the literature, they are rare. Careful observation can decrease not only a lot of unnecessary investigations but also allow clinicians at secondary and primary centers to better care for neonates with TTN.
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Khan MN, Kabir MA, Shariff AA, Rahman MM. Too many yet too few caesarean section deliveries in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys data. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000091. [PMID: 36962249 PMCID: PMC10022004 DOI: 10.1371/journal.pgph.0000091] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Caesarean section (CS) use is rising rapidly in Bangladesh, though lack of CS use remains common among disadvantage women. This increases risks of long-term obstetric complications as well as maternal and child deaths among disadvantage women. We aimed to determine the interaction effects of women's disadvantage characteristics on CS use in Bangladesh. For this we have analysed a total of 27,093 women's data extracted from five rounds of Bangladesh Demographic and Health Survey conducted during 2004 and 2017/18. The outcome variable was CS use, coded as use (1) and non-use (0). The major exposure variables were individual level, household level, and community level characteristics. Multilevel logistic regression model was used to determine association of CS use with socio-demographic characteristics and the interactions of three variables: working status, wealth quintile, and place of residence. We found a 751% increase of CS use over the last 13 years-from 3.88% in 2004 to 33% in 2017/18. Nearly, 80% of the total CS operation occurred in the private health facilities followed by the government health facilities (15%). Women living in rural areas with no engagement in formal income generating activities showed a 11% (OR, 0.89, 95% CI, 0.71-0.99) lower use of CS in 2004. This association was further strengthened over time, and a 51% (OR, 0.49, 0.03-0.65) lower in CS use was reported in 2017/18. Similarly, around 12%-83% lower likelihoods of CS use were found among rural poor and poorer women. These indicate Bangladesh is facing a double burden of CS use, that is a group of women with improved socio-economic condition are using this life saving procedure without medical necessity while their counterpart of disadvantage characteristics could not access the service. Improved monitoring from the government along with support to use CS services for the disadvantage groups on necessity are important.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Md Awal Kabir
- Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Asma Ahmad Shariff
- Institute of mathematical sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Md Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Das P, Samad N, Sapkota A, Al-Banna H, A Rahman NA, Ahmad R, Haque M, Godman B. Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample. Cureus 2021; 13:e20326. [PMID: 35028222 PMCID: PMC8743029 DOI: 10.7759/cureus.20326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background Caesarian sections (CS) are life-saving management for a pregnant mother and fetus subject to obstetric complications. The World Health Organization (WHO) expected CS rates not to exceed 10 to 15 per 100 live births in any country. This study aimed to assess the prevalence of CS and its associated factors from the 2016 Nepal Demographic and Health Survey (NDHS), building on previous studies mentioned in detail in the latter part of the paper. Methods This study analyzed the secondary data from the 2016 Nepal Demographic and Health Survey (NDHS), conducted from June 19, 2016, to January 31, 2017. The survey is undertaken every five years; consequently, the data capture the information in the previous five years from the data collection period. We used the 2016 NDHS, which is implemented by the new Enumeration Area (EA) under the support of the Ministry of Health (MOH) and funded by the U.S. Agency for International Development (USAID). In the rural areas, the sample is stratified and selected in two stages. In the first stage, wards are selected as the primary sampling units (PSU), with households subsequently chosen from the PSUs. In the urban areas, the sample is nominated in three stages. In the first stage, wards are selected as PSUs; in the second stage, one EA is chosen from each PSU, and finally, households are selected from the EAs. Then data were collected from the women in the reproductive age group within the selected households. Results The prevalence of CS in Nepal conforms to the WHO standard with 7.8, 7.5, and 8.1 per 100 deliveries, or 9.8, 8.9, and 9.1 per women's last births in the previous one, three, and five years, respectively. Older mothers of 30 years old or more, having high incomes, being overweight and obese, using the internet, ante-natal care (ANC) visits of more than four times, ANC by doctors, twin delivery, and having babies of 4 kg or more, had higher odds for a CS while having two or more children seemed to be protective towards CS. Conclusion These findings can be used to update health policies surrounding CS delivery to limit unnecessary CS and ensure better health as CS is not without complications.
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Affiliation(s)
- Pranta Das
- Statistics, University of Dhaka, Dhaka, BGD
| | | | - Ashmita Sapkota
- Public Health, School of Health and Allied Science, Pokhara University, Pokhara, NPL
| | - Hasan Al-Banna
- Social Welfare, Institute of Social Welfare and Research, University of Dhaka, Dhaka, BGD
| | | | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Mainul Haque
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Brian Godman
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, ARE
- Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow, GBR
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Ekholuenetale M, Mistry SK, Chimoriya R, Nash S, Doyizode AM, Arora A. Socioeconomic inequalities in early initiation and exclusive breastfeeding practices in Bangladesh: findings from the 2018 demographic and health survey. Int Breastfeed J 2021; 16:73. [PMID: 34565400 PMCID: PMC8474822 DOI: 10.1186/s13006-021-00420-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Optimal breastfeeding practices including early initiation of breastfeeding and exclusive breastfeeding (EBF) are associated with positive health outcomes. Socioeconomic inequalities in key breastfeeding indicators may play a role in the prevalence of breastfeeding practices. The objective of this study was to examine the socioeconomic inequalities in early initiation of breastfeeding and EBF practices in Bangladesh based on the 2018 Bangladesh Demographic and Health Survey (BDHS). METHODS This was a secondary data analysis of the nationally representative 2018 BDHS. Data on 4950 women of reproductive age who had ever given birth and 924 children aged 0-5 months were extracted, for early initiation of breastfeeding and EBF. Early initiation of breastfeeding was determined from children who were put to the breast within the first hour of birth. Exclusive breastfeeding was estimated from children aged 0-5 months who were exclusively breastfed. RESULTS The weighted prevalence of early initiation of breastfeeding and EBF were 60.8% (95% CI; 59.0, 62.6%) and 66.8% (95% CI; 63.1, 70.3%), respectively. The estimated prevalence of early initiation among the poorest, poorer, middle, richer and richest households were 67.8, 66.3, 58.4, 56.3 and 54.4%, respectively. Similarly, early initiation prevalence of 64.4, 65.0, 61.1 and 52.3% were estimated among women with no formal education, primary, secondary and higher education, respectively. The estimated prevalence of EBF among the poorest, poorer, middle, richer and richest households were 63.0, 65.2, 67.7, 66.7 and 69.9%, respectively. Similarly, the estimated EBF prevalence were 62.5, 66.0, 66.3 and 68.9% among women with no formal education, primary, secondary and higher education, respectively. Early initiation of breastfeeding was higher among lower household wealth (Conc. Index = - 0.049; SE = 0.006) and lower educational attainment groups (Conc. Index = - 0.035; SE = 0.006). CONCLUSIONS Improving optimal breastfeeding practices in Bangladesh should be given utmost priority. A need to address the socioeconomic inequalities in breastfeeding practices was also identified.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.,BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Health Equity Laboratory, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Simone Nash
- Health Equity Laboratory, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Ashish M Doyizode
- Health Equity Laboratory, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- Health Equity Laboratory, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, Westmead, NSW, 2145, Australia. .,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
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24
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Roy A, Paul P, Chouhan P, Rahaman M, Kapasia N. Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu. BMC Public Health 2021; 21:1715. [PMID: 34548059 PMCID: PMC8456626 DOI: 10.1186/s12889-021-11750-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively. Methods This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data. Results Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31). Conclusion Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.
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Affiliation(s)
- Avijit Roy
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India. .,Department of Geography, Malda College, Malda, West Bengal, 732101, India.
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi, 110067, India.,International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
| | - Margubur Rahaman
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Nanigopal Kapasia
- Department of Geography, Malda College, Malda, West Bengal, 732101, India
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25
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Afiaz A, Arusha AR, Ananna N, Kabir E, Biswas RK. A national assessment of elective cesarean sections in Bangladesh and the need for health literacy and accessibility. Sci Rep 2021; 11:16854. [PMID: 34413409 PMCID: PMC8376956 DOI: 10.1038/s41598-021-96337-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 08/09/2021] [Indexed: 11/12/2022] Open
Abstract
There has been a gradual rise in the number of cesarean sections (CSs) in Bangladesh. The present study identified the cohort of women, who were more likely to opt for an elective CS based on their sociodemographic characteristics, pre-delivery care history, and media exposure, using the Bangladesh Multiple Indicator Cluster Survey-2019. The survey stratification adjusted logistic regression model and interpretable machine learning method of building classification trees were utilized to analyze a sample of 9202 women, alongside district-wise heat maps. One-in-five births (20%) were elective CSs in the 2 years prior to the survey. Women residing in affluent households with educated house-heads, who accessed antenatal care prior to delivery (AOR 4.12; 95% CI 3.06, 5.54) with regular access to media (AOR 1.31; 95% CI 1.10, 1.56) and who owned a mobile phone (AOR 1.25; 95% CI 1.04, 1.50) were more likely to opt for elective CSs, which suggests that health access and health literacy were crucial factors in women's mode of delivery. Spatial analyses revealed that women living in larger cities had more elective CS deliveries, pointing towards the availability of better health and access to multiple safe delivery options in peripheral areas.
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Affiliation(s)
- Awan Afiaz
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Anowara Rayhan Arusha
- Applied Linguistics and English Language Teaching (ELT), University of Dhaka, Dhaka, Bangladesh
| | | | - Enamul Kabir
- School of Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, Australia.
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Simmons E, Lane K, Rao SR, Kurhe K, Patel A, Hibberd PL. Trends in cesarean section rates in private and public facilities in rural eastern Maharashtra, India from 2010-2017. PLoS One 2021; 16:e0256096. [PMID: 34383862 PMCID: PMC8360542 DOI: 10.1371/journal.pone.0256096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/01/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rates of cesarean sections (CS) have increased dramatically over the past two decades in India. This increase has been disproportionately high in private facilities, but little is known about the drivers of the CS rate increase and how they vary over time and geographically. METHODS Women enrolled in the Nagpur, India site of the Global Network for Women's and Children's Health Research Maternal and Neonatal Health Registry, who delivered in a health facility with CS capability were included in this study. The trend in CS rates from 2010 to 2017 in public and private facilities were assessed and displayed by subdistrict. Multivariable generalized estimating equations models were used to assess the association of delivering in private versus public facilities with having a CS, adjusting for known risk factors. RESULTS CS rates increased substantially between 2010 and 2017 at both public and private facilities. The odds of having a CS at a private facility were 40% higher than at a public facility after adjusting for other known risk factors. CS rates had unequal spatial distributions at the subdistrict level. DISCUSSION Our study findings contribute to the knowledge of increasing CS rates in both public and private facilities in India. Maps of the spatial distribution of subdistrict-based CS rates are helpful in understanding patterns of CS deliveries, but more investigation as to why clusters of high CS rates have formed in warranted.
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Affiliation(s)
- Elizabeth Simmons
- Department of Global Health, Boston University School of Public health, Boston, MA, United States of America
| | - Kevin Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Sowmya R. Rao
- Department of Global Health, Boston University School of Public health, Boston, MA, United States of America
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Datta Meghe Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public health, Boston, MA, United States of America
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Das MK, Arora NK, Dalpath SK, Kumar S, Kumar AP, Khanna A, Bhatnagar A, Bahl R, Nisar YB, Qazi SA, Arora GK, Dhankhad RK, Kumar K, Chander R, Singh B. Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study. PLoS One 2021; 16:e0254781. [PMID: 34297746 PMCID: PMC8301676 DOI: 10.1371/journal.pone.0254781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/04/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. Methods This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider’s knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. Results The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19–42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. Conclusion This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.
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Affiliation(s)
| | | | - Suresh Kumar Dalpath
- Department of Health and Family Welfare, Government of Haryana, Panchkula, Haryana, India
| | - Saket Kumar
- Department of Health and Family Welfare, Government of Haryana, Panchkula, Haryana, India
| | - Amneet P. Kumar
- Department of Health and Family Welfare, Government of Haryana, Panchkula, Haryana, India
| | | | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Shamim Ahmad Qazi
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Gulshan Kumar Arora
- Department of Health and Family Welfare, Office of Chief Medical Officer and Civil Surgeon (Faridabad), Government of Haryana, Faridabad, Haryana, India
| | - R. K. Dhankhad
- Department of Health and Family Welfare, Office of Chief Medical Officer and Civil Surgeon, (Jhajjar), Government of Haryana, Jhajjar, Haryana, India
| | - Krishan Kumar
- Department of Health and Family Welfare, Office of Chief Medical Officer and Civil Surgeon (Rewari), Government of Haryana, Rewari, Haryana, India
| | - Ramesh Chander
- Department of Health and Family Welfare, Office of Chief Medical Officer and Civil Surgeon (Faridabad), Government of Haryana, Faridabad, Haryana, India
| | - Bhanwar Singh
- Department of Health and Family Welfare, Office of Chief Medical Officer and Civil Surgeon (Rewari), Government of Haryana, Rewari, Haryana, India
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Taye MG, Nega F, Belay MH, Kibret S, Fentie Y, Addis WD, Fenta E. Prevalence and factors associated with caesarean section in a comprehensive specialized hospital of Ethiopia: A cross-sectional study; 2020. Ann Med Surg (Lond) 2021; 67:102520. [PMID: 34276980 PMCID: PMC8264103 DOI: 10.1016/j.amsu.2021.102520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Caesarean section is one of the lifesaving procedures of medical interventions attributed to the decrease of maternal and newborn mortality and morbidity rates. The World Health Organization (WHO) shows a cesarean rate between 5% and 15%. However, the prevalence of cesarean section is increasing globally as well as in Ethiopia. Different scholars argue that the prevalence and factors of the caesarian section vary in different countries and health institutions. The aim of this study was to assess the prevalence and factors associated with cesarean section in Debre Tabor Comprehensive Specialized Hospital. METHOD An institutional-based cross-sectional study was conducted on a total of 320 mothers who gave birth at Debre Tabor Comprehensive Specialized Hospital from July 01, 2020, to October 30, 2020. The samples were selected using the convenience sampling technique. The Data were collected using a structured checklist. Bivariable and multivariable logistic regressions were used to check the association. P-values less than 0.05 were considered statistically significant. RESULTS The overall prevalence of cesarean section was 39.1% in the current study. Mothers age 35-39 years, educational level college and above, employed, mothers with a monthly income of >6000, and mothers with a previous history of cesarean section were significantly associated with an increased risk of cesarean section. CONCLUSION The prevalence of cesarean section was high in Debre Tabor Comprehensive Specialized Hospital. Age of the mothers, educational status, occupation, monthly income, and previous history of cesarean section were significantly associated with an increased occurrence of cesarean section.
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Affiliation(s)
- Moges Gelaw Taye
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Firehiwot Nega
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Metages Hunie Belay
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Simegnew Kibret
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yewlsew Fentie
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wondimnew Desalegn Addis
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Shen M, Wu Y, Xiang X. Hukou-based rural-urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province. Int J Equity Health 2021; 20:145. [PMID: 34158068 PMCID: PMC8218440 DOI: 10.1186/s12939-021-01485-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most existing research on rural-urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural-urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. METHODS Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015-2019) and 25,849 live births in City B (2018-2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. RESULTS While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. CONCLUSIONS Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services.
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Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, China
| | - Yushan Wu
- The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N. T. HKSAR, China
| | - Xin Xiang
- Graduate School of Education, Harvard University, 14 Appian Way, MA, 02139, Cambridge, USA.
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Lee HY, Kim R, Oh J, Subramanian SV. Association between the type of provider and Cesarean section delivery in India: A socioeconomic analysis of the National Family Health Surveys 1999, 2006, 2016. PLoS One 2021; 16:e0248283. [PMID: 33684180 PMCID: PMC7939292 DOI: 10.1371/journal.pone.0248283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/23/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Prevalence of Cesarean section (C-section) is unequally distributed. Since both extremely low and high levels of C-section can not only cause adverse birth outcomes but also impose a double burden of inefficiency within maternal health care, it is important to monitor the dynamics of key factors associated with the use of C-section. OBJECTIVES To examine the association between type of provider and C-section in India in three-time points: 1999, 2006, and 2016, and also to assess whether this association differed across maternal education and wealth level. METHODS Data were from three waves of cross-sectional and nationally representative Indian National Health Family Survey: Wave II (1999), III (2006), and IV (2016). Target population is women aged 15 and 49 who had an institutional delivery for the most recent live birth during the three or five years preceding the survey (depending on the survey round). Multivariate logistic regression models adjusting for state cluster effect were performed to determine the association between the type of providers and C-section. Differential association between the type of providers and C-section by maternal education and wealth level was examined by stratified analyses. RESULTS The prevalence of C-section among institutional delivery increased from 20.5% in 1999 to 24.8% in 2006 while it declined to 19.4% in 2016. The positive association between private providers and C-section became stronger over the study period (Odds Ratio (OR) = 1.39, 95% Confidence Interval (CI) 1.18-1.64 in 1999, OR = 3.71 95% CI 2.93-4.70 in 2016). The association was consistently significant across all states in 2016. The gap in C-section between public and private providers was greater among less-educated and poorer women. The ORs gradually increased from the poorest to the richest quintiles, and also from the least educated group (no formal education) to the most educated group (college graduate or above). CONCLUSIONS Our results suggest that disparity in C-section between private and public providers has increased over the last 15 years and was higher in lower SES women. The behavior of providers needs to be closely monitored to ensure that C-section is performed only when medically justified.
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Affiliation(s)
- Hwa-Young Lee
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Institute of Convergence Science (ICONS) Convergence Science Academy, Yonsei University, Seoul, Korea
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Korea
- Department of Public Health Sciences, Interdisciplinary Program in Precision Public Health, Graduate School of Korea University, Seoul, Korea
- Harvard Center for Population & Development Studies, Cambridge, Massachusetts, United States of America
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - S. V. Subramanian
- Harvard Center for Population & Development Studies, Cambridge, Massachusetts, United States of America
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Sengupta A, Sabastin Sagayam M, Reja T. Increasing trend of C-section deliveries in India: A comparative analysis between southern states and rest of India. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100608. [PMID: 33652351 DOI: 10.1016/j.srhc.2021.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/02/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the socio-demographic variations in overwhelming existence of C-section deliveries in south India, with a comparison to rest of India. METHODS This study analyses data collected from 51,136 mothers under National Family Health Survey (NFHS)-3 (2005-06) and 2,52,183 mothers under NFHS-4 (2015-16), those who have given births during last five years preceding the survey. MAIN OUTCOME MEASURES Descriptive statistics, bivariate analysis with Chi-squared tests and binary logistic regression models with 95% confidence intervals are used. RESULTS In south India at least one out of four women deliver through C-section and there was a notable rise in caesarean deliveries in public facilities as well as among tribal population. In aggregate, number of states exceeding 15% prevalence rate of C-section deliveries doubled to sixteen, while nineteen states registered more than 100% rise. Rural-urban difference is slim in south India, while likelihood for C-section deliveries for richest women as compared to poorest has gone down from 2.76 to 1.88 in south India and 7.75 to 4.58 in other regions during 2005-06 to 2015-16. The odds ratio for C-section is higher in private hospitals (3.26) of southern states with reference to public institutions, while the odds are 3.90 times higher for private facilities in other states. In south India, percentage of C-section deliveries were actually lower among those who reported about pregnancy complications. CONCLUSIONS Despite, several maternal and child health related programs being launched in India, their impact on improving the C-section scenario has remained microscopic, or they have continued to contribute towards a rising prevalence of C-section, especially in south India.
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Affiliation(s)
- Angan Sengupta
- Department of Management, Amrita Vishwa Vidyapeetham, Kasavanahalli, Off Sarjapur Road, Bangalore 560035, Karnataka, India.
| | - Maria Sabastin Sagayam
- Department of Management, Amrita Vishwa Vidyapeetham, Kasavanahalli, Off Sarjapur Road, Bangalore 560035, Karnataka, India.
| | - Tamal Reja
- Centre of Excellence on Public Health Nutrition, Department of Humanities and Social Sciences, National Institute of Technology, Rourkela 769008, Odisha, India
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Analysing the expenditure on childbearing: a community-based cross-sectional study in rural areas of Punjab (India). BMC Health Serv Res 2021; 21:76. [PMID: 33478474 PMCID: PMC7818910 DOI: 10.1186/s12913-021-06075-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background A vast array of literature has established that high maternity expenditure precludes women from accessing health services. Further, this maternity expenditure takes catastrophic form, forcing individuals or households to significantly lower their standard of living now or at some time in future. The present study analyses expenditure on childbearing in rural areas of one of the richest and top performer states on health parameters in India, namely Punjab along with examining the determinants of catastrophic expenditure. It also attempts to examine the implementation of Janani Shishu Suraksha Karyakaram (JSSK) which entitles pregnant women to free maternity services in public health facilities. Methods A cross-sectional study was conducted in rural areas of Punjab involving 420 recently delivered women, who were questioned about their socio-economic attributes and expenditure incurred in the process of childbearing using face to face, semi-structured interviews. Employing logistic regression, an attempt has been made to understand the determinants of catastrophic maternity expenditure, i.e., expenditure exceeding 10% of annual household income. Results Of the 420 respondents surveyed, 96.7% reported bearing expenditure on childbearing, irrespective of the type of health facility used and 25% respondents spent catastrophically. On an average, respondents have spent US$62.87 on antenatal care, US$112.86 on delivery and US$6.55 on postnatal care. The results of multivariable analysis reveal that respondents belonging to general category (non reserve category), lower wealth quintiles and using private health facilities have higher odds of incurring catastrophic expenditure. At the same time, poor quality of care at government hospitals and inability of public health staff to provide timely treatment are the driving forces for utilizing private health facilities. Even in the presence of free maternity scheme at government hospitals, respondents on an average spent US$55.22 on availing maternity services. Conclusion The study shows that risk of bearing catastrophic expenditure and being pushed down to abject poverty is higher for respondents who are already at the bottom of wealth quintiles. The policy imperative has to swing towards upgrading the creaky health infrastructure and addressing the issues of poor accountability and corruption at government hospitals, along with thwarting unregulated expansion of private health sector. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06075-2.
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Wells JCK, Marphatia AA, Cortina-Borja M, Manandhar DS, Reid AM, Saville N. Maternal physical, socioeconomic, and demographic characteristics and childbirth complications in rural lowland Nepal: Applying an evolutionary framework to understand the role of phenotypic plasticity. Am J Hum Biol 2021; 33:e23566. [PMID: 33452758 DOI: 10.1002/ajhb.23566] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Evolutionary perspectives on human childbirth have primarily focused on characteristics of our species in general, rather than variability within and between contemporary populations. We use an evolutionary framework to explore how physical and demographic characteristics of mothers shape the risks of childbirth complications in rural lowland Nepal, where childbearing typically commences in adolescence and chronic undernutrition is widespread, though maternal overweight is increasing in association with nutrition transition. METHODS We conducted secondary analyses of data from a cluster-randomized trial. Women aged 14-35 years were categorized by age, number of previous pregnancies, height, body mass index (BMI), husband's education, and household wealth. Multivariable logistic regression models tested whether these characteristics independently predicted risks of episiotomy and cesarean section (CS, n = 14 261), and obstructed labor (OL, n = 5185). RESULTS Risks were greatest among first-time adolescent mothers, though associations with age varied by outcome. Independent of age and parity, short stature and high BMI increased risks of CS and OL, whereas associations were weaker for episiotomy. Male offspring had increased risk of CS and OL but not episiotomy. Wealth was not associated with OL, but lower wealth and lower husband's education were associated with lower likelihood of episiotomy and CS. CONCLUSIONS At the individual level, the risk childbirth complications is shaped by trade-offs between fertility, growth, and survival. Some biological markers of disadvantage (early childbearing, short stature) increased the risk, whereas low socio-economic status was associated with lower risk, indicating reduced access to relevant facilities. Independent of these associations, maternal age showed complex effects.
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Affiliation(s)
- Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Alice M Reid
- Department of Geography, University of Cambridge, Cambridge, UK
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Rengaraj S, Murugesan K. Analysis of cesarean section using Robson's ten group classification system in a tertiary care center from Southern India: A cross-sectional study. INTERNATIONAL JOURNAL OF ADVANCED MEDICAL AND HEALTH RESEARCH 2021. [DOI: 10.4103/ijamr.ijamr_152_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bhandari AKC, Dhungel B, Rahman M. Trends and correlates of cesarean section rates over two decades in Nepal. BMC Pregnancy Childbirth 2020; 20:763. [PMID: 33298004 PMCID: PMC7724849 DOI: 10.1186/s12884-020-03453-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. METHODS We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. RESULTS We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6-1.2) %] to 10.2% in 2016 [95% CI: (8.9-11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3-12.9) %] to 16.4% in 2016 [95% CI: (14.5-18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8-16.0) %] vs. 26.3% in 2016[95% CI: (21.9-31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83-7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. CONCLUSION Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.
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Affiliation(s)
- Aliza K. C. Bhandari
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
| | - Bibha Dhungel
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
| | - Mahbubur Rahman
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
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Ayalew M, Mengistie B, Dheressa M, Demis A. Magnitude of Cesarean Section Delivery and Its Associated Factors Among Mothers Who Gave Birth at Public Hospitals in Northern Ethiopia: Institution-Based Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1563-1571. [PMID: 33235456 PMCID: PMC7678705 DOI: 10.2147/jmdh.s277747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/06/2020] [Indexed: 12/05/2022] Open
Abstract
Background Cesarean section is one of the most common surgeries around the world performed whenever abnormal conditions complicate labour and vaginal delivery, threatening the life or health of the mother or the baby. Although the cesarean section is a safe operation, when it is performed without medical need, it puts mothers and their babies at risk of short- and long-term health problems. However, the factors are not persistent and there is limited information concerning the levels of cesarean section delivery and its associated factors in public hospitals of North Wollo Zone. Therefore, this study aimed to assess the magnitude of cesarean section and associated factors in hospitals of North Wollo Zone, Northern Ethiopia. Methods and Materials An institution-based cross-sectional study design was employed among 433 mothers who gave birth in public hospitals of North Wollo Zone, Northern Ethiopia, from March 01 to 30, 2019. A systematic random sampling method was used to select the study participants. A structured questionnaire was used to collect data. Bivariable and multivariable analyses were carried out to identify independent predictors of cesarean section. Results The magnitude of cesarean section delivery was 30.9% (95% CI, 26.8–35.3). Being urban resident (AOR=4.04, 95% CI: 2.19–7.45), malpresentation (AOR=2.56, 95% CI: 1.29–5.05), having a previous cesarean section (AOR=9.11, 95% CI: 3.77–22.01) and antepartum haemorrhage (AOR=8.65, 95% CI: 3.82–19.56) were statistically and positively associated with cesarean section delivery. Conclusion The magnitude of cesarean section delivery among mothers who gave birth at North Wollo Zone public hospitals was high. Residence, antepartum haemorrhage, having a previous cesarean section, and malpresentation were factors associated with cesarean section. Therefore, health education and giving a clear picture regarding the risks and benefits of cesarean section as well as avoiding unjustified cesarean section delivery should be encouraged.
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Affiliation(s)
- Melese Ayalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheressa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Bhatia M, Dwivedi LK, Banerjee K, Dixit P. An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play? Soc Sci Med 2020; 265:113511. [PMID: 33203552 DOI: 10.1016/j.socscimed.2020.113511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE AND SETTING OF RESEARCH Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds. METHODS This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector. PRINCIPAL FINDINGS Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector. CONCLUSIONS This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play.
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Affiliation(s)
- M Bhatia
- Dept. of Health Policy, London School of Economics, London, UK.
| | - L K Dwivedi
- International Institute for Population Sciences, Mumbai, India
| | - K Banerjee
- International Institute for Population Sciences, Mumbai, India
| | - P Dixit
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
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Ensor T, Virk A, Aruparayil N. Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery. BMJ Open 2020; 10:e038470. [PMID: 33093032 PMCID: PMC7583072 DOI: 10.1136/bmjopen-2020-038470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India. METHODS The study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken. RESULTS Surgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity. CONCLUSION In low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated.
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Affiliation(s)
- Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Amrit Virk
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Noel Aruparayil
- Leeds Institute of Medical Research at St James', University of Leeds, Leeds, West Yorkshire, UK
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Hernández-Vásquez A, Chacón-Torrico H, Bendezu-Quispe G. Differences in the prevalence of cesarean section and associated factors in private and public healthcare systems in Peru. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100570. [PMID: 33130536 DOI: 10.1016/j.srhc.2020.100570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/03/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cesarean section rates have been steadily increasing worldwide. Private health facilities are reported as being a major contributor to this rising rate in Latin America. AIM To assess the prevalence and determinants of cesarean section rates among public and private health facilities in Peru. METHODS We performed a cross-sectional analytical study pooling the data of 52,215 women between 15 and 49 years of age from the 2015-2017 Peruvian Demographic and Family Health Survey (ENDES) database. Sociodemographic and pregnancy-related variables were used to construct adjusted logistic regression models for the indication of cesarean section. FINDINGS The prevalence of cesarean births was 73.0% (95%CI: 71.1-74.9) and 30.3% (95% CI: 29.6-31.0) in private and public health facilities, respectively. In private facilities, living in an urban area, having a higher educational level, being in the age group of 35-49 years, and having multiple pregnancies increased the probability of a cesarean section. In public health facilities, living in an urban area, having a higher wealth quintile, higher education level, older maternal age, birth order, newborn size and gender, type of pregnancy, language, and maternal height were all factors associated with cesarean section. CONCLUSION The prevalence of cesarean section found in the present study was above the value recommended by the WHO (10%) for both public and private facilities. It is necessary to address the indiscriminate rise in the use of cesarean sections, developing strategies according to the type of health facility.
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Affiliation(s)
- Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Peru.
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Sk R. Does delivery in private hospitals contribute largely to Caesarean Section births? A path analysis using generalised structural equation modelling. PLoS One 2020; 15:e0239649. [PMID: 33031397 PMCID: PMC7544137 DOI: 10.1371/journal.pone.0239649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/11/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The rate of Caesarean Section (CS) deliveries has shown an alarming rise in recent years. CS is a surgical procedure used when there is apprehension of risk to the life of mother or baby in case of vaginal delivery, but its rates higher than 10-15 per cent are not justifiable. It is well recognised that a CS delivery could have a large number of adverse impacts on women and infants. Several studies, especially in developing countries, have revealed that delivery in private hospitals is one of the most contributing factors in CS deliveries. The present study conceptualises a causal pathway in which the possible risk factors, socio-economic, maternal and pregnancy-related, as well as institutional, influence the chances of CS delivery. It is hypothesised that certain factors would contribute to CS deliveries largely indirectly through the place of delivery, that is, either a public or private institution. METHODS AND FINDINGS To test the hypotheses, this study analysed 146,280 most recent live births delivered in hospitals during the five years preceding the fourth round of India's National Family Health Survey (NFHS-4), carried out during 2015-2016. The analysis, using generalised structural equation modelling (GSEM), revealed that many exogenous variables considered in the path models influence CS deliveries significantly, directly and/or indirectly through the place of delivery factor. Prominent among these are wealth index and receiving ANC services at only private hospitals; the total effects of these variables are even higher than the direct/total effect of place of delivery. CONCLUSION From this finding, it could be said that the place of delivery is a proximate determinant of a CS delivery or a mediator of other co-factors. Interventions to curb higher CS deliveries should be focused on improving the quality of public health sectors and on developing protocols for CS deliveries.
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Affiliation(s)
- Rayhan Sk
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
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Kumar R, Lakhtakia S. Rising cesarean deliveries in India: medical compulsions or convenience of the affluent? Health Care Women Int 2020; 42:611-635. [PMID: 32779972 DOI: 10.1080/07399332.2020.1798963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
From 2005-06 to 2015-16, proportion of cesarean deliveries in total deliveries has almost doubled in India. In this paper, we study changes in prevalence of cesarean deliveries across different social-economic groups and study factors affecting odds of undergoing cesarean delivery. The present paper was based on National Family Health Surveys and employs logistic regression. We find that rise in cesarean deliveries has been across social groups, religions, urban/rural India, wealth groups, though increase has not been uniform. Further, many economically affluent states have high proportion of cesarean deliveries. We find that women delivering at private hospitals had significantly higher odds of opting for cesarean delivery. Further, women belonging to rich households were more likely to go through surgery for birth. In case of earlier terminated pregnancies, odds were higher too. The higher odds of cesarean sections in the relatively affluent geographic regions, richer households and private institutions indicate that these procedures may be driven by non-medical reasons in many cases, pointing toward the use of surgical procedures for the convenience.
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Affiliation(s)
- Rishi Kumar
- Department of Economics and Finance, Birla Institute of Technology and Science,Telangana, India
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Sindiani A, Rawashdeh H, Obeidat N, Zayed F, Alhowary AA. Factors that influenced pregnant women with one previous caesarean section regarding their mode of delivery. Ann Med Surg (Lond) 2020; 55:124-130. [PMID: 32477510 PMCID: PMC7251298 DOI: 10.1016/j.amsu.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. MATERIAL AND METHODS A cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. RESULTS About 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients' choice that our study revealed was "being informed about the complications of TOLAC". The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. CONCLUSION Proper counselling is a main factor that affected the patients' choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC.
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Affiliation(s)
- Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Hasan Rawashdeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Nail Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Faheem Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ala”a A. Alhowary
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan
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Prevalence and factors associated with caesarean section in four Hard-to-Reach areas of Bangladesh: Findings from a cross-sectional survey. PLoS One 2020; 15:e0234249. [PMID: 32516321 PMCID: PMC7282647 DOI: 10.1371/journal.pone.0234249] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caesarean section (C-section) is a major obstetric life-saving intervention for the prevention of pregnancy and childbirth related complications. Globally C-section is increasing, as well as in Bangladesh. This study identifies the prevalence of C-section and socio-economic and health care seeking related determinants of C-section among women living in hard-to-reach (HtR) areas in Bangladesh. METHODS A cross-sectional survey was conducted using a structured questionnaire between August and December 2017 at four distinct types of HtR areas of Bangladesh, namely coastal, hilly, haor (wetland), and char areas (shallow land-mass rising out of a river). Total 2,768 women of 15-49 years of age and who had delivery within one year prior to data collection were interviewed. For the analysis of determinants of C- section, the explanatory variables were maternal age, educational status of women and their husbands, women's religion, employment status and access to mobile phone, wealth index of the household, distance to the nearest health facility from the household, the number of ANC visits and presence of complications during pregnancy and the last childbirth. Logistic regression model was run among 850 women, who had facility delivery. Variables found significantly associated with the outcome (C-section) in bivariate analysis were included in the multivariable logistic model. A p-value <0.05 was considered as statistically significant in the analyses. RESULTS Of the 2,768 women included in the study, 13% had C-sections. The mean (±SD) age of respondents was 25.4 (± 0.1) years. The adjusted prevalence of C-section was 13.1 times higher among women who had their delivery in private facilities than women who delivered in public facilities (Adjusted Odds Ratio, AOR: 13.1; 95% CI 8.6-19.9; p-value: <0.001). Women from haor area and coastal area had 4.7 times (AOR: 4.7; 95% CI 2.4-9.4; p value: <0.001) and 6.8 times (AOR: 6.8; 95% CI 3.6-12.8; p value: <0.001) more chance of having C-section, respectively, than women living in char area. Among women who reported complications during the last childbirth, the AOR of C-section was 3.6 times higher than those who did not report any complication (AOR: 3.6; 95% CI 2.4-5.4; p value: <0.001). CONCLUSIONS The study identifies that the prevalence of C-sections in four HtR areas of Bangladesh in substantially below the national average, although, the prevalence was higher in coastal areas than three other HtR regions. Both public and private health services for C-section should be made available and accessible in remote HtR areas for women with pregnancy complications. Establishment of an accreditation system for regulating private hospitals are needed to ensure rational use of the procedure.
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Srivastava S, Chaurasia H, Kumar Singh KHJ, Chaudhary P. Exploring the spatial patterns of cesarean section delivery in India: Evidence from National Family Health Survey-4. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Singh SK, Vishwakarma D, Sharma SK. Prevalence and determinants of voluntary caesarean deliveries and socioeconomic inequalities in India: Evidence from National Family Health Survey (2015-16). CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ruktanonchai CW, Nieves JJ, Ruktanonchai NW, Nilsen K, Steele JE, Matthews Z, Tatem AJ. Estimating uncertainty in geospatial modelling at multiple spatial resolutions: the pattern of delivery via caesarean section in Tanzania. BMJ Glob Health 2020; 4:e002092. [PMID: 32154032 PMCID: PMC7044704 DOI: 10.1136/bmjgh-2019-002092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 11/03/2022] Open
Abstract
Visualising maternal and newborn health (MNH) outcomes at fine spatial resolutions is crucial to ensuring the most vulnerable women and children are not left behind in improving health. Disaggregated data on life-saving MNH interventions remain difficult to obtain, however, necessitating the use of Bayesian geostatistical models to map outcomes at small geographical areas. While these methods have improved model parameter estimates and precision among spatially correlated health outcomes and allowed for the quantification of uncertainty, few studies have examined the trade-off between higher spatial resolution modelling and how associated uncertainty propagates. Here, we explored the trade-off between model outcomes and associated uncertainty at increasing spatial resolutions by quantifying the posterior distribution of delivery via caesarean section (c-section) in Tanzania. Overall, in modelling delivery via c-section at multiple spatial resolutions, we demonstrated poverty to be negatively correlated across spatial resolutions, suggesting important disparities in obtaining life-saving obstetric surgery persist across sociodemographic factors. Lastly, we found that while uncertainty increased with higher spatial resolution input, model precision was best approximated at the highest spatial resolution, suggesting an important policy trade-off between identifying concealed spatial heterogeneities in health indicators.
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Affiliation(s)
| | - Jeremiah J Nieves
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Nick W Ruktanonchai
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Kristine Nilsen
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Jessica E Steele
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
| | - Zoe Matthews
- Department of Social Statistics & Demography, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- School of Geography & Environmental Science, University of Southampton, Southampton, UK
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Panda BK, Nayak I, Mishra US. Determinant of inequality in cesarean delivery in India: A decomposition analysis. Health Care Women Int 2020; 41:817-832. [PMID: 31928373 DOI: 10.1080/07399332.2020.1711757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In India, Cesarean Section (CS) rate had got doubled in the last decade, with widespread diversity across the population subgroup. Hence, this study examined the pattern, inequality and driving correlates of CS in India. The attributes that shape the inequality in CS were private health facility, followed by the richest economic status, southern region, highest education level. A substantial rise in CS in private sectors and richer section raises the apprehension as to whether commercial motive of private providers contributes to the undue rise in CS that need not necessarily be genuine.
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Affiliation(s)
- Basant Kumar Panda
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Itishree Nayak
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Udaya S Mishra
- Centre for Development Studies, Trivandrum, Kerala, India
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Fan H, Gu H, You H, Xu X, Kou Y, Yang N. Social determinants of delivery mode in Jiangsu, China. BMC Pregnancy Childbirth 2019; 19:473. [PMID: 31805886 PMCID: PMC6894495 DOI: 10.1186/s12884-019-2639-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Less evidence exists regarding the association of social determinants and delivery mode in Jiangsu, and if the trend is influenced by the type of residence. This study aims to identify the significant social determinants of delivery mode, and also to compare the main differences in delivery mode between urban and rural areas. Methods We used data from the cross-sectional National Health Service Surveys conducted in Jiangsu Province in 2013. For the purposes of this study, information from women (15–64 years old) who had experienced childbirth the last 5 years were examined, and a total of 1365 participants were selected as research subjects. Results Participants using vaginal delivery mode and cesarean delivery mode were found in 616 (45.1%) and 751(54.9%) participants, respectively. The proportion of women using cesarean delivery was 53.5% in rural area and 58.2% in urban area. Meanwhile, our results showed that women in middle Jiangsu were more likely to use cesarean delivery, and cesarean delivery is more prevalent among richer women. We also find that the more use of prenatal care visit, the more use of cesarean delivery. Conclusions This study validated the relationship between social determinants and the mode of delivery in Jiangsu province. Social determinants are contextual factors, which may vary by region and additional work is needed to fully understand these relationships globally. Further studies are needed to elucidate mechanisms and pathways across various populations, and these social determinants should be incorporated into future multi-level interventions designed to decrease the cesarean delivery rate.
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Affiliation(s)
- Hong Fan
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China. .,Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, People's Republic of China.
| | - Hai Gu
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China.
| | - Hua You
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China.,Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, People's Republic of China
| | - Xinpeng Xu
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China
| | - Yun Kou
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China
| | - Nichao Yang
- Center for Health Policy and Management Research, Nanjing University, 22 Hankou Road, Nanjing, People's Republic of China
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Begum T, Nababan H, Rahman A, Islam MR, Adams A, Anwar I. Monitoring caesarean births using the Robson ten group classification system: A cross-sectional survey of private for-profit facilities in urban Bangladesh. PLoS One 2019; 14:e0220693. [PMID: 31393926 PMCID: PMC6687131 DOI: 10.1371/journal.pone.0220693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Globally, Caesarean section (CS) rates are mounting and currently exceed the safe upper limit of 15%. Monitoring CS rates using clinical indications and obstetric sub-group analysis could confirm that women in need have been served. In Bangladesh, the reported CS rate was 31% in 2016, and almost twice that rate in urban settings. Delivering in the private healthcare sector was a strong determinant. This study uses Robson Ten Group Classification System (TGCS) to report CS rates in urban Bangladesh. The clinical causes and determining factors for CS births have also been examined. METHODS This record linkage cross-sectional survey was undertaken in 34 urban for-profit private hospitals having CS facilities during the period June to August 2015. Data were supplied by inpatient case records and operation theatre registers. Descriptive analyses were performed to calculate the relative size of each group; the group-specific CS rate, and group contribution to total CS and overall CS rate. CS indications were grouped into eleven categories using ICD 10 codes. Binary logistic regression was performed to explore the determinants of CS. RESULTS Out of 1307 births, delivery by CS occurred in 1077 (82%). Three obstetric groups contributed the most to overall CS rate: previous CS (24%), preterm (23%) and term elective groups (22%). The major clinical indications for CS were previous CS (35%), prolonged and obstructed labor (15%), fetal distress (11%) and amniotic fluid disorder (11%). Multiple gestation, non-cephalic presentation, previous bad obstetric history were positive predictors while oxytocin used for labour induction and increased parity were negative predictors of CS. CONCLUSIONS As the first ever study in urban private for-profit health facilities in Bangladesh, this study usefully identifies the burden of CS and where to intervene. Engagement of multiple stakeholders including the private sector is crucial in planning effective strategies for safe reduction of CS.
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Affiliation(s)
- Tahmina Begum
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- The Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Herfina Nababan
- Nossal Institute for Global Health, School of Population and Global Health, the University of Melbourne, Melbourne, Australia
| | - Aminur Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md Rajibul Islam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne Adams
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Department of International Health, Georgetown University, Washington, United States of America
- James P Grant School of Public Health, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Mia MN, Islam MZ, Chowdhury MR, Razzaque A, Chin B, Rahman M. Socio-demographic, health and institutional determinants of caesarean section among the poorest segment of the urban population: Evidence from selected slums in Dhaka, Bangladesh. SSM Popul Health 2019; 8:100415. [PMID: 31206004 PMCID: PMC6558294 DOI: 10.1016/j.ssmph.2019.100415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/21/2019] [Accepted: 05/24/2019] [Indexed: 11/30/2022] Open
Abstract
Caesarean sections (CS) is the most common lifesaving surgeries for obstructed labour and other emergency obstetrical conditions. The WHO had recommended ideal rate for CS to be between 5% and 15%. The rate higher than 15% indicates overused other than lifesaving. Bangladesh has experienced a dramatic increase in CS delivery from 4% in 2004 to 23% in 2014. This increase is elevated by the several factors including maternal education, maternal request or elective CS, and by the urban richest population. However, little is known about the use CS by the urban poorest population. Therefore, the study aimed to examine and identify the factors associated with CS among the urban disadvantaged section of the population. A total of 1063 randomly chosen women aged 15-49 years from the population of 121,912 residing five-different slums were interviewed during November-December 2016. CS delivery was considered as outcome variable. Both bivariate and multivariable statistical analyses were carried-out. We performed logistic regression analyses to examine the net-effect of independent variables on outcome variable. Over 25% of total deliveries and 50% of facility-based deliveries were CS. The odds of CS delivery was 3.4-fold greater among better-off women than poorest. Women who had 4 + ANC checks-up during pregnancy had a 2-fold higher odds of CS delivery than women of ANC check-up. In private facilities, 76% of births were delivered as CS, followed by 51% in public facilities and 24% in NGO facilities. The likelihood of CS delivery in private facilities was 9.2-fold greater than NGO facilities after controlling for women socio-demographic, pregnancy and delivery characteristics. Thus, the high use of CS is largely associated with private facility, ANC visits and household wealth. Therefore, the Government of Bangladesh should take immediate actions by designing new policies and regulations to ensure CS for the lifesaving condition, not for financial gain.
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Affiliation(s)
- Mohammad Nahid Mia
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Razib Chowdhury
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdur Razzaque
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Brian Chin
- Asian Development Bank (ADB), Manila, Philippines
| | - M.Shafiqur Rahman
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
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