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Minani P, Ross A. Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review. Afr J Prim Health Care Fam Med 2024; 16:e1-e11. [PMID: 38708736 PMCID: PMC11079335 DOI: 10.4102/phcfm.v16i1.4128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality. AIM The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB. METHODS A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies. RESULTS These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention. CONCLUSION The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions: This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.
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Affiliation(s)
- Patrick Minani
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Mezemir R, Olayemi O, Dessie Y. Trend and associated factors of cesarean section rate in Ethiopia: Evidence from 2000-2019 Ethiopia demographic and health survey data. PLoS One 2023; 18:e0282951. [PMID: 36928080 PMCID: PMC10019649 DOI: 10.1371/journal.pone.0282951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The world health organization considers cesarean section (CS) prevalence of less than 5% suggests an unmet need. On the other hand, a prevalence of more than 15% may pose to risk to mother and child, however, access to CS in a resource-limited country like Ethiopia was much lower than the aforementioned level, Therefore, this was the first study to determine the trend of CS, and factors that influence it. METHODS This was done based on the five Ethiopia Demographic and Health Surveys. Trend analysis was done separately for rural and urban. The significance of the trend was assessed using the Extended Mantel-Haenszel chi-square test. The factors on CS delivery were identified based on DHS 2016 data. A multi-level logistic regression analysis technique was used to identify the factors associated with cesarean section delivery. The analysis was adjusted for the different individual- and community-level factors affecting cesarean section delivery. Data analysis was conducted using STATA 14.1 software. RESULT The rate of cesarean section increased from 5.1% in 1995 to 16% in 2019 in an urban area and 0.001 in 1995 to 3% in a rural area, the overall increment of CS rate was 0.7% in 1995 to 2019 at 6%. The odds of cesarean section were higher among 25-34 years (AOR = 2.79; 95% CI: 1.92, 4.07) and 34-49 years (AOR = 5.23;95% CI: 2.85,9.59), among those educated at primary school level (AOR = 1.94; 95% CI: 1.23,3.11), secondary education (AOR = 2.01; 95% CI: 1.17, 3.56) and higher education (AOR = 4.12; 95% CI: 2.33-7.29)with multiple pregnancies (AOR = 11.12; 95% CI: 5.37, 23.), with obesity (AOR = 1.73; 95% CI: 1.22, 2.45), living in an urban area (AOR = 2.28; /95% CI: 1.35-3.88), and increased with the number of ANC visit of 1-3 and 4th(AOR = 2.26; 95% CI: 1.12, 4.58), (AOR = 3.34; 95% CI: 1.12, 4.58), respectively. The odds of cesarean section are lower among parity of 2-4 children (AOR = 0.54; 95% CI: 0 .37, 0.80) and greater than four birth order (AOR = 0.42;95% CI: 0.21,0.84). CONCLUSION In Ethiopia, the CS rate is below the WHO recommended level in both urban and rural areas, thus, intervention efforts need to be prioritized for women living in a rural area, empowering women's education, encouraging co-services such as ANC usage could all help to address the current problem.
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Affiliation(s)
- Rahel Mezemir
- Pan African University, Life and Earth Sciences Institute (Including Health and Agriculture), Ibadan, Nigeria
- St. Paul’s Hospital Millennium Medical College, School of Nursing, Addis Ababa, Ethiopia
- * E-mail: ,
| | - Oladapo Olayemi
- Department of Obstetrics and Gynaecology, College of Medicine, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- College of Health and Medical Sciences Haramaya University, Harar, Ethiopia
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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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Factors associated with cesarean delivery in Bangladesh: A Multilevel Modeling. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100792. [DOI: 10.1016/j.srhc.2022.100792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 09/01/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022]
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Abdel-Rahman ME, Thalib L, Rayis DA. Caesarean section in Sudan: findings from nationwide household surveys on rates, trends, and geographic and sociodemographic variability. BMC Pregnancy Childbirth 2022; 22:716. [PMID: 36127631 PMCID: PMC9487139 DOI: 10.1186/s12884-022-04995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Medically unjustifiable caesarean section (CS) deliveries have been rising rapidly in many developed countries over the last three decades. While many developing countries show rates beyond optimal levels, few poorer countries appear to have sub-optimal obstetric care in relation to essential surgeries. The objective of this study is to document the rates of CS delivery, its time trend, and geographic and sociodemographic variability in Sudan. Methods We utilized a number of Multiple Indicator Cluster Surveys (MICS) conducted in 2014, 2010, and 2006 to quantify CS rates per 1000 live births. We also documented absolute changes in rates over three-time points and variation in CS rates across geographic regions and areas of residence. Results Over a decade, CS rates in Sudan increased steadily from 4.3% in 2006 to 6.7% in 2010 and 9.1% in 2014. During this period, CS rates varied considerably across regions showing higher rates in the Northern region (7–25%) and lower rates in Darfur (2–3%). Urban areas experienced rapidly increasing rates (6–14%), while rural areas showed negligible changes to absolute CS rates over time (5–7%). We also found geographic regions, maternal age, maternal education, receiving antenatal care, and birth order of the child were important determinants of CS in Sudan. Conclusion Sudan may be facing a double burden of problems associated with surgical interventions for childbirth. While the wealthier parts of Sudan are experiencing a rapid surge in CS, some poor parts of rural Sudan may not be getting the essential surgical intervention for birth when mandated. Urgent improvement to obstetric care and the development of appropriate public health interventions that focus on regional disparities are warranted.
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Affiliation(s)
- Manar E Abdel-Rahman
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - Duriya A Rayis
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Islam MS, Awal MA, Laboni JN, Pinki FT, Karmokar S, Mumenin KM, Al-Ahmadi S, Rahman MA, Hossain MS, Mirjalili S. HGSORF: Henry Gas Solubility Optimization-based Random Forest for C-Section prediction and XAI-based cause analysis. Comput Biol Med 2022; 147:105671. [DOI: 10.1016/j.compbiomed.2022.105671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 01/02/2023]
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Factors Associated with Caesarean and Peripartum Complications at Southern Mozambique’s Rural Hospitals: A Cross-Sectional Analytical Study. Healthcare (Basel) 2022; 10:healthcare10061013. [PMID: 35742065 PMCID: PMC9223089 DOI: 10.3390/healthcare10061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients’ files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had “high obstetric-risk” and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8; 95% Confidence Interval (95%CI) = 1.3–2.6], preeclampsia [aOR (95%CI) = 2.0 (1.2–3.3)], age [aOR (95%CI) = 0.96 (0.93–0.99)] and “high obstetric-risk” [aOR (95%CI) = 0.54 (0.37–0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8–2.6)], “high obstetric-risk” [aOR (95%CI) = 1.6 (1.3–1.96)], preeclampsia [aOR (95%CI) = 1.5 (1.2–1.8), mother’s age [aOR (95%CI) = −2% (−3%, −0.1%)] and gestational age [aOR (95%CI) = −8% (−13%, −6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals’ performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads.
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Caesarean delivery and its association with educational attainment, wealth index, and place of residence in Sub-Saharan Africa: a meta-analysis. Sci Rep 2022; 12:5554. [PMID: 35365718 PMCID: PMC8975863 DOI: 10.1038/s41598-022-09567-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
Caesarean delivery (C-section) has been increasing worldwide; however, many women from developing countries in Sub-Saharan Africa are deprived of these lifesaving services. This study aimed to explore the impact of certain socioeconomic factors, including respondent's education, husband's education, place of residence, and wealth index, on C-section delivery for women in Sub-Saharan Africa. We used pooled data from 36 demographic and health surveys (DHS) in Sub-Saharan Africa. Married women aged 15-49 years who have at least one child in the last five years were considered in this survey. After inclusion and excluding criteria, 234,660 participants were eligible for final analysis. Binary logistic regression was executed to determine the effects of selected socioeconomic factors. The countries were assembled into four sub-regions (Southern Africa, West Africa, East Africa, and Central Africa), and a meta-analysis was conducted. We performed random-effects model estimation for meta-analysis to assess the overall effects and consistency between covariates and utilization of C-section delivery as substantial heterogeneity was identified (I2 > 50%). Furthermore, the meta-regression was carried out to explain the additional amount of heterogeneity by country levels. We performed a sensitivity analysis to examine the effects of outliers in this study. Findings suggest that less than 15% of women in many Sub-Saharan African countries had C-section delivery. Maternal education (OR 4.12; CI 3.75, 4.51), wealth index (OR 2.05; CI 1.94, 2.17), paternal education (OR 1.71; CI 1.57, 1.86), and place of residence (OR 1.51; CI 1.44, 1.58) were significantly associated with the utilization of C-section delivery. These results were also consistent in sub-regional meta-analyses. The meta-regression suggests that the total percentage of births attended by skilled health staff (TPBASHS) has a significant inverse association with C-section utilization regarding educational attainment (respondent & husband), place of residence, and wealth index. The data structure was restricted to define the distinction between elective and emergency c-sections. It is essential to provide an appropriate lifesaving mechanism, such as C-section delivery opportunities, through proper facilities for rural, uneducated, impoverished Sub-Saharan African women to minimize both maternal and infant mortality.
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Okyere J, Duah HO, Seidu AA, Ahinkorah BO, Budu E. Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014. BMC Pregnancy Childbirth 2022; 22:64. [PMID: 35065625 PMCID: PMC8783997 DOI: 10.1186/s12884-022-04378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Caesarean section (CS) is an intervention to reduce maternal and perinatal mortality, for complicated pregnancy and labour. We analysed trends in the prevalence of birth by CS in Ghana from 1998 to 2014. METHODS Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1998-2014 Ghana Demographic and Health Surveys (GDHS) were analysed with respect of inequality in birth by CS. First, we disaggregated birth by CS by four equity stratifiers: wealth index, education, residence, and region. Second, we measured inequality through simple unweighted measures (Difference (D) and Ratio (R)) and complex weighted measures (Population Attributable Risk (PAR) and Population Attributable Fraction (PAF)). A 95% confidence interval was constructed for point estimates to measure statistical significance. RESULTS The proportion of women who underwent CS increased significantly between 1998 (4.0%) and 2014 (12.8%). Throughout the 16-year period, the proportion of women who gave birth by CS was positively skewed towards women in the highest wealth quintile (i.e poorest vs richest: 1.5% vs 13.0% in 1998 and 4.0% vs 27.9% in 2014), those with secondary education (no education vs secondary education: 1.8% vs 6.5% in 1998 and 5.7% vs 17.2% in 2014) and women in urban areas (rural vs urban 2.5% vs 8.5% in 1998 and 7.9% vs 18.8% in 2014). These disparities were evident in both complex weighted measures of inequality (PAF, PAR) and simple unweighted measures (D and R), although some uneven trends were observed. There were also regional disparities in birth by CS to the advantage of women in the Greater Accra Region over the years (PAR 7.72; 95% CI 5.86 to 9.58 in 1998 and PAR 10.07; 95% CI 8.87 to 11.27 in 2014). CONCLUSION Ghana experienced disparities in the prevalence of births by CS, which increased over time between 1998 and 2014. Our findings indicate that more work needs to be done to ensure that all subpopulations that need medically necessary CS are given access to maternity care to reduce maternal and perinatal deaths. Nevertheless, given the potential complications with CS, we advocate that the intervention is only undertaken when medically indicated.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Zipfel L, Weidmann C. [Factors Influencing the Caesarean Section Rates in German Hospitals in the Years 2015-2017: An Ecological Study]. DAS GESUNDHEITSWESEN 2021; 84:944-951. [PMID: 34560802 DOI: 10.1055/a-1531-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies in various other countries have shown that there are urban-rural differences in caesarean section rates. Most urban areas showed higher caesarean section rates. The aim of this study was to compare the caesarean section rates between hospitals in urban and rural areas in Germany, and to identify other factors affecting the caesarean section rate. METHODS A secondary data analysis was carried out to investigate the present research topic. The years 2015-2017 were considered, using as data sources the quality reports of the hospitals. Using the statistical program SPSS, mean value comparisons and multiple linear regressions were conducted. RESULTS The mean value analysis showed no significant differences in caesarean section rate between urban and rural hospitals (2015: urban hospitals=31.87% vs. rural hospitals=31.6%, 2016: urban hospitals=31.09% vs. rural hospitals=31.04%, 2017: urban hospitals=31.26% vs. rural hospitals: 31.03%). The multiple linear regression showed that the variables "number of beds" (2015: b=0.005, 2016: b=0.007, 2017: b=0.006), "teaching activity" (2015: b=- 1.42, 2016: b=- 1.351, 2017: b=- 1.823), "number of gynaecologists per 100,000 inhabitants" (2015: b=0.198, 2016: b=0.241, 2017: b=0.254) and the "percentage of the population with a college/university degree" (2015: b=- 0.45, 2016: b=- 0.507, 2017: b=- 0.392) were significant predictors of the caesarean section rate in all years of the study. CONCLUSION The study was able to identify hospital characteristics as well as population- and care-specific characteristics that have an influence on the caesarean section rate in a hospital. The average level of education in the district where the hospital was located was particularly relevant. Thus, caesarean section rates seem to be influenced less by population density than by the regional level of education.
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Affiliation(s)
- Linda Zipfel
- Fakultät Wirtschafts- und Sozialwissenschaften, Universität Hohenheim, Stuttgart, Deutschland
| | - Christian Weidmann
- Fakultät Gesundheit, Sicherheit, Gesellschaft, Hochschule Furtwangen University, Furtwangen, Deutschland
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Roy A, Paul P, Chouhan P, Rahaman M, Kapasia N. Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu. BMC Public Health 2021; 21:1715. [PMID: 34548059 PMCID: PMC8456626 DOI: 10.1186/s12889-021-11750-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively. Methods This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data. Results Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31). Conclusion Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.
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Affiliation(s)
- Avijit Roy
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India. .,Department of Geography, Malda College, Malda, West Bengal, 732101, India.
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi, 110067, India.,International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
| | - Margubur Rahaman
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Nanigopal Kapasia
- Department of Geography, Malda College, Malda, West Bengal, 732101, India
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Nedberg IH, Rylander C, Skjeldestad FE, Blix E, Ugulava T, Anda EE. Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study. J Epidemiol Glob Health 2020; 10:337-343. [PMID: 33009731 PMCID: PMC7758855 DOI: 10.2991/jegh.k.200813.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/11/2020] [Indexed: 11/21/2022] Open
Abstract
Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia.
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Affiliation(s)
- Ingvild Hersoug Nedberg
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Finn Egil Skjeldestad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Tamar Ugulava
- United Nations Children's Fund (UNICEF), Tbilisi, Georgia
| | - Erik Eik Anda
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Jaén-Sánchez N, González-Azpeitia G, Saavedra-Santana P, Saavedra-Sanjuán E, Manguiza AA, Manwere N, Carranza-Rodriguez C, Pérez-Arellano JL, Serra-Majem L. Adolescent motherhood in Mozambique. Consequences for pregnant women and newborns. PLoS One 2020; 15:e0233985. [PMID: 32492055 PMCID: PMC7269336 DOI: 10.1371/journal.pone.0233985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn. Aims To identify the factors associated with adolescent motherhood in Tete (Mozambique). Methods This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn. Results The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040–0.110), pregnancy follow-up (OR 0.29; CI 0.173–0.488) and previous abortions (OR 4.419; 95% CI 1.931–10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn. Conclusion Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.
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Affiliation(s)
- Nieves Jaén-Sánchez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Univer-sitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gloria González-Azpeitia
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Pediatric Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra-Santana
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Esther Saavedra-Sanjuán
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Cristina Carranza-Rodriguez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Univer-sitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- * E-mail:
| | - José Luis Pérez-Arellano
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Univer-sitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Lluis Serra-Majem
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Department of Clinical Sciences (iUIBS), Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Ciber OBN (CB06/03), Instituto Carlos III, Spanish Government, Madrid, Spain
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Dankwah E, Kirychuk S, Zeng W, Feng C, Farag M. Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data. Int J Equity Health 2019; 18:162. [PMID: 31653255 PMCID: PMC6814993 DOI: 10.1186/s12939-019-1063-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana's high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it. METHODS Data from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities. RESULTS Out of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile . CONCLUSIONS This study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana's free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.
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Affiliation(s)
- Emmanuel Dankwah
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Shelley Kirychuk
- Canadian Centre for Health and Safety in Agriculture (CCHSA), College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4 Canada
| | - Wu Zeng
- Department of International Health, School of Nursing & Health Studies, Georgetown University, 37th and O Streets, N.W, Washington, DC 20057 USA
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3 Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
- School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Al Tarfa Street, Zone 70, Doha, Qatar
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Govender I, Steyn C, Maphasha O, Abdulrazak AT. A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1671655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- I Govender
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - C Steyn
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - O Maphasha
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - AT Abdulrazak
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Mocumbi S, Högberg U, Lampa E, Sacoor C, Valá A, Bergström A, von Dadelszen P, Munguambe K, Hanson C, Sevene E. Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique. BMC Pregnancy Childbirth 2019; 19:303. [PMID: 31426758 PMCID: PMC6701029 DOI: 10.1186/s12884-019-2449-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022] Open
Abstract
Background Client satisfaction is an essential component of quality of care. Health system factors, processes of care as well as mothers’ characteristics influence the extent to which care meets the expectations of mothers and families. In our study, we specifically aimed to address the mothers’ experiences of, and satisfaction with, care during childbirth. Methods A population-based cross-sectional study, using structured interviews with published sequences of questions assessing satisfaction, including 4358 mothers who gave birth during the 12 months before June 2016 to estimate satisfaction with childbirth care. Regression analysis was used to determine the predictors of client satisfaction. Results Most mothers (92.5%) reported being satisfied with care during childbirth and would recommend that a family member to deliver at the same facility. Specifically, 94.7% were satisfied with the cleanliness of the facility, 92.0% reported being satisfied with the interaction with the healthcare providers, but only 49.8% felt satisfied with the assistance to feed their baby. Mothers who had negative experiences during the process of care, such as being abandoned when needing help, disrespect, humiliation, or physical abuse, reported low levels of satisfaction when compared to those who had not had such experiences (68.5% vs 93.5%). Additionally, they reported higher levels of dissatisfaction (20.1% vs 2.1%). Regression analysis revealed that mothers who gave birth in primary level facilities tended to be more satisfied than those who gave birth in hospitals, and having a companion increased, on average, the overall satisfaction score, with 0.06 in type II health centres (CI 0.03–0.10) and with 0.05 in type I health centres (CI − 0.02 – 0.13), compared to − 0.01(CI -0.08 – 0.07) in the hospitals, irrespective of age, education and socio-economic background. Conclusion Childbirth at the primary level facilities contributes to the level of satisfaction. The provision of childbirth care should consider women’s preferences and needs, including having a companion of choice. We highlight the challenge in balancing safety of care versus satisfaction with care and in developing policies on the optimum configuration of childbirth care. Interventions to improve the interaction with providers and the provision of respectful care are recommended. Electronic supplementary material The online version of this article (10.1186/s12884-019-2449-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Salvador Allende 702, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Erik Lampa
- Uppsala Clinical Research Centre, Uppsala University, Dag Hammarskjölds väg 38, 751 85, Uppsala, Sweden
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique
| | - Anna Bergström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique.,Department of Public Health, Faculty of Medicine, Universidade Eduardo Mondlane, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Av. Salvador Allende 702 R/C, Maputo, Mozambique
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Identifying the factors associated with cesarean section modeled with categorical correlation coefficients in partial least squares. PLoS One 2019; 14:e0219427. [PMID: 31348793 PMCID: PMC6660071 DOI: 10.1371/journal.pone.0219427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 06/24/2019] [Indexed: 11/19/2022] Open
Abstract
Cesarean section (CS) is associated with maternal morbidity and mortality in developing countries. This study is conducted to assess factors associated with CS in Pakistan using partial least squares (PLS) algorithm, where categorical factors are modeled. Nationally representative maternal data from Pakistan Demographic and Health Surveys (PDHS) conducted during 2012-2013 is used in this study. Among correlation coefficient based PLS regression proposed algorithms for categorical factors, Pearson's Contingency Coefficient (CC) PLS coupled with loading weight (LW) appeared to be the most efficient method in terms of model performance and influential factor selection. Region of residence, type of place of residence, mother's and her partner's level of education, wealth index, year of birth, previous terminated pregnancy, use of contraception, prenatal care provided by a doctor and nurse/midwife/LHV (lady health visitor), assistance provided by a nurse/midwife/LHV,number of antenatal visits, size of child, antenatal care provided by government hospital, transport facility for medical care, baby birth status, mother's age at first birth, preceding birth interval and vaccination of hepatitis B-1 and B2 are found to be significantly affecting the CS delivery method. Correlation coefficient based PLS regression algorithms may serve more efficiently as a multivariate technique to treat high-dimensional categorical data.
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Socioeconomic inequalities and determinants of maternal health services in Shaanxi Province, Western China. PLoS One 2018; 13:e0202129. [PMID: 30183720 PMCID: PMC6124721 DOI: 10.1371/journal.pone.0202129] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/28/2018] [Indexed: 11/19/2022] Open
Abstract
Prenatal health care interventions are effective ways to improve maternal and neonatal health. There have been few large investigations conducted on the inequalities in maternal health services utilization in Shaanxi Province of west China since the health care reform in 2009. This study examined the inequalities and determinants of maternal health services utilization in Shaanxi Province. A household survey was conducted from August to November in 2013. By using a multistage sampling method, local women aged 15-49 who had given birth in the preceding three years were recruited. Information including social-demographic characteristics and maternal health services utilization was collected through a face-to-face interview. A concentration index approach was used to measure inequalities in maternal health services utilization. A logistic regression model was employed to investigate the determinants of maternal health services utilization. There were 8,488 women from urban areas and 18,724 women from rural areas enrolled in this study. The concentration index for all the indicators of maternal health services utilization showed significance in these two areas. In urban areas, the concentration index of having 5 or more prenatal visits, receiving the first prenatal visit within 12 weeks, delivering at secondary- or higher-level health facilities and delivering by C-section were 0.0356, 0.0166, 0.0177 and 0.0591, respectively, while in rural areas, the corresponding figures were 0.0385, 0.0183, 0.0334 and 0.0566, respectively. The determinants related to maternal health services utilization were women's age at delivery, educational level, employment status, parity, health problems during pregnancy and household income. Inequalities in maternal health services utilization still exist in Shaanxi Province. Providing maternal health services for younger, less educated, unemployed, high parity and poorer women, especially in rural areas, is expected to reduce the inequalities in maternal health services utilization.
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Cole CB, Pacca J, Mehl A, Tomasulo A, van der Veken L, Viola A, Ridde V. Toward communities as systems: a sequential mixed methods study to understand factors enabling implementation of a skilled birth attendance intervention in Nampula Province, Mozambique. Reprod Health 2018; 15:132. [PMID: 30075791 PMCID: PMC6091088 DOI: 10.1186/s12978-018-0574-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skilled birth attendance, institutional deliveries, and provision of quality, respectful care are key practices to improve maternal and neonatal health outcomes. In Mozambique, the government has prioritized improved service delivery and demand for these practices, alongside "humanization of the birth process." An intervention implemented in Nampula province beginning in 2009 saw marked improvement in institutional delivery rates. This study uses a sequential explanatory mixed methods case study design to explore the contextual factors that may have contributed to the observed increase in institutional deliveries. METHODS A descriptive time series analysis was conducted using clinic register data from 2009 to 2014 to assess institutional delivery coverage rates in two primary health care facilities, in two districts of Nampula province. Site selection was based on facilities exhibiting an initial increase in institutional deliveries from 2009 to 2011, similarity of health system attributes, and accessibility for study participation. Using a modified Delphi technique, two expert panels-each composed of ten stakeholders familiar with maternal health implementation at facility, district, provincial, and national levels-were convened to formulate the "story" of the implementation and to identify contextual factors to use in developing semi-structured interview guides. Thirty-four key informant interviews with facility MCH nurses, facility managers, traditional birth attendants, community leaders, and beneficiaries were then conducted and analyzed using the Consolidated Framework for Implementation Research through inductive and deductive coding. RESULTS The two sites' skilled birth attendance coverage of estimated live births reached 80 and 100%, respectively. Eight contextual and human factors were found as dominant themes. Though both sites achieved increases, implementation context differed significantly with compelling examples of both respectful and disrespectful care. In one site, facility and community actors worked together as complementary systems to sustain improved care and institutional deliveries. In the other, community actors sustained implementation and institutional deliveries largely in absence of health system counterparts. CONCLUSION Findings support global health recommendations for combined health system and community interventions for improved MNH outcomes including delivery of respectful care, and further suggest the capacity of communities to act as systems both in partnership to and independent of the formal health system.
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Affiliation(s)
- Claire B. Cole
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Julio Pacca
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Alicia Mehl
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Anna Tomasulo
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA 02472 USA
| | - Luc van der Veken
- Pathfinder International Mozambique, 135 Rua Eca De Queiros, Maputo, Mozambique
| | - Adalgisa Viola
- Pathfinder International Mozambique, 135 Rua Eca De Queiros, Maputo, Mozambique
| | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
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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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Augusto O, Keyes EE, Madede T, Abacassamo F, de la Corte P, Chilundo B, Bailey PE. Progress in Mozambique: Changes in the availability, use, and quality of emergency obstetric and newborn care between 2007 and 2012. PLoS One 2018; 13:e0199883. [PMID: 30020958 PMCID: PMC6051588 DOI: 10.1371/journal.pone.0199883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal mortality in Mozambique has not declined significantly in the last 10-15 years, plateauing around 480 maternal deaths per 100,000 live births. Good quality antenatal care and routine and emergency intrapartum care are critical to reducing preventable maternal and newborn deaths. MATERIALS AND METHODS We compare the findings from two national cross-sectional facility-based assessments conducted in 2007 and 2012. Both were designed to measure the availability, use and quality of emergency obstetric and neonatal care. Indicators for monitoring emergency obstetric care were used as were descriptive statistics. RESULTS The availability of facilities providing the full range of obstetric life-saving procedures (signal functions) decreased. However, an expansion in the provision of individual signal functions was highly visible in health centers and health posts, but in hospitals, performance was less satisfactory, with proportionally fewer hospitals providing assisted vaginal delivery, obstetric surgery and blood transfusions. All other key indicators showed signs of improvements: the institutional delivery rate, the cesarean delivery rate, met need for emergency obstetric care (EmOC), institutional stillbirth and early neonatal death rates, and cause-specific case fatality rates (CFRs). CFRs for most major obstetric complications declined between 17% and 69%. The contribution of direct causes to maternal deaths decreased while the proportion of indirect causes doubled during the five-year interval. CONCLUSIONS The indicator of EmOC service availability, often used for planning and developing EmONC networks, requires close examination. The standard definition can mask programmatic weaknesses and thus, fails to inform decision makers of what to target. In this case, the decline in the use of assisted vaginal delivery explained much of the difference in this indicator between the two surveys, as did faltering hospital performance. Despite this backsliding, many signs of improvement were also observed in this 5-year period, but indicator levels continue below recommended thresholds. The quality of intrapartum care and the adverse consequences from infectious diseases during pregnancy point to priority areas for programmatic improvement.
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Affiliation(s)
- Orvalho Augusto
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
- * E-mail:
| | - Emily E. Keyes
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
| | - Tavares Madede
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Fátima Abacassamo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | | | - Baltazar Chilundo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Patricia E. Bailey
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
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Geelhoed D, de Deus V, Sitoe M, Matsinhe O, Lampião Cardoso MI, Manjate CV, Pinto Matsena PI, Mosse Lazaro C. Improving emergency obstetric care and reversing the underutilisation of vacuum extraction: a qualitative study of implementation in Tete Province, Mozambique. BMC Pregnancy Childbirth 2018; 18:266. [PMID: 29945551 PMCID: PMC6020342 DOI: 10.1186/s12884-018-1901-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/17/2018] [Indexed: 01/29/2023] Open
Abstract
Background Maternal and perinatal mortality in Mozambique were declining at a slow pace, despite progress in coverage of institutional childbirth. Implementation of quality emergency obstetric care including vacuum extraction remained inadequate. In 2015–2017, Tete Province achieved remarkable progress in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, with encouraging results for maternal and perinatal outcomes, despite severe resource constraints. This paper presents the experience of Tete Province, generating a rich, contextualised understanding, which might provide generalizable insights and lessons. Methods This qualitative study design is used to present Tete’s experience in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, drawing on principles from implementation science and applying a systems thinking approach. Sources include routine data, documents, social media messages, and the lived experience of the authors, all intimately involved in the implementation process during 2014–2017. Iterative learning and analysis, involving all authors, led to the final interpretations. Results Within a context of severe resource constraints, Tete applied 4 interventions (training, accreditation, audit, monitoring and evaluation with feedback) to improve the implementation of emergency obstetric care. Considerable progress was achieved in vacuum extraction and other signal functions of emergency obstetric care and in the decision-making process for caesarean sections, contributing to important reductions in the provincial institutional maternal mortality and stillbirth rates. Facilitating factors include attributes of the vacuum extraction itself, of the structural and organisational environments in which it was introduced, of the people involved in implementation, and of the process through which the implementation was rolled-out. Conclusions The lessons from implementation science and systems thinking can contribute to surprising results in the improvement of emergency obstetric care including the use of vacuum extraction, even in a severely resource-constrained setting. The creation of conditions for real change, with empowerment of the staff and managers at the front-line of day-to-day practice in Tete may inspire others in similar conditions and circumstances. The underutilisation of vacuum extraction in middle- and low-income countries is indeed a missed opportunity. Its reversion is possible and provides a good chance to make considerable difference in maternal and perinatal outcomes.
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Affiliation(s)
- D Geelhoed
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique.
| | - V de Deus
- Tete Provincial Hospital, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M Sitoe
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - O Matsinhe
- Rural Hospital of Mutarara, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M I Lampião Cardoso
- Rural Hospital of Ulongue, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C V Manjate
- District Services of Health, Women and Social Action of Chifunde, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - P I Pinto Matsena
- District Services of Health, Women and Social Action of Cidade de Tete, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C Mosse Lazaro
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
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Chavane LA, Bailey P, Loquiha O, Dgedge M, Aerts M, Temmerman M. Maternal death and delays in accessing emergency obstetric care in Mozambique. BMC Pregnancy Childbirth 2018; 18:71. [PMID: 29566655 PMCID: PMC5863898 DOI: 10.1186/s12884-018-1699-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/02/2018] [Indexed: 01/15/2023] Open
Abstract
Background Despite declining trends maternal mortality remains an important public health issue in Mozambique. The delays to reach an appropriate health facility and receive care faced by woman with pregnancy related complications play an important role in the occurrence of these deaths. This study aims to examine the contribution of the delays in relation to the causes of maternal death in facilities in Mozambique. Methods Secondary analysis was performed on data from a national assessment on maternal and neonatal health that included in-depth maternal death reviews, using patient files and facility records with the most comprehensive information available. Statistical models were used to assess the association between delay to reach the health facility that provides emergency obstetric care (delay type II) and delay in receiving appropriate care once reaching the health facility providing emergency obstetric care (delay type III) and the cause of maternal death within the health facility. Results Data were available for 712 of 2,198 maternal deaths. Delay type II was observed in 40.4% of maternal deaths and delay type III in 14.2%.and 13.9% had both delays. Women who died of a direct obstetric complication were more likely to have experienced a delay type III than women who died due to indirect causes. Women who experienced delay type II were less likely to have also delay type III and vice versa. Conclusions The delays in reaching and receiving appropriate facility-based care for women facing pregnancy related complications in Mozambique contribute significantly to maternal mortality. Securing referral linkages and health facility readiness for rapid and correct patient management are needed to reduce the impact of these delays within the health system.
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Affiliation(s)
| | - Patricia Bailey
- RMNCH Unit, Global Health Programs, FHI, Durham, NC, 360, USA
| | - Osvaldo Loquiha
- Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique
| | - Martinho Dgedge
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Marc Aerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health- East Africa, Aga Khan University, Karachi, Pakistan.,Ghent University Belgium, Ghent, Belgium
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24
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Long Q, Madede T, Parkkali S, Chavane L, Sundby J, Hemminki E. Maternity care system in Maputo, Mozambique: Plans and practice? COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1412138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Qian Long
- Global Health Research Centre, Duke Kunshan University, No.8 Duke Avenue, Kunshan, Jiangshu, China
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tavares Madede
- Faculty of Medicine, Department of Community Health, University Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Saara Parkkali
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Leonardo Chavane
- Faculty of Medicine, Department of Community Health, University Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Johanne Sundby
- Institute of Health and Society, University of Oslo, Olso, Norway
| | - Elina Hemminki
- National Institute for Health and Welfare (THL), Helsinki, Finland
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25
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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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26
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Mocumbi S, Hanson C, Högberg U, Boene H, von Dadelszen P, Bergström A, Munguambe K, Sevene E. Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment. Reprod Health 2017; 14:147. [PMID: 29126412 PMCID: PMC5681779 DOI: 10.1186/s12978-017-0408-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula is one of the most devastating consequences of unmet needs in obstetric services. Systematic reviews suggest that the pooled incidence of fistulae in community-based studies is 0.09 per 1000 recently pregnant women; however, as facility delivery is increasing, for the most part, in Africa, incidence of fistula should decrease. Few population-based studies on fistulae have been undertaken in Sub-Saharan Africa, including Mozambique. This study aimed to estimate the incidence of obstetric fistulae in recently delivered mothers, and to describe the clinical characteristics and care, as well as the outcome, after surgical repair. METHODS We selected women who had delivered up to 12 months before the start of the study (June, 1st 2016). They were part of a cohort of women of reproductive age (12-49 years), recruited from selected clusters in rural areas of Maputo and Gaza provinces, Southern Mozambique, who were participating in an intervention trial (the Community Level Interventions for Pre-eclampsia trial or CLIP trial). Case identification was completed by self-reported constant urine leakage and was confirmed by clinical assessment. Women who had confirmed obstetric fistulae were referred for surgical repair. Data were entered into a REDCap database and analysed using R software. RESULTS Five women with obstetric fistulae were detected among 4358 interviewed, giving an incidence of 1.1 per 1000 recently pregnant women (95% CI 2.16-0.14). All but one had Caesarean section and all of the babies died. Four were stillborn, and one died very soon after birth. All of the patients identified and reached the primary health facility in reasonable time. Delays occurred in the care: in diagnosis of obstructed labour, and in the decision to refer to the secondary or third-level hospital. All but one of the women were referred to surgical repair and the fistulae successfully closed. CONCLUSION This population-based study reports a high incidence of obstetric fistulae in an area with high numbers of facility births. Few first and second delays in reaching care, but many third delays in receiving care, were identified. This raises concerns for quality of care.
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Affiliation(s)
- Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Agostinho Neto 679, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Helena Boene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | | | - Anna Bergström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Public Health, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
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Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013. PLoS One 2017; 12:e0186563. [PMID: 29040316 PMCID: PMC5645133 DOI: 10.1371/journal.pone.0186563] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
Despite global efforts to improve maternal health, many developing countries including Pakistan have failed to achieve the target of a 75% reduction in maternal deaths by 2015. Addressing socioeconomic inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality rate. This study was done to examine the time trends and socioeconomic inequalities in the utilization of cesarean section (C-section) in Pakistan during 1990-2013. We used data from the Pakistan Demographic and Health Surveys (PDHS) conducted during 1990 to 2013. All these surveys are nationally representative surveys of ever-married women aged 15-49 years with a sample size of 6611, 10,023, and 13,558 women in 1990-1991, 2006-2007, and 2012-2013, respectively, with an overall response rate of over 90%. The unit of analysis for this study was women with their most recent live birth in the five years preceding the surveys. Bivariate analyses and multivariable logistic regression models were employed to investigate the prevalence of cesarean sections according to selected sociodemographic characteristics of women. C-section rates were found to have increased during this period, with an especially significant rise from 2.7% in 1990-1991 to 15.8% in 2012-2013 with lower utilization among the non-educated women (7.5%), compared with the women with higher education (40.3%). C-section rates ranged from 5.5% in the poorest women to 35.3% in the richest women. Only 11.5% of the rural women had a C-section compared to 25.6% of the urban women. A greater likelihood of having a cesarean section was observed in the richest, highly educated, and urban-living women while there was no significant difference observed in cesarean section rates between the private and public sectors in all three surveys. To improve maternal health, routine monitoring and evaluation of the provision of emergency obstetric services are needed to address the underuse of C-section in poor and rural areas and overuse in rich and urban areas.
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Kaboré C, Ridde V, Kouanda S, Agier I, Queuille L, Dumont A. Determinants of non-medically indicated cesarean deliveries in Burkina Faso. Int J Gynaecol Obstet 2017; 135 Suppl 1:S58-S63. [PMID: 27836086 DOI: 10.1016/j.ijgo.2016.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify the factors associated with non-medically indicated cesarean deliveries (NMIC) in Burkina Faso in centers where user fees for cesarean delivery were partially removed. METHODS We carried out a criteria-based audit in 22 referral hospitals, using data from a 6-month prospective observational study, to assess the proportion of NMIC. Multivariate logistic regression analyses were used to identify factors associated with NMIC. RESULTS The decision of cesarean delivery was not medically indicated in 24% of cases. The factors independently associated with NMIC were urban residence (adjusted OR 1.55; 95% CI, 1.12-2.12; P=0.006), spouse's occupation other than breeder or farmer (aOR varying from 1.77 [95% CI, 1.19-2.62] to 2.15 [95% CI, 1.38-3.32] according to the profession), and cesarean decided by a general practitioner (aOR 1.61; 95% CI, 1.13-2.30; P=0.009). CONCLUSION The high percentage of unnecessary cesarean deliveries is in contrast to the unmet needs of women who still deliver outside health facilities. NMIC is associated with both socioeconomic determinants and medical factors. Hence, interventions are needed to improve the skills of healthcare professionals and awareness of women concerning the risks associated with unnecessary cesarean delivery.
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Affiliation(s)
- Charles Kaboré
- Institute for Development Research, University Paris Descartes, UMR 216 MERIT, Paris, France; Research Institute of Health Sciences, Ouagadougou, Burkina Faso.
| | - Valéry Ridde
- Department of Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada; Public Health Research Institute, University of Montreal, Montreal, Canada
| | - Seni Kouanda
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Isabelle Agier
- Department of Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
| | - Ludovic Queuille
- Department of Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada; Public Health Research Institute, University of Montreal, Montreal, Canada
| | - Alexandre Dumont
- Institute for Development Research, University Paris Descartes, UMR 216 MERIT, Paris, France
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Wang L, Xu X, Baker P, Tong C, Zhang L, Qi H, Zhao Y. Patterns and Associated Factors of Caesarean Delivery Intention among Expectant Mothers in China: Implications from the Implementation of China's New National Two-Child Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070686. [PMID: 27399752 PMCID: PMC4962227 DOI: 10.3390/ijerph13070686] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/22/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study explores the basic demographic characteristics of expectant mothers in the context of their intentions regarding mode of delivery, in particular, the preference for caesarean delivery, and analyzes the social and psychological factors that influence delivery preference. METHOD A cross-sectional survey of pregnant women was conducted during June to August in 2015. This study adopted a stratified sampling method, and 16 representative hospitals in five provinces of China were included. RESULTS 1755 and 590 of expectant mothers in their first and second pregnancies, respectively, were enrolled in this study. 354 (15.10%) intended to deliver by caesarean section and 585 (24.95%) participants were uncertain prior to delivery. 156 (8.89%) of expectant mothers in their first pregnancy and 198 (33.56%) expectant mothers in their second pregnancy intended to deliver by caesarean section. Ordinal logistic regression analysis found that nationality, parity, trimester of pregnancy, and advanced maternal age were factors associated with intention to deliver by caesarean (ordered logistic regression/three-level caesarean delivery intention criterion; odds ratios p < 0.05). CONCLUSIONS 8.89% of first pregnancy expectant mothers and 33.56% of second pregnancy expectant mothers intended to deliver by caesarean section. Any intervention program to reduce the rate of Caesarean delivery should focus on the Han population, older pregnant women, and expectant mothers in their second pregnancy, at an early gestation.
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Affiliation(s)
- Lianlian Wang
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Department of Reproduction Health and Infertility, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Philip Baker
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
- College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester 3182, UK.
| | - Chao Tong
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100062, China.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3182, Australia.
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3053, Australia.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.
| | - Hongbo Qi
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing 400016, China.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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