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Etcheverry C, Betrán AP, de Loenzien M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries. Midwifery 2024; 132:103979. [PMID: 38520954 DOI: 10.1016/j.midw.2024.103979] [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: 03/23/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DESIGN A cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SETTING Thirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. PARTICIPANTS A total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FINDINGS The overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and "avoid pain in labour" was the most common perceived benefit of caesarean section. KEY CONCLUSIONS Our results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. CLINICAL TRIAL REGISTRY 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, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France.
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 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, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, Paris 75006, France
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Abuduxike G, Cali S, Vaizoğlu SA, Aşut Ö, Çavuş M, Olgu M, Çavuş SN, Arkut M, Idehen BO, Almezghwi HAS, Asswayeh HMA, Abawu JJ, Hossain MJ, Almawali NA. An Analysis of the Mode of Delivery, Risk Factors, and Subgroups with High Caesarean Birth Rates Using Robson Classification System. Matern Child Health J 2024; 28:667-678. [PMID: 37840109 DOI: 10.1007/s10995-023-03783-5] [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] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to understand the utilization of the mode of delivery and related risk factors. Further aimed to apply the Robson classification system to evaluate the data quality and analyze the CS rates in subgroups. METHODS We conducted a retrospective descriptive study by reviewing the medical records of all women who delivered at the State Hospital in 2019. A proforma was developed for extracting data from patient records. All women with six obstetric parameters were categorized into Robson groups to determine the absolute and relative contributions of each group to the overall CS rate. RESULTS Of 797 deliveries, 401 (50.2%) were CSs. Being older, being Turkish Cypriot, having preterm births, previous CS, multiple fetuses, and having breech or transverse fetal presentations were related to having higher risks of CS. The most common medical indication for CSs (52.3%) was a history of previous CSs. Robson Group 5 contributed the most (50.7%) to the overall CS rate, with the highest absolute contribution of 21.8%. Group 10 and Group 8 were the second and third highest contributors to the overall CS rate, with relative contributions of 25.3% and 9.0%, respectively. CONCLUSIONS Findings revealed the substandard quality of obstetric data and a noticeably high overall CS rate. The top priority should be given to improving the quality of medical records. It underscored the necessity of implementing the Robson classification system as a standard clinical practice to enhance data quality, which helps to effectively evaluate and monitor the CS rates in obstetric populations.
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Affiliation(s)
- Gulifeiya Abuduxike
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus.
| | - Sanda Cali
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Songül Acar Vaizoğlu
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Özen Aşut
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Mahmut Çavuş
- Dr. Burhan Nalbantoğlu State Hospital Obstetrics and Gynaecology Department, Nicosia, Northern Cyprus
| | - Musa Olgu
- Dr. Burhan Nalbantoğlu State Hospital Obstetrics and Gynaecology Department, Nicosia, Northern Cyprus
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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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Akay A, Akdaş Reis Y, Çelik S, Fıratlıgil FB, Engin Üstün Y. Peripartum Hysterectomy Outcomes: Our Eleven-Year Experience at a Tertiary Care Hospital. J Obstet Gynaecol India 2023; 73:185-190. [PMID: 38143966 PMCID: PMC10746615 DOI: 10.1007/s13224-023-01818-z] [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: 04/15/2023] [Accepted: 07/24/2023] [Indexed: 12/26/2023] Open
Abstract
Aim To investigate the outcomes of peripartum hysterectomies (PHs) conducted to prevent maternal morbidity and mortality at a tertiary care hospital with 15,000 deliveries per year. Method Patients who underwent PHs during delivery and/or within 24 h of delivery between the years 2011-2022 were retrospectively evaluated. Hysterectomies not performed in the peripartum period, cases that were managed by methods such as balloon tamponade, compression suture, or arterial ligation rather than hysterectomy, and hysterectomies performed before 20 weeks were excluded. Obstetric and demographic characteristics of the cases, as well as indications and outcomes of PH, were investigated. Results Among the 130 patients who underwent PH, 4 (3.04%) patients delivered vaginally, 1 (0.7%) patient delivered vaginally after cesarean section, 12 (9.2%) patients delivered by primary cesarean section, and 113 (86.9%) patients delivered by secondary cesarean section. Placenta accreta spectrum disorder was the reason for PH in 54.6% (n = 71) of the cases while 16.1% (n = 21) underwent PH due to uterine atony. The PH rate was 0.75 per 1000 births, and the maternal mortality rate was 7.6 per 1000 hysterectomies in this study. Conclusion Obstetricians in developed/ing countries support the active management of the third stage of labor mainly to mitigate the preventable risk factors of post-/peri-partum hemorrhage. The current study suggests that obstetricians need to focus on the placenta in order to reduce PH.
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Affiliation(s)
- Arife Akay
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, Bingöl Maternety and Children Hospital, Bingöl, Türkiye
| | - Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Susam Çelik
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
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Ashipala DO, Kandjaba V. Factors associated with caesarean sections among pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia. J Public Health Afr 2023; 14:2402. [PMID: 37753437 PMCID: PMC10519116 DOI: 10.4081/jphia.2023.2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/30/2023] [Indexed: 09/28/2023] Open
Abstract
Background Caesarean section rates are increasing worldwide in both developed and developing countries becoming an issue of grave concern. Objective The aim of the study was to determine the factors associated with caesarean sections performed on pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia. Materials and Methods A retrospective data approach was conducted on 200 patients' files using a self-administered checklist at a private academic hospital. A total of 200 records of mothers who underwent caesarean sections were systematically reviewed from January 2020 to December 2020 at a private academic hospital in Ongwediva, Namibia. A pretested structured checklist was used to record the data. Results The study revealed that 95.5% of women who had caesarean sections (C-section) were performed. A previous C-section was the most frequent indication, while 0.5% were performed due to patient requests. The p-value for the chi-square statistic was smaller than the standard alpha value (P<0.05), i.e., there is a relationship between the demographic characteristics and factors associated with caesarean sections, as well as between socioeconomic factors and factors associated with caesarean sections. Conclusions This study shows that 95.5% of C-sections are done as a necessity with clear indications, while only 0.5% are done due to patient requests. This study's findings can be used to develop strategies and targeted interventions geared towards reducing the increasing rates of cesarean section considering maternal age, the number of indications of primary cesarean delivery, and following standard operating procedures that might improve the quality of prenatal and delivery care.
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Affiliation(s)
- Daniel Opotamutale Ashipala
- Department of General Nursing Science, School of Nursing and Public Health, Faculty of Health Sciences and Veterinary Medicine, University of Namibia (UNAM), Rundu, Namibia
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Piva VMR, Voget V, Nucci LB. Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil. BMC Pregnancy Childbirth 2023; 23:455. [PMID: 37340447 DOI: 10.1186/s12884-023-05768-2] [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: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates. METHODS We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data. RESULTS CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries. CONCLUSION Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
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Affiliation(s)
- Veridiana Monteiro Ramos Piva
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
| | - Verena Voget
- Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
| | - Luciana Bertoldi Nucci
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
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Reddy B V, Desu SS, Aravindakshan R, Marimuthu Y. Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study. Cureus 2023; 15:e37026. [PMID: 37143633 PMCID: PMC10152772 DOI: 10.7759/cureus.37026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction In some obstetric situations, a caesarean section (CS) can be a crucial, life-saving treatment for both the mother and the infant. Nonetheless, unnecessary CS can raise the risk of morbidity for both. The present study was conducted to study the factors associated with CS delivery and to study the patterns of utilization of health facilities by pregnant women in the state of Andhra Pradesh in India. Materials and methods A community-based case-control study was done in Mangalagiri mandal, Guntur district, Andhra Pradesh, India in 2022. A total of 268 mothers (134 CS and 134 normal vaginal childbirth) who delivered between 2019 to 2022 with at least one biological child less than three years of age were studied. The data was collected using a structured questionnaire. Robson's 10-Group Classification was used to differentiate the type of deliveries of the participants. A p-value less than 0.05 was considered to be significant. Results The mean age of the 268 women studied was 25.49±3.73 years. We found that 47 of the 82 (57.3%) women who went to government healthcare facilities and 87 of the 181 (48.1%) women who went to private healthcare facilities had a CS. Of the total CS studied, approximately 83.5% were emergency CSs. All four mothers who had twins had undergone CS. All women with oblique or transverse fetal lie underwent CS irrespective of parity. On multivariate analysis, participants' education status less than or equal to 10th standard was positively associated with CS and identification of complications in the third trimester by healthcare provider was significantly protective for CS. Conclusion CS rate reduction necessitates a multi-faceted strategy that includes a variety of programming initiatives. Audits of CS performed as part of health programs and other creative monitoring techniques can be useful tools for assessing the standard of maternity care, particularly emergency CS.
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Tegegne TK, Chojenta C, Getachew T, Smith R, Loxton D. Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: Evidence from national population and health facility data. PLoS One 2022; 17:e0277885. [PMID: 36395274 PMCID: PMC9671448 DOI: 10.1371/journal.pone.0277885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/06/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caesarean section has a significant role in reducing maternal and neonatal mortality. A linked analysis of population and health facility data is valuable to map and identify caesarean section use and associated factors. This study aimed to identify geographic variation and associated factors of caesarean delivery in Ethiopia. METHOD Linked data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) and the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) survey was performed. Spatial analysis was conducted to identify geographic variations and factors associated with caesarean delivery. Hierarchical Bayesian analysis was also performed to identify factors associated with caesarean delivery using the SAS MCMC procedure. RESULTS Women's age and education, household wealth, parity, antenatal care (ANC) visits, and distance to caesarean section facility were associated with caesarean delivery use. Women who had ≥4 ANC visits were 4.67 (95% Credible Interval (CrI): 2.17, 9.43) times more likely to have caesarean delivery compared to those who had no ANC visits. Women who had education and were from rich households were also 2.80 (95% CrI: 1.83, 4.19) and 1.80 (95% CrI: 1.08, 2.84) times more likely to have caesarean deliveries relative to women who had no education and were from poor households, respectively. A one-kilometer increase in distance to a caesarean section facility was associated with an 88% reduction in the odds of caesarean delivery (Adjusted Odds Ratio (AOR) = 0.12, 95% CrI: 0.01, 0.78). Hotspots of high caesarean section rates were observed in Addis Ababa, Dire Dawa, and the Harari region. In addition, women's age at first childbirth and ≥4 ANC visits showed significant spatially varying relations between caesarean delivery use across Ethiopia. CONCLUSION Caesarean section is a lifesaving procedure, and it is essential to narrow disparities to reduce maternal and neonatal mortality and avoid unnecessary procedures.
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Affiliation(s)
- Teketo Kassaw Tegegne
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia
- * E-mail:
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Morais MBD, Toporovski MS, Tofoli MHC, Barros KVD, Ferreira CHT, Silva LR. Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity. J Pediatr (Rio J) 2022; 98:241-247. [PMID: 34508665 PMCID: PMC9432061 DOI: 10.1016/j.jped.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. METHODS This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. RESULTS Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). CONCLUSION Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.
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Affiliation(s)
- Mauro Batista de Morais
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brazil.
| | | | | | | | - Cristina Helena Targa Ferreira
- Universidade Federal de Ciências da Saúde de Porto Alegre, Divisão de Gastroenterologia Pediátrica, Porto Alegre, RS, Brazil
| | - Luciana Rodrigues Silva
- Universidade Federal da Bahia, Divisão de Gastroenterologia Pediátrica, Salvador, BA, Brazil; Presidente da Sociedade Brasileira de Pediatria, Brazil
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Hernández-Vásquez A, Chacón-Torrico H, Bendezu-Quispe G. Geographic and socioeconomic inequalities in cesarean birth rates in Peru: A comparison between 2009 and 2018. Birth 2022; 49:52-60. [PMID: 34240458 DOI: 10.1111/birt.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a global concern about the high rates of cesarean birth (CB). This study aimed to investigate the geographic and socioeconomic inequalities in CB rates in the Peruvian population. METHODS We conducted a population-based study using the Peruvian Demographic and Family Health Surveys (ENDES, the Spanish acronym for Encuesta Demográfica y de Salud Familiar) between 2009 and 2018. ENDES reported data from births registered in the five years preceding survey execution. For the years 2009 (n = 10 289) and 2018 (n = 23 077), we calculated the weighted rates of CB among variables such as natural geographic domain (Coast, Andean, or Amazon), area of residence (rural or urban), wealth index quintile (quintile 1 is poorest, and quintile 5 is richest), and educational level. To assess inequalities, we calculated the concentration index (CIs), the slope index of inequality (SII), and the relative index of inequality (RII). RESULTS The CB rates by year were 21.4% (95% confidence interval [CI]: 20.0-22.9) in 2009 and 34.5% (95% CI: 33.4-35.5) in 2018. Women living in urban and coastal regions and with a higher education level had the highest CB rates. All the CIs were positive, reflecting a prowealthy inequality in CB rates, and both SII and RII were positive, indicating a gap between the use of cesarean in women in the higher wealth quintile compared with those in the lower quintile. CONCLUSIONS Cesarean birth rates have increased by 60% during the last decade in Peru. The richest wealth quintiles had the highest CB rates during the study years, which were well above global recommendations.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Guido Bendezu-Quispe
- Centro de Investigación Epidemiológica en Salud Global, Universidad Privada Norbert Wiener, Lima, Peru
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Ahmed MS, Islam M, Jahan I, Shaon IF. Multilevel analysis to identify the factors associated with caesarean section in Bangladesh: evidence from a nationally representative survey. Int Health 2022; 15:30-36. [PMID: 35194644 PMCID: PMC9808510 DOI: 10.1093/inthealth/ihac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Caesarean delivery has a significant role in reducing maternal and child death. However, unnecessary utilization has adverse health effects. This study aimed to assess the prevalence and associated factors of caesarean delivery in Bangladesh. METHODS Data from the latest Bangladesh Multiple Indicator Cluster Survey (MICS, 2019) was used in this study. Since MICS data are hierarchical in nature, multilevel modelling was used. RESULTS The prevalence of caesarean section (CS) was 67.4% among Bangladeshi women. Multilevel analysis suggests the age of the women, household wealth status, utilization of antenatal care (ANC) , delivery at a health facility and division were significantly associated with CS. Women who delivered in a private health facility had the highest odds for CS (odds ratio [OR] 10.35 [95% confidence interval {CI} 8.55 to 12.54]). Women 30-34 y of age had a 36% higher likelihood of CS compared with women 15-19 y of age (OR 1.36 [95% CI 1.03 to 1.79]). The odds of CS positively increased with household wealth status. Women who had at least one ANC visit had a 1.7 times higher possibility of CS (OR 1.70 [95% CI 1.26 to 2.30]). CONCLUSIONS Policy guidelines on caesarean deliveries are urgently needed in Bangladesh to avoid unnecessary caesarean deliveries and protect mothers from the consequences.
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Affiliation(s)
- Md Sabbir Ahmed
- Department of Community Health and Hygiene, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Patuakhali-8602, Bangladesh
| | | | - Ishrat Jahan
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Patuakhali-8602, Bangladesh
| | - Imran Faisal Shaon
- Department of Animal Nutrition, Faculty of Animal Husbandry, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
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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: 1] [Impact Index Per Article: 0.5] [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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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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Ahmmed F, Manik MMR, Hossain MJ. Caesarian section (CS) delivery in Bangladesh: A nationally representative cross-sectional study. PLoS One 2021; 16:e0254777. [PMID: 34265013 PMCID: PMC8282068 DOI: 10.1371/journal.pone.0254777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
A growing trend in the caesarian section (CS) for delivery is a threat to child health as well as maternal health. This study was conducted to identify the potential socioeconomic and demographic factors associated with CS delivery in Bangladesh. Data obtained from the Bangladesh Demographic and Health Survey (BDHS) 2014 has been used for this study. The prevalence of CS delivery among Bangladeshi mothers was 24% (Urban: 36.9%, Rural: 17.9%). A two-level logistic regression showed that mothers having delivery in the private sector or private hospital (adjusted odds ratio [AOR] = 38.70, 95% confidence interval [CI] = 29.58 to 50.62), mother’s age 25–35 years (AOR = 1.73, 95% CI = 1.26 to 2.37), wealth index average (AOR = 1.61, 95% CI = 1.15 to 2.27) and rich (AOR = 1.80, 95% CI = 1.29 to 2.51), antenatal visit 1–2 (AOR = 2.31, 95% CI = 1.47 to 3.64) and ≥ 3 (AOR = 3.68, 95% CI = 2.35 to 5.76), overweight mothers (AOR = 1.44, 95% CI = 1.09 to 1.90), multiple births (AOR = 3.87, 95% CI = 1.15 to 12.58), husband’s occupation professional/technical/managerial (AOR = 1.68, 95% CI = 1.15 to 2.47) were significantly more prone to CS delivery. Also, place of residence, number of family members, birth order, child’s size during birth, and divisions of Bangladesh, were potentially associated with CS delivery. The current epidemiological findings and evidence suggest adopting and implementing some urgent clinical practices and strict guidelines in the healthcare system to avoid unnecessary CS delivery in Bangladesh.
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Affiliation(s)
- Foyez Ahmmed
- Department of Statistics, Comilla University, Kotbari, Cumilla, Bangladesh
- * E-mail:
| | | | - Md. Jamal Hossain
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh
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Teixeira RF, Costa CM, Maria de Abreu C, Lessa CA, Carvalho AC, Kassar SB, Barreto ID, Gurgel RQ, Medeiros AM. Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil. J Perinat Med 2021; 49:506-513. [PMID: 33470964 DOI: 10.1515/jpm-2020-0313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/06/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants. METHODS A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model. RESULTS Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26-18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables. CONCLUSIONS Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.
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Affiliation(s)
- Raphaela Farias Teixeira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- CESMAC University Centre, Maceió, Alagoas, Brazil
- Santa Monica Maternity School Hospital, Maceió, Alagoas, Brazil
| | | | | | | | | | | | | | - Ricardo Queiroz Gurgel
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Ladeira LLC, Martins SP, Costa CM, Costa EL, da Silva RA, Fraiz FC, Ribeiro CCC. Caesarean delivery and early childhood caries: Estimation with marginal structural models in Brazilian pre-schoolers. Community Dent Oral Epidemiol 2021; 49:602-608. [PMID: 33834500 DOI: 10.1111/cdoe.12634] [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: 12/05/2019] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. METHODS This was a historical cohort study of 697 mother-child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure. RESULTS Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure. CONCLUSION The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.
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Affiliation(s)
| | | | - Cayara Mattos Costa
- Postgraduate Program in Dentistry, Federal University of Maranhão, São Luís, Brazil
| | - Elizabeth Lima Costa
- Postgraduate Program in Dentistry, Federal University of Maranhão, São Luís, Brazil
| | | | | | - Cecilia Claudia Costa Ribeiro
- Postgraduate Program in Dentistry, Federal University of Maranhão, São Luís, Brazil.,Postgraduate Program in Public Health, Federal University of Maranhão, São Luís, Brazil
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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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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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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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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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González-Cortés T, Gutiérrez-Contreras E, Espino-Silva PK, Haro-Santa Cruz J, Álvarez-Cruz D, Rosales-González CC, Sida-Godoy C, Nava-Hernández MP, López-Márquez FC, Ruiz-Flores P. Clinical Profile of Autism Spectrum Disorder in a Pediatric Population from Northern Mexico. J Autism Dev Disord 2019; 49:4409-4420. [PMID: 31385173 DOI: 10.1007/s10803-019-04154-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition classified based on needs of support, in order to address impairments in the areas of social communication and restricted and repetitive behavior. The aim of this work is to describe the main clinical features of the ASD severity levels in a group of Mexican pediatric patients. The results show firstly that this condition was more frequent in males than females. Secondly, an inverse relationship was found between the intellectual coefficient and the level of severity of the disorder. Thirdly, deficits in social reciprocity and communication were more evident in Level 3, than in Levels 1 and 2, while the difference was less evident in restricted and repetitive patterns of behavior.
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Affiliation(s)
- Tania González-Cortés
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico.
| | - Elizabeth Gutiérrez-Contreras
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico
| | - Perla Karina Espino-Silva
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Jorge Haro-Santa Cruz
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Diana Álvarez-Cruz
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico
| | - Claudia Cecilia Rosales-González
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico
| | - Cristina Sida-Godoy
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Martha Patricia Nava-Hernández
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Francisco Carlos López-Márquez
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Pablo Ruiz-Flores
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico.,Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
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Trends in the Mode of Delivery of Pregnant Women in Rural Guatemala from a Quality Improvement Database. Matern Child Health J 2019; 23:435-442. [PMID: 30542986 DOI: 10.1007/s10995-018-2655-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose To evaluate trends and factors associated with mode of delivery in the rural Southwest Trifinio region of Guatemala. Description We conducted a retrospective analysis of self-reported antepartum factors and postpartum outcomes recorded in a quality improvement database among 430 women enrolled in a home-based maternal healthcare program between June 1, 2015 and August 1, 2017. Assessment Over the study period, the rates of cesarean delivery (CD) increased (from 30 to 45%) and rates of vaginal delivery (VD) decreased (70-55%) while facility-based delivery attendance remained stable around 70%. Younger age (23.5 years for VD vs. 21.6 years for CD, p < 0.001), nulliparity (25.1% for VD vs. 45.0% for CD, p < 0.001), prolonged/obstructed labor (2.4% for VD vs. 55.6% for CD, p < 0.001), and fetal malpresentation (0% for VD vs. 16.3% CD, p < 0.001) significantly influenced mode of delivery in univariate analysis. The leading indications for CD were labor dysfunction (47.5%), malpresentation (14.5%), and prior cesarean delivery (19.8%). The CD rate among the subpopulation of term, nulliparous women with singleton pregnancies in vertex presentation also increased from 20% of all CD in 2015, to 38% in 2017. Conclusion Among low-income women from rural Guatemala, the CD rate has increased above the World Health Organization (WHO) recommendations in a period of 3 years. Additional research on the factors affecting this trend are essential to guide interventions that might improve the appropriateness of CD, and to determine if reducing or stabilizing rates is necessary.
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Pileggi C, Squillace L, Giordano M, Papadopoli R, Bianco A, Pavia M. Quality in perinatal care: applying performance measurement using joint commission on accreditation of healthcare organizations indicators in Italy. BMC Med Res Methodol 2019; 19:83. [PMID: 31018835 PMCID: PMC6480744 DOI: 10.1186/s12874-019-0722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Maternal and child health are internationally considered to be among the best measures for assessing health-care quality. The study was carried out with the following aims: 1) to assess the quality of perinatal care (PC) by measuring the frequencies of the five PC indicators developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and comparing results with international standards; 2) to examine whether maternal, pregnancy care and neonatal characteristics could be factors associated with the quality of perinatal care hospital performance, measured through these indicators. Methods We retrospectively reviewed medical charts of women over the age of 18 who experienced delivery in Gynecology/obstetrics wards between January–December 2016, and those of their newborns hospitalized in the Neonatology or Neonatal Intensive Care Unit (NICU) of a public non-teaching hospital in Catanzaro (Italy). Indicators were calculated according to the methodology specified in the manual for JCAHO measures. Univariate and multivariate analyses were performed to test the independent association of maternal, pregnancy care and neonatal characteristics on the adherence to JCAHO PC indicators. Results The records of 1943 women and 1974 newborns were identified and reviewed in order to be included in at least one of the PC indicators. Elective/early-term delivery, was performed in 27.6% of eligible women, far from the recommended goal (0%); cesarean section in nulliparous women with a term, singleton baby in a vertex position exceeded the suggested target of < 24% and the adherence to antenatal steroids administration was suboptimal (87%). Results of the exclusive breastfeeding indicator achieved a better performance (81%) and compliance with the PC-04 indicator was satisfactory with only 0.4% healthcare-associated bloodstream infection developed in eligible newborns. Conclusions This is the first study performed in Italy that has evaluated the quality of PC by using all the five JCAHO indicators. The application of this feasible set of indicators allowed us to measure several aspects of PC for which there is no standardized monitoring system in Italy. Our findings revealed significant deficiencies in the adherence to recommended processes of PC and suggest that there is still substantial work required to improve care. Electronic supplementary material The online version of this article (10.1186/s12874-019-0722-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Via Tommaso Campanella, 88100, Catanzaro, Italy
| | - Lorena Squillace
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Via Tommaso Campanella, 88100, Catanzaro, Italy
| | - Mariavalentina Giordano
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Via Tommaso Campanella, 88100, Catanzaro, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Via Tommaso Campanella, 88100, Catanzaro, Italy
| | - Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Via Tommaso Campanella, 88100, Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Via Tommaso Campanella, 88100, Catanzaro, Italy.
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Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India. Soc Sci Med 2019; 224:45-57. [DOI: 10.1016/j.socscimed.2019.01.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/15/2018] [Accepted: 01/28/2019] [Indexed: 01/20/2023]
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Reply. Am J Obstet Gynecol 2019; 220:205-206. [PMID: 30315789 DOI: 10.1016/j.ajog.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022]
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Dusabe J, Akuze J, Kisakye AN, Kwesiga B, Nsubuga P, Ekirapa E. A case-control study of factors associated with caesarean sections at health facilities in Kabarole District, Western Uganda, 2016. Pan Afr Med J 2018; 29:179. [PMID: 30050643 PMCID: PMC6057596 DOI: 10.11604/pamj.2018.29.179.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction World Health Organization estimates that the appropriate caesarean section rates should range from 10% to 15% at the population level. There is limited access and utilisation of caesarean section services in Uganda. This case-control study explored factors associated with caesarean section delivery, focusing on service-related and individual level factors. Methods we interviewed 134 cases that had a caesarean section and 134 controls that had a “normal” vaginal delivery. The study was conducted at health facilities in Kabarole district during March to May 2016. Multivariable logistic regression was used to determine individual factors associated with caesarean sections, at a significance level of p < 0.05. Key Informant (KI) data obtained from health workers was analysed using MAXQDA (version 12) software to determine health service factors affecting caesarean section service delivery. Results the mean age of the overall sample was 26 years (SD ± 6.5 years). Cases had 5% more women who belonged to the eldest age group (> 35 years) compared to the controls. The factors associated with caesarean section delivery were: having a previous caesarean section delivery (adjusted odds ratio (AOR): 4.5 CI: 2.22-9.0), attendance of four or more ANC visits (AOR: 2.0 CI: 1.04-3.83). Inadequate human resource, medicines and supplies affected access to the service. Misconceptions such as negative branding of women that have caesarean section deliveries as “lazy” reduced its acceptance thus low utilisation of the service. Conclusion health system inadequacies and misconceptions about caesarean section delivery contributed to the low access and utilisation of the service.
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Affiliation(s)
- Jacinta Dusabe
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Joseph Akuze
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Angela Nakanwagi Kisakye
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Benon Kwesiga
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Peter Nsubuga
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
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Yaya S, Uthman OA, Amouzou A, Bishwajit G. Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries. Glob Health Res Policy 2018; 3:19. [PMID: 29988650 PMCID: PMC6027740 DOI: 10.1186/s41256-018-0074-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background Access to safe Cesarean section (C-section) in resource-constrained settings such as sub-Sahara Africa (SSA) region is a foremost approach to reduce maternal mortality. C-section is an obstetric operative procedure used appropriately to improve delivery outcomes. However, errors in the procedure have enormous potential harm that may outweigh the benefits. This study assessed the prevalence and determinants of C-section in several SSA countries. This study examined the prevalence and determinants associated with cesarean delivery in SSA countries. Methods Secondary data of women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 34 SSA countries was utilized in this study. The mode of delivery among women was the primary outcome variable. Percentage and descriptive statistics were used to conduct univariate analyses. Furthermore, multivariable multilevel logistic regression was used to investigate correlates of C-section among SSA women. Results Results showed disparities in the percentage of C-section among women from 34 SSA countries. C-section at public healthcare settings ranged from 3% in Burkina Faso to 15.6% in Ghana. However, in private healthcare settings, C-section ranged from 0% in Sao Tome and Principe to 64.2% in Rwanda. Overall, C-section was 7.9% from public healthcare and 12.3% from private healthcare facilities respectively. In the adjusted regression model; women aged 35–49 had increase in the odds of C-section, while a unit increase in the number of children ever born had 17 and 20% significant reduction in the odds of C-section in public and private healthcare respectively. Assessing public healthcare settings; women from richer/richest households, male and large size children at birth had increase in the odds of C-section, while those from rich neighbourhood had reduction in the odds of C-section. In private healthcare settings, women with high decision making power and multiple births had increase in the odds of C-section, while those who attended ANC visits had significant reduction in the odds of C-section. Conclusion The findings from this study would help formulate health policies and implement actions that would improve the outcome of C-section care. Monitoring of emergency obstetric care services is necessary to address issues connected to poor C-section outcomes in resource-constrained settings. Also training of medical personnel including midwives and nurses in emergency obstetric care, ensuring accessibility to life-saving drugs and supplies should be encouraged in health care system.
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Affiliation(s)
- Sanni Yaya
- 1School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Olalekan A Uthman
- 2Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Agbessi Amouzou
- 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Ghose Bishwajit
- 1School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5 Canada
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Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health 2018; 18:613. [PMID: 29747609 PMCID: PMC5946478 DOI: 10.1186/s12889-018-5533-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/01/2018] [Indexed: 01/29/2023] Open
Abstract
Background Worldwide rising cesarean section (CS) births is an issue of concern. In India, with increase in institutional deliveries there has also been an increase in cesarean section births. Aim of the study is to quantify the prevalence of cesarean section births in public and private health facility, and also to determine the factors associated with cesarean section births. Methods We analyzed data from district level household survey data 4 (DLHS-4) combined individual level dataset for 19 states/UTs of India comprising 24,398 deliveries resulting in 22,111 live births for year 2011. The percentages and Chi-square has been computed for the select variables viz. Socio demographic, maternal, antenatal care and delivery related based on type of births (CS Vs normal births). The multiple logistic regression model has been used to identify the potential risk factors associated with CS births. Results Of 22,111 live birth analyzed 49.2% were delivered at public sector, 31.9% at private sector and 18.9% were home deliveries. Prevalence of CS births were 13.7% (95% CI; 13.0- 14.3%) and 37.9% (95% CI; 36.7- 39.0%) in the public and private sectors, respectively. Higher odds of CS births were observed with- delivery at private health facility (OR 3.79; 95% C.I 3.06-4.72), urban residence (OR 1.15; 95% C.I 1.00- 1.35), first delivery after 35 years of maternal age (OR 5.5; 95% C.I 1.85- 16.4), hypertension in pregnancy (OR 1.32; 95% C.I 1.06- 1.65) and breach presentation (OR 2.37; 95% C.I. 1.63- 3.43). Conclusions Our findings shows that CS births are nearly three times more in private as compared to public sector health facilities.The higher rates of CS births, especially in private sector, not only increase the cost of care but may pose unnecessary risks to women (when there is no indications for CS). The government of India need to take measures to strengthen existing public health facilities as well as ensure that cesarean sections are performed based upon medical indications in both public and private sector health facilities.
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Amini P, Mohammadi M, Omani-Samani R, Almasi-Hashiani A, Maroufizadeh S. Factors Associated with Cesarean Section in Tehran, Iran using Multilevel Logistic Regression Model. Osong Public Health Res Perspect 2018; 9:86-92. [PMID: 29740533 PMCID: PMC5935148 DOI: 10.24171/j.phrp.2018.9.2.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives Over the past few decades, the prevalence of cesarean sections (CS) have risen dramatically worldwide, particularly in Iran. The aim of this study was to determine the prevalence of CS in Tehran, and to examine the associated risk factors. Methods A cross-sectional study of 4,308 pregnant women with singleton live-births in Tehran, Iran, between July 6–21, 2015 was performed. Multilevel logistic regression analysis was performed using demographic and obstetrical variables at the first level, and hospitals as a variable at the second level. Results The incidence of CS was 72.0%. Multivariate analysis showed a significant relationship between CS and the mother’s age, socioeconomic status, body mass index, parity, type of pregnancy, preeclampsia, infant height, and baby’s head circumference. The intra-class correlation using the second level variable, the hospital was 0.292, indicating approximately 29.2% of the total variation in the response variable accounted for by the hospital. Conclusion The incidence of CS was substantially higher than other countries. Therefore, educational and psychological interventions are necessary to reduce CS rates amongst pregnant Iranian women.
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Affiliation(s)
- Payam Amini
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Maryam Mohammadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Yip BHK, Leonard H, Stock S, Stoltenberg C, Francis RW, Gissler M, Gross R, Schendel D, Sandin S. Caesarean section and risk of autism across gestational age: a multi-national cohort study of 5 million births. Int J Epidemiol 2018; 46:429-439. [PMID: 28017932 DOI: 10.1093/ije/dyw336] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/16/2022] Open
Abstract
Background The positive association between caesarean section (CS) and autism spectrum disorder (ASD) may be attributed to preterm delivery. However, due to lack of statistical power, no previous study thoroughly examined this association across gestational age. Moreover, most studies did not differentiate between emergency and planned CS. Methods Using population-based registries of four Nordic countries and Western Australia, our study population included 4 987 390 singletons surviving their first year of life, which included 671 646 CS deliveries and 31 073 ASD children. We used logistic regression to estimate odds ratios (OR) and their 95% confidence intervals (CI) for CS, adjusted for gestational age, site, maternal age and birth year. Stratified analyses were conducted by both gestational age subgroups and by week of gestation. We compared emergency versus planned CS to investigate their potential difference in the risk of ASD. Results Compared with vaginal delivery, the overall adjusted OR for ASD in CS delivery was 1.26 (95% CI 1.22-1.30). Stratified ORs were 1.25 (1.15-1.37), 1.16 (1.09-1.23), 1.34 (1.28-1.40) and 1.17 (1.04-1.30) for subgroups of gestational weeks 26-36, 37-38, 39-41 and 42-44, respectively. CS was significantly associated with risk of ASD for each week of gestation, from week 36 to 42, consistently across study sites (OR ranged 1.16-1.38). There was no statistically significant difference between emergency and planned CS in the risk of ASD. Conclusion Across the five countries, emergency or planned CS is consistently associated with a modest increased risk of ASD from gestational weeks 36 to 42 when compared with vaginal delivery.
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Affiliation(s)
- Benjamin Hon Kei Yip
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helen Leonard
- Telethon Kids Institute.,Centre for Child Health Research, University of Western Australia, Crawley, WA, Australia
| | - Sarah Stock
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK.,Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Richard W Francis
- Telethon Kids Institute.,Centre for Child Health Research, University of Western Australia, Crawley, WA, Australia
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland.,Department of Child Psychiatry, Turku University and Turku University Hospital, Turku, Finland
| | - Raz Gross
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Diana Schendel
- Department of Public Health, Institute of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark.,Department of Economics and Business, National Centre for Register-based Research, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus University, Aarhus, Denmark
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA and
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Khan M, Islam M, Rahman M. Inequality in utilization of cesarean delivery in Bangladesh: a decomposition analysis using nationally representative data. Public Health 2018. [DOI: 10.1016/j.puhe.2018.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Solanke BL. Individual and community factors associated with indications of caesarean delivery in Southern Nigeria: Pooled analyses of 2003-2013 Nigeria demographic and health surveys. Health Care Women Int 2018; 39:697-716. [PMID: 29485329 DOI: 10.1080/07399332.2018.1443107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this study, the researcher examines associated individual and community factors of indications of caesarean delivery in Southern Nigeria. Data were pooled from 2003-2013 Nigeria Demographic and Health Surveys. Analyses were performed using Stata 12. The multilevel mixed-effects logistic regression was applied. Indications of caesarean delivery were 4.9% over the studied period. Maternal age, parity, education, and household wealth were significantly associated with indications of caesarean delivery. Community effects on indications of caesarean delivery were significant. A public health education programme is needed to address aversion to caesarean sections among those who may have medical need for caesarean delivery.
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Affiliation(s)
- Bola Lukman Solanke
- a Department of Demography and Social Statistics , Obafemi Awolowo University , Ile-Ife , Nigeria
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Abstract
The aims of this study was to determine the trends in rates of caesarean sections in Turkey. The data source for this study was the Turkey Demographic and Health Survey (TDHS) 1993-1998-2003-2008-2013 conducted by Hacettepe University, Institute of Population Studies. Cross tables and binary logistic regression were used for analysis. It was found that the caesarean section rate, which was 14.3% in 1993, increased to 51.9% in 2013. The rate increased with maternal age and educational level at childbirth. The Caesarean section rate was higher in women who were under health insurance coverage, first time mothers, childbirth in the private health institutions, those staying in the Western region and urban areas, and having the highest level of wealth. This study aims to contribute to the literature of caesarean sections especially in developing countries, in which caesarean section has become a major healthcare issue. Impact Statement What is already known on this subject: Caesarean section is among the most widely practiced obstetric surgery worldwide. Previous studies have suggested that the rates of caesarean section were affected by the biological, genetic and medical factors. What the results of this study add: Besides the biological, genetic and medical factors, it is believed that social factors (income and social status, education, employment, etc.) play an important role on the caesarean section in developing countries. Although the laws on caesarean sections have been enforced since 2012 in Turkey, this study shows that there has been a significant increase in caesarean section between the 1993 and 2013 periods. The study also reveals that prohibiting caesarean sections, except in cases of medical necessity, is a problematic issue in the health system despite all efforts. What the implications are of these findings for clinical practice and/or further research: This study may be of interest for authorities and researchers in terms of showing the social factors associated with the caesarean section.
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Affiliation(s)
- Gulcan Santas
- a Department of Health Management , Hacettepe University , Ankara , Turkey
| | - Fatih Santas
- b Department of Health Management , Bozok University , Yozgat , Turkey
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Mueller NT, Shin H, Pizoni A, Werlang IC, Matte U, Goldani MZ, Goldani HAS, Dominguez-Bello MG. Delivery Mode and the Transition of Pioneering Gut-Microbiota Structure, Composition and Predicted Metabolic Function. Genes (Basel) 2017; 8:E364. [PMID: 29207565 PMCID: PMC5748682 DOI: 10.3390/genes8120364] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 02/07/2023] Open
Abstract
Cesarean (C-section) delivery, recently shown to cause excess weight gain in mice, perturbs human neonatal gut microbiota development due to the lack of natural mother-to-newborn transfer of microbes. Neonates excrete first the in-utero intestinal content (referred to as meconium) hours after birth, followed by intestinal contents reflective of extra-uterine exposure (referred to as transition stool) 2 to 3 days after birth. It is not clear when the effect of C-section on the neonatal gut microbiota emerges. We examined bacterial DNA in carefully-collected meconium, and the subsequent transitional stool, from 59 neonates [13 born by scheduled C-section and 46 born by vaginal delivery] in a private hospital in Brazil. Bacterial DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq (San Diego, CA, USA) platform. We found evidence of bacterial DNA in the majority of meconium samples in our study. The bacterial DNA structure (i.e., beta diversity) of meconium differed significantly from that of the transitional stool microbiota. There was a significant reduction in bacterial alpha diversity (e.g., number of observed bacterial species) and change in bacterial composition (e.g., reduced Proteobacteria) in the transition from meconium to stool. However, changes in predicted microbiota metabolic function from meconium to transitional stool were only observed in vaginally-delivered neonates. Within sample comparisons showed that delivery mode was significantly associated with bacterial structure, composition and predicted microbiota metabolic function in transitional-stool samples, but not in meconium samples. Specifically, compared to vaginally delivered neonates, the transitional stool of C-section delivered neonates had lower proportions of the genera Bacteroides, Parabacteroides and Clostridium. These differences led to C-section neonates having lower predicted abundance of microbial genes related to metabolism of amino and nucleotide sugars, and higher abundance of genes related to fatty-acid metabolism, amino-acid degradation and xenobiotics biodegradation. In summary, microbiota diversity was reduced in the transition from meconium to stool, and the association of delivery mode with microbiota structure, composition and predicted metabolic function was not observed until the passing of the transitional stool after meconium.
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Affiliation(s)
- Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD 21205, USA.
| | - Hakdong Shin
- Department of Food Science and Biotechnology, College of Life Science, Sejong University, Seoul 05006, Korea.
| | - Aline Pizoni
- Post Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, RS 90040-060, Brazil.
| | - Isabel C Werlang
- Post Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, RS 90040-060, Brazil.
| | - Ursula Matte
- Post Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, RS 90040-060, Brazil.
| | - Marcelo Z Goldani
- Post Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, RS 90040-060, Brazil.
| | - Helena A S Goldani
- Post Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, RS 90040-060, Brazil.
- Post Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, RS 90040-060, Brazil.
| | - Maria G Dominguez-Bello
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Division of Translational Medicine, New York University School of Medicine, New York, NY 10016, USA.
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Yisma E, Smithers LG, Lynch JW, Mol BW. Cesarean section in Ethiopia: prevalence and sociodemographic characteristics. J Matern Fetal Neonatal Med 2017; 32:1130-1135. [PMID: 29103331 DOI: 10.1080/14767058.2017.1401606] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to assess the prevalence and sociodemographic characteristics of cesarean section in Ethiopia. METHODS We used data collected for Ethiopia Demographic and Health Surveys (DHS) conducted in 2000, 2005, 2011, and 2016. A two-stage, stratified, clustered random sampling design was used to gather information from women who gave birth within the 5-year period before each of the surveys. We analyzed the data to identify sociodemographic characteristics associated with cesarean section using log-Poisson regression models. RESULTS The national cesarean section rate increased from 0.7% in 2000 to 1.9% in 2016, with increases across seven of the eleven administrative regions of Ethiopia. Addis Ababa had the highest cesarean section rate (21.4%) in 2016 and the greatest increase since 2000. In the adjusted analysis, women who gave birth in private health facility had a 78.0% higher risk of cesarean section (adjusted prevalence ratio (aPR) (95% CI) 1.78 (1.22, 2.58)) compared with women who gave birth in public health facility. Having four or more births was associated with a lower risk of cesarean section compared with first births (aPR (95% CI) 0.36 (0.16, 0.79)). CONCLUSIONS The Ethiopian national cesarean section rate is about 2%, but the rate varies widely among administrative regions, suggesting unequal access. Cesarean sections were highest among urban mothers, first births, births to women with higher education, and births to women from the richest quintile of household wealth.
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Affiliation(s)
- Engida Yisma
- a Robinson Research Institute, School of Medicine , The University of Adelaide , Adelaide , Australia.,b School of Allied Health Sciences, College of Health Sciences , Addis Ababa University , Addis Ababa , Ethiopia
| | - Lisa G Smithers
- a Robinson Research Institute, School of Medicine , The University of Adelaide , Adelaide , Australia.,c School of Public Health , The University of Adelaide , Adelaide , Australia
| | - John W Lynch
- a Robinson Research Institute, School of Medicine , The University of Adelaide , Adelaide , Australia.,c School of Public Health , The University of Adelaide , Adelaide , Australia.,d School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Ben W Mol
- a Robinson Research Institute, School of Medicine , The University of Adelaide , Adelaide , Australia
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Wilunda C, Yoshida S, Blangiardo M, Betran AP, Tanaka S, Kawakami K. Caesarean delivery and anaemia risk in children in 45 low- and middle-income countries. MATERNAL AND CHILD NUTRITION 2017; 14:e12538. [PMID: 29048731 DOI: 10.1111/mcn.12538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/30/2017] [Accepted: 09/09/2017] [Indexed: 01/18/2023]
Abstract
Caesarean delivery (CD) may reduce placental transfusion and cause poor iron-related haematological indices in the neonate. We aimed to explore the association between CD and anaemia in children aged <5 years utilising data from Demographic and Health Surveys conducted between 2005 and 2015 in 45 low- and middle-income countries (N = 132,877). We defined anaemia categories based on haemoglobin levels, analysed each country's data separately using propensity-score weighting, pooled the country-specific odds ratios (ORs) using random effects meta-analysis, and performed meta-regression to determine whether the association between CD and anaemia varies by national CD rate, anaemia prevalence, and gross national income. Individual-level CD was not associated with any anaemia (OR 0.95, 95% confidence interval (CI) [0.86, 1.06]; I2 = 40.2%), mild anaemia (OR 0.91, 95% CI [0.81, 1.02]; I2 = 24.8%), and moderate/severe anaemia (OR 0.97, 95% CI [0.85, 1.11]; I2 = 47.7%). CD tended to be positively associated with moderate/severe anaemia in upper middle-income countries and negatively associated with mild anaemia in lower middle-income countries; however, meta-regression did not detect any variation in the association between anaemia and CD by the level of income, CD rate, and anaemia prevalence. In conclusion, there was no evidence for an association between CD and anaemia in children younger than 5 years in low- and middle-income countries. Our conclusions were consistent when we looked at only countries with CD rate >15% with data stratified by individual-level wealth status and type of health facility of birth.
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Affiliation(s)
- Calistus Wilunda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Marta Blangiardo
- Department of Epidemiology and Biostatistics, School of Medicine, Imperial College, London, UK
| | - Ana Pilar Betran
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Defining Behavior Patterns Towards Exclusive Breastfeeding Using Latent Class Analysis. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.10575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Birth by cesarean section in relation to adult offspring overweight and biomarkers of cardiometabolic risk. Int J Obes (Lond) 2017; 42:15-19. [PMID: 28757643 DOI: 10.1038/ijo.2017.175] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 05/15/2017] [Accepted: 06/21/2017] [Indexed: 11/09/2022]
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Matinnia N, Haghighi M, Jahangard L, Ibrahim FB, Rahman HA, Ghaleiha A, Holsboer-Trachsler E, Brand S. Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae. ACTA ACUST UNITED AC 2017; 40:83-88. [PMID: 28614494 PMCID: PMC6899414 DOI: 10.1590/1516-4446-2017-2229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/06/2017] [Indexed: 12/01/2022]
Abstract
Objective: Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. Methods: A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Results: Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. Conclusions: The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.
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Affiliation(s)
- Nasrin Matinnia
- Department of Nursing, College of Basic Science, Hamadan Branch, Islamic Azad University, Hamadan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, University of Medical Sciences, Hamadan, Iran
| | - Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, University of Medical Sciences, Hamadan, Iran
| | - Faisal B Ibrahim
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hejar A Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ali Ghaleiha
- Research Center for Behavioral Disorders and Substance Abuse, University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland.,University of Basel, Department of Sport, Exercise and Health Science, Division Sport and Psychosocial Health, Switzerland
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Beogo I, Mendez Rojas B, Gagnon MP. Determinants and materno-fetal outcomes related to cesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review and meta-analysis protocol. Syst Rev 2017; 6:5. [PMID: 28088214 PMCID: PMC5237475 DOI: 10.1186/s13643-016-0402-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite the well-established morbidity, mortality, long-term effects, and unnecessary extra-cost burden associated with cesarean section delivery (CSD) worldwide, its rate has grown exponentially. This has become a great topical challenge for the international healthcare community and individual countries. Estimated at three times the acceptable rate as defined by the World Health Organization in 1985, the continued upward trend has been fuelled by higher income countries. Some low- and middle-income countries (LMICs) have now taken the lead, and the factors contributing to this situation are poorly understood. The expansion of the private healthcare sector may be playing a significant role. Distinguishing between the public and private hospitals' role is critical in this investigation as it has not yet been approached. This review aims to systematically synthesize knowledge on the determinants of the CSD rate rise in private and public hospitals in LMICs and to investigate materno-fetal and materno-infant outcomes of CSD in perinatal period, between private and public hospitals. METHODS/DESIGN We will include studies published in English, French, Spanish, and Portuguese since 2000, using any experimental design, including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, and interrupted time series. Outcomes of interest are the determinants of CSD and materno-fetal and materno-infant outcomes. We will only include studies carried out in private and public hospitals in LMICs. The literature searches will be conducted in the following databases: MEDLINE, Embase, CINAHL, Cochrane database, LILACS, and HINARI. We will also include unpublished studies in the gray literature (theses and technical reports). Using the two-person approach, two independent review authors will screen eligible articles, extract data, and assess risk of bias. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. If possible, a meta-analysis will be conducted and, subsequently, an analysis for heterogeneity will be implemented. DISCUSSION The proposed systematic review of the CSD rate rise will provide up-to-date evidence in regard to differences in proportions, determinants, and materno-fetal and materno-infant outcomes in perinatal period, between private and public hospitals in LMICs. We believe that this knowledge synthesis will help to shed light on the evidence and support evidence-informed decision-making with a view to addressing the issue in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016036871.
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Affiliation(s)
- Idrissa Beogo
- École Nationale de Santé Publique, Ouagadougou, Burkina Faso
- Université Laval, 2325 rue de l’Université , Québec (Québec), G1V 0A6 Canada
| | - Bomar Mendez Rojas
- International Health Program, National Yang Ming University, 155 Sec 2, Linong St. 112, Taipei, Taiwan
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Ferdinand-Vandry Building, 1050 Avenue de la Médecine, Québec City (Québec), G1V 0A6 Canada
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