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Habteyes AT, Mekuria MD, Negeri HA, Kassa RT, Deribe LK, Sendo EG. Prevalence and associated factors of caesarean section among mothers who gave birth across Eastern Africa countries: Systematic review and meta-analysis study. Heliyon 2024; 10:e32511. [PMID: 38952380 PMCID: PMC11215273 DOI: 10.1016/j.heliyon.2024.e32511] [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: 08/24/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
Background Caesarean section (CS) rate increased dramatically worldwide, exceeding the World Health Organization's benchmark (10-15 %) in many countries. This rate varies in different regions of the continent. Using various study designs, researchers from across East African countries investigated the prevalence of caesarean section and the factor associated with it but no study shows a pooled prevalence of caesarean section in the Eastern African region. Therefore, this review aimed to systematically summarize and estimate the pooled prevalence of caesarean section and its associated factors in Eastern Africa, 2023. Methods PubMed, Web of Science, EMBASE, Scopus and CINAHL were rigorously searched to find relevant studies. All identified observational studies reporting the prevalence of CS and its associated factors in East Africa published till August 2023 were considered. Heterogeneity across the studies was evaluated using the I2 test. Publication bias was assessed by funnel plot and Egger's regression test. Finally, a random effect meta-analysis model was computed to estimate the pooled prevalence of CS and qualitative analysis was employed for associated factors. The study protocol was registered in PROSPERO. Results This review was assessed using twenty-six eligible studies from a total of 2223 articles with a total of 600,431 participants. In this meta-analysis, the pooled prevalence of caesarean section in Eastern Africa was 24.0 % (95%CI: 22-27 %). The highest pooled prevalence of caesarean section was in Ethiopia, 28.30 % (95%CI; 21.3-35.2 %), and the lowest was seen in Uganda, 11.9 % (95%CI; 7.9-15.9 %). Urban residency, having high level of wealth asset, education level college and above, advanced maternal age, big birth weight, history of previous caesarean section, private institution delivery, multiple pregnancies, pregnancy-induced hypertension, antepartum haemorrhage and fetal malpresentation were linked with a greater likelihood of having CS. Conclusions and recommendation: The overall pooled prevalence of CS in Eastern Africa was high compared to the WHO proposed recommended range. Therefore, the finding implies that each East African countries Ministry of Health and health care professionals shall be given particular emphasis made on strengthening antenatal care services and ensure more women have access to skilled healthcare professionals during childbirth. This can help in providing appropriate interventions, support to women and reducing the need for emergency and unnecessary CSs. The result of this research are a baseline data for future researchers to conduct further studies to better understand the reasons behind the high rates and identify potential interventions and solutions specific to the African context.PROSPERO protocol number: CRD42023440131.
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Affiliation(s)
- Abrham Tesfaye Habteyes
- Department of Midwifery, College of Medicine & Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mihret Debebe Mekuria
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Haweni Adugna Negeri
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Roza Teshome Kassa
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leul Kitaw Deribe
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Endalew Gemechu Sendo
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Nakinobe FG, Lwanga C, Ojiambo Wandera S, Kalule-Sabiti I, Mangombe K. Caesarean delivery in Uganda: Do non-clinical factors explain the trend? J Biosoc Sci 2023; 55:980-993. [PMID: 36226659 DOI: 10.1017/s0021932022000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this paper was to assess the association between non-clinical factors and Caesarean delivery in Uganda. Self-reported data from the individual recode file were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a sub sample of 9929 women aged 15-49 with a recent birth in the last 5 years preceding the survey. Chi-square tests and multivariate comlementary log-log regression models were used to examine the relationship between non-clinical factors and Caesarean section delivery. About one in ten (7%) of the women aged 15-49 had Caesarean deliveries. Non-clinical factors which were significantly associated with Caesarean section delivery include advanced maternal age, having the first birth compared to subsequent births, having 1-3 children compared to 4 or more children, higher level of women's education relative to no education, being in the middle, richer, and richest wealth quintile compared to the poorest quintile. In conclusion, evidence suggests that the trend in Caesarean delivery can be attributed partially to non-clinical factors including advanced maternal age, birth order, parity, women's education level, and wealth quintile. Thus, efforts to address the trend in Caesarean section delivery, need to take account of non-clinical factors.
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Affiliation(s)
| | - Charles Lwanga
- Population Studies, School of Statistics and Planning, Makerere University, Uganda
| | | | - Ishmael Kalule-Sabiti
- Population Research and Training Unit, North-West University (Mafikeng Campus), South Africa
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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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Jean Simon D, Jean-Baptiste S, Nazaire R, Joseph G, Carmil JA, Joseph F, Kondo Tokpovi VC. Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey. Trop Med Health 2023; 51:21. [PMID: 37069696 PMCID: PMC10108480 DOI: 10.1186/s41182-023-00513-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. METHODS Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. RESULTS The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight. CONCLUSIONS While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.
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Affiliation(s)
- David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
| | | | - Roodjmie Nazaire
- Université d'Etat d'Haïti (UEH), Faculté de Médecine et de Pharmacie (FMP), Port-au-Prince, Haiti
| | - Ghislaine Joseph
- Centre de Recherche Cultures Arts Sociétés (CELAT), University of Laval, Quebec City, Canada
| | | | - Fanor Joseph
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
- University of Antananarivo, Doctoral School of Social and Human Sciences, Antananarivo, Madagascar
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Rahman M, Haque SE, Islam MJ, Chau NH, Adam IF, Haque MN. The double burden of maternal overweight and short stature and the likelihood of cesarean deliveries in South Asia: An analysis of national datasets from Bangladesh, India, Maldives, Nepal, and Pakistan. Birth 2022; 49:661-674. [PMID: 35352380 DOI: 10.1111/birt.12632] [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: 07/19/2020] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim was to investigate: (a) whether there is an association between the maternal double burden of overweight and short stature and the risk of cesarean delivery and (b) whether socioeconomic status (SES) acts as a moderator in the association between the maternal double burden of overweight and short stature and the risk of cesarean birth (CB). MATERIALS AND METHODS The data for this study were obtained from the nationally representative Demographic and Health Survey databases of five South Asian countries. The analyses were based on responses from married women between 15 and 49 years of age. The risk of CB was the primary outcome, while the maternal double burden of overweight and short stature (coexistence of overweight and short stature) was the exposure of interest. RESULTS Maternal double burden of overweight and short stature was significantly associated with 179% higher likelihood of undergoing CB in South Asia (SA), with 304%, 200%, 167%, 155%, and 125% higher likelihood of undergoing CB in Nepal, Pakistan, India, Maldives, and Bangladesh, respectively. Findings also demonstrated that mothers belonging to low SES groups with a double overweight and short stature burden were not uniquely disadvantaged. CONCLUSIONS A significant marker in SA of higher risk of CB is the maternal double burden of overweight and short stature. The negative effect of the maternal double burden of overweight and short stature extends across all economic backgrounds in relation to the risk of CB. It is not limited to poor mothers who suffer from the double burden of overweight and short stature.
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Affiliation(s)
- Mosiur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Syed Emdadul Haque
- Department of Research and Training, UChicago Research Bangladesh, Dhaka, Bangladesh
| | - Md Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, Queensland, Australia.,Skills for Employment Investment Program, Ministry of Finance, Dhaka, Bangladesh
| | - Nguyen Huu Chau
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | | | - Md Nuruzzaman Haque
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Ahinkorah BO, Aboagye RG, Seidu AA, Okyere J, Mohammed A, Chattu VK, Budu E, Adoboi F, Yaya S. Rural–urban disparities in caesarean deliveries in sub-Saharan Africa: a multivariate non-linear decomposition modelling of Demographic and Health Survey data. BMC Pregnancy Childbirth 2022; 22:709. [PMID: 36115842 PMCID: PMC9482294 DOI: 10.1186/s12884-022-04992-6] [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: 11/15/2021] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Globally, the rate of caesarean deliveries increased from approximately 16.0 million in 2000 to 29.7 million in 2015. In this study, we decomposed the rural–urban disparities in caesarean deliveries in sub-Saharan Africa. Methods Data for the study were extracted from the most recent Demographic and Health Surveys of twenty-eight countries in sub-Saharan Africa. We included 160,502 women who had delivered in health facilities within the five years preceding the survey. A multivariate non-linear decomposition model was employed to decompose the rural–urban disparities in caesarean deliveries. The results were presented using coefficients and percentages. Results The pooled prevalence of caesarean deliveries in the 28 countries considered in the study was 6.04% (95% CI = 5.21–6.88). Caesarean deliveries' prevalence was highest in Namibia (16.05%; 95% CI = 14.06–18.04) and lowest in Chad (1.32%; 95% CI = 0.91–1.73). For rural-urban disparities in caesarean delivery, the pooled prevalence of caesarean delivery was higher in urban areas (10.37%; 95% CI = 8.99–11.75) than rural areas (3.78%; 95% CI = 3.17-4.39) across the 28 countries. Approximately 81% of the rural–urban disparities in caesarean deliveries were attributable to the differences in child and maternal characteristics. Hence, if the child and maternal characteristics were levelled, more than half of the rural–urban inequality in caesarean deliveries would be reduced. Wealth index (39.2%), antenatal care attendance (13.4%), parity (12.8%), mother’s educational level (3.5%), and health insurance subscription (3.1%) explained approximately 72% of the rural–urban disparities in caesarean deliveries. Conclusion This study shows significant rural–urban disparities in caesarean deliveries, with the disparities being attributable to the differences in child and maternal characteristics: wealth index, parity, antenatal care attendance, mother’s educational level, and health insurance subscription. Policymakers in the included countries could focus and work on improving the socioeconomic status of rural-dwelling women as well as encouraging antenatal care attendance, women's education, health insurance subscription, and family planning, particularly in rural areas.
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7
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Kibe PM, Mbuthia GW, Shikuku DN, Akoth C, Oguta JO, Ng'ang'a L, Gatimu SM. Prevalence and factors associated with caesarean section in Rwanda: a trend analysis of Rwanda demographic and health survey 2000 to 2019-20. BMC Pregnancy Childbirth 2022; 22:410. [PMID: 35578320 PMCID: PMC9112592 DOI: 10.1186/s12884-022-04679-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades. METHODS We used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019-20. All births in the preceding 3 years to the survey were assessed for the mode of delivery. The participants' characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys. RESULTS The population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8-2.6) in 2000 to 15.6% (95% CI 13.9-16.5) in 2019-20. Despite increasing in all health facilities over time, the rate of CS was about four times higher in private (60.6%) compared to public health facilities (15.4%) in 2019-20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies. CONCLUSION Over the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.
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Affiliation(s)
- Peter M Kibe
- African Population and Health Research Centre, Nairobi, Kenya.
| | - Grace Wambura Mbuthia
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Catherine Akoth
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - James Odhiambo Oguta
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Health Section, UNICEF, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Samwel Maina Gatimu
- Department of Economics, Population and Development Studies, University of Nairobi, Nairobi, Kenya.,Diabetic Foot Foundation Kenya, Nairobi, Kenya
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8
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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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Habib M, Adegnika AA, Honkpehedji J, Klug SJ, Lobmaier S, Vogg K, Bustinduy AL, Ullrich A, Reinhard-Rupp J, Esen M, Prazeres da Costa C. The challenges for women's health in sub-Saharan Africa: Lessons learned from an integrative multistakeholder workshop in Gabon. J Glob Health 2021; 11:02002. [PMID: 34552713 PMCID: PMC8442509 DOI: 10.7189/jogh.11.02002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marrium Habib
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich (TUM), Munich, Germany.,Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Ayola Akim Adegnika
- Institute for Tropical Medicine (ITM), University Clinic Tübingen, (UKT), Tübingen, Germany.,Centre de Réchèrches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Josiane Honkpehedji
- Centre de Réchèrches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,German Center for Infection Research (DZIF), Tübingen, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich (TUM), Munich, Germany
| | - Silvia Lobmaier
- Clinic and Polyclinic for Gynecology, University Hospital, Klinikum Rechts der Isar (MRI), Technical University Munich (TUM), Munich, Germany
| | - Kathrin Vogg
- Clinic and Polyclinic for Gynecology, University Hospital, Klinikum Rechts der Isar (MRI), Technical University Munich (TUM), Munich, Germany
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | | | | | - Meral Esen
- Institute for Tropical Medicine (ITM), University Clinic Tübingen, (UKT), Tübingen, Germany.,Centre de Réchèrches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,German Center for Infection Research (DZIF), Tübingen, Germany
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich (TUM), Munich, Germany.,Center for Global Health, TUM School of Medicine, Technical University of Munich (TUM), Munich, Germany.,German Center for Infection Research (DZIF), Tübingen, Germany
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10
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Koffi AK, Kalter HD, Kamwe MA, Black RE. Verbal/social autopsy analysis of causes and determinants of under-5 mortality in Tanzania from 2010 to 2016. J Glob Health 2021; 10:020901. [PMID: 33274067 PMCID: PMC7699006 DOI: 10.7189/jogh.10.020901] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Tanzania has decreased its child mortality rate by more than 70 percent in the last three decades and is striving to develop a nationally-representative sample registration system with verbal autopsy to help focus health policies and programs toward further reduction. As an interim measure, a verbal and social autopsy study was conducted to provide vital information on the causes and social determinants of neonatal and child deaths. Methods Causes of neonatal and 1-59 month-old deaths identified by the 2015-16 Tanzania Demographic and Health Survey were assessed using the expert algorithm verbal autopsy method. The social autopsy examined prevalence of key household, community and health system indicators of preventive and curative care provided along the continuum of care and Pathway to Survival models. Careseeking for neonates and 1-59 month-olds was compared, and tests of associations of age and cause of death to careseeking indicators and place of death were conducted. Results The most common causes of death of 228 neonates and 351 1-59 month-olds, respectively, were severe infection, intrapartum related events and preterm delivery, and pneumonia, diarrhea and malaria. Coverage of early initiation of breastfeeding (24%), hygienic cord care (29%), and full immunization of 12-59 month-olds (33%) was problematic. Most (88.8%) neonates died in the first week, including 44.3% in their birth facility before leaving. Formal care was sought for just 41.9% of newborns whose illness started at home and was delayed by 5.3 days for 1-59 month-olds who sought informal care. Care was less likely to be sought for the youngest neonates and infants and severely ill children. Although 70.3% of 233 under-5 year-olds were moderately or severely ill on discharge from their first provider, only 29.0%-31.2% were referred. Conclusions The study highlights needed actions to complete Tanzania’s child survival agenda. Low levels of some preventive interventions need to be addressed. The high rate of facility births and neonatal deaths requires strengthening of institutionally-based interventions targeting maternal labor and delivery complications and neonatal causes of death. Scale-up of Integrated Community Case Management should be considered to strengthen careseeking for the youngest newborns, infants and severely ill children and referral practices at first level facilities.
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Affiliation(s)
- Alain K Koffi
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Henry D Kalter
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Robert E Black
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Liu M, Xue M, Yang Q, Du W, Yan X, Tan J, Duan T, Hua J. Association between migration status and caesarean section delivery based on a modified Robson classification in China. BMC Pregnancy Childbirth 2021; 21:215. [PMID: 33731060 PMCID: PMC7971954 DOI: 10.1186/s12884-021-03708-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/10/2021] [Indexed: 11/11/2022] Open
Abstract
Background China has one of the highest caesarean section (C-Section) rates in the world. In recent years, China has been experiencing a massive flow of migration due to rapid urbanization. In this study, we aimed to differentiate the rates of C-Section between migrants and residents, and explore any possible factors which may moderate the association between migrant status and C-Section rates. Methods We conducted a retrospective cohort study in Shanghai, China. All deliveries were classified using the modified Robson Classification. The association between women’s migrant status and C-Section rates was assessed using the Poisson regression of sandwich estimation, after adjusting for possible factors. Results Of the 40,621 women included in the study, 66.9% were residents and 33.1% were internal migrants. The rate of C-Section in migrants was lower than that of residents in all subjects (39.9 and 47.7%) and in group 1 subjects (based on the Robson Classification) using a modified Robson Classification. There was an association between migrant status and caesarean delivery on maternal request that was statistically significant (RR = 0.664, p < 0.001), but the association was weakened after adjusting for such factors as maternal age at delivery (aRR = 0.774, p = 0.02), ethnicity (aRR = 0.753, p < 0.001), health insurance (aRR = 0.755, p < 0.001), and occupation (aRR = 0.747, p = 0.004), but had no significant changes when adjusting for health conditions (aRR = 0.668, p = 0.001) and all considering variables (aRR = 0.697, p = 0.002). In group 1 subjects, the effect of migrant status on maternal requested intrapartum C-Section was also statistically significant (RR = 0.742, p = 0.004). Conclusion C-Section rates are lower among migrant women than residents, especially on maternal request. The medical practitioners should further reinforce the management of elective C-Section in resident women. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03708-6.
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Affiliation(s)
- Ming Liu
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China.,The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Mengqi Xue
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China
| | - Qing Yang
- Songjiang Maternity & Child Health Hospital of Shanghai, Shanghai, 200042, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Xiaoling Yan
- The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Jing Tan
- The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Tao Duan
- The Obstetrical Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, P.O. 536 Changle Road, Shanghai, 200042, China
| | - Jing Hua
- The Women and Children's Health Care Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200000, China.
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12
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Bhandari AKC, Dhungel B, Rahman M. Trends and correlates of cesarean section rates over two decades in Nepal. BMC Pregnancy Childbirth 2020; 20:763. [PMID: 33298004 PMCID: PMC7724849 DOI: 10.1186/s12884-020-03453-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. METHODS We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. RESULTS We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6-1.2) %] to 10.2% in 2016 [95% CI: (8.9-11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3-12.9) %] to 16.4% in 2016 [95% CI: (14.5-18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8-16.0) %] vs. 26.3% in 2016[95% CI: (21.9-31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83-7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. CONCLUSION Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.
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Affiliation(s)
- Aliza K. C. Bhandari
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
| | - Bibha Dhungel
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
| | - Mahbubur Rahman
- St. Luke’s International University Graduate School of Public Health, Tokyo, Japan
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13
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Armstrong-Mensah E, Ruiz K, Fofana A, Hawley V. Perinatal HIV Transmission Prevention: Challenges among Women Living with HIV in sub-Saharan Africa. Int J MCH AIDS 2020; 9:354-359. [PMID: 32832201 PMCID: PMC7433295 DOI: 10.21106/ijma.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing.
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Affiliation(s)
| | - Krystal Ruiz
- Georgia State University, School of Public Health, Atlanta, Georgia 30303
| | - Aminata Fofana
- Georgia State University, School of Public Health, Atlanta, Georgia 30303
| | - Victoria Hawley
- Georgia State University, School of Public Health, Atlanta, Georgia 30303
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14
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Tognon F, Borghero A, Putoto G, Maziku D, Torelli GF, Azzimonti G, Betran AP. Analysis of caesarean section and neonatal outcome using the Robson classification in a rural district hospital in Tanzania: an observational retrospective study. BMJ Open 2019; 9:e033348. [PMID: 31822545 PMCID: PMC6924846 DOI: 10.1136/bmjopen-2019-033348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Caesarean section (CS) rates have increased worldwide in recent decades. In 2015, the WHO proposed the use of the 10-group Robson classification as a global standard for assessing, monitoring and comparing CS rates both within healthcare facilities over time and between them. The aim of this study was to assess the pattern of CS rates according to the Robson classification and describe maternal and perinatal outcomes by group at the Tosamaganga Hospital in rural Tanzania. DESIGN Observational retrospective study. SETTING St. John of the Cross Tosamaganga Hospital, a referral centre in rural Tanzania. PARTICIPANTS 3012 women who gave birth in Tosamaganga Hospital from 1 January to 30 June 2014 and from 1 March to 30 November 2015. RESULTS The overall CS rate was 35.2%, and about 90% of women admitted for labour were in Robson groups 1 through 5. More than 40% of the CS carried out in the hospital were performed on nulliparous women at term with a single fetus in cephalic presentation (groups 1 and 3), and the most frequent indication for the procedure was previous uterine scar (39.2%). The majority of severe neonatal outcomes were observed in groups 1 (27.7%), 10 (24.5%) and 3 (19.1%). CONCLUSION We recorded a high CS rate in Tosamaganga Hospital, particularly in low-risk patients groups (Robson groups 1 and 3). Our analysis of Robson classification and neonatal outcomes suggests the need to improve labour management at the hospital and to provide timely referrals in order to prevent women from arriving there in critical conditions.
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Affiliation(s)
- Francesca Tognon
- Dipartimento di Salute della Donna e del Bambino, Universita degli Studi di Padova Dipartimento di Medicina, Padova, Italy
- Research Unit, Cuamm Medici con l'Africa, Padova, Veneto, Italy
| | - Angela Borghero
- Tosamaganga Council Designated Hospital, Cuamm Medici con l'Africa, Iringa, United Republic of Tanzania
| | - Giovanni Putoto
- Research Unit, Cuamm Medici con l'Africa, Padova, Veneto, Italy
| | - Donald Maziku
- Maternity Department, Tosamaganga Council Designated Hospital, Iringa, United Republic of Tanzania
| | - Giovanni Fernando Torelli
- Tosamaganga Council Designated Hospital, Cuamm Medici con l'Africa, Iringa, United Republic of Tanzania
| | - Gaetano Azzimonti
- Tosamaganga Council Designated Hospital, Cuamm Medici con l'Africa, Iringa, United Republic of Tanzania
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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15
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Ogbo FA, Ezeh OK, Awosemo AO, Ifegwu IK, Tan L, Jessa E, Charwe D, Agho KE. Determinants of trends in neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016. BMC Public Health 2019; 19:1243. [PMID: 31500599 PMCID: PMC6734430 DOI: 10.1186/s12889-019-7547-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 08/26/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Under-five mortality is still a major health issue in many developing countries like Tanzania. To achieve the Sustainable Development Goal target of ending preventable child deaths in Tanzania, a detailed understanding of the risk factors for under-five deaths is essential to guide targeted interventions. This study aimed to investigate trends and determinants of neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016. METHODS The study used combined data from the 2004-2005, 2010 and 2015-2016 Tanzania Demographic and Health Surveys, with a sample of 25,951 singletons live births and 1585 under-five deaths. We calculated age-specific mortality rates, followed by an assessment of trends and determinants (community, socioeconomic, individual and health service) of neonatal, postneonatal, infant, child and under-five mortalities in Cox regression models. The models adjusted for potential confounders, clustering and sampling weights. RESULTS Between 2004 and 2016, we found that neonatal mortality rate remained unchanged, while postneonatal mortality and child mortality rates have halved in Tanzania. Infant mortality and under-five mortality rates have also declined. Mothers who gave births through caesarean section, younger mothers (< 20 years), mothers who perceived their babies to be small or very small and those with fourth or higher birth rank and a short preceding birth interval (≤2 years) reported higher risk of neonatal, postneonatal and infant mortalities. CONCLUSION Our study suggests that there was increased survival of children under-5 years in Tanzania driven by significant improvements in postneonatal, infant and child survival rates. However, there remains unfinished work in ending preventable child deaths in Tanzania.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751 Australia
- General Practice Unit, Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Osita Kingsley Ezeh
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Akorede O. Awosemo
- General Practice Unit, Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Ifegwu K. Ifegwu
- General Practice Unit, Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Lawrence Tan
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, NSW 2751 Australia
| | - Emmanuel Jessa
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, NSW 2751 Australia
| | - Deborah Charwe
- Tanzania Food and Nutrition Centre, No 22. Ocean Road, Dar es Salaam, Tanzania
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751 Australia
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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16
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Adewuyi EO, Auta A, Khanal V, Tapshak SJ, Zhao Y. Cesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study. BMJ Open 2019; 9:e027273. [PMID: 31213450 PMCID: PMC6596937 DOI: 10.1136/bmjopen-2018-027273] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the prevalence and factors associated with caesarean delivery in Nigeria. DESIGN This is a secondary analysis of the nationally representative 2013 Nigeria Demographic and Health Survey (NDHS) data. We carried out frequency tabulation, χ2 test, simple logistic regression and multivariable binary logistic regression analyses to achieve the study objective. SETTING Nigeria. PARTICIPANTS A total of 31 171 most recent live deliveries for women aged 15-49 years (mother-child pair) in the 5 years preceding the 2013 NDHS was included in this study. OUTCOME MEASURE Caesarean mode of delivery. RESULTS The prevalence of caesarean section (CS) was 2.1% (95% CI 1.8 to 2.3) in Nigeria. At the region level, the South-West had the highest prevalence of 4.7%. Factors associated with increased odds of CS were urban residence (adjusted OR (AOR): 1.51, 95% CI 1.15 to 1.97), maternal age ≥35 years (AOR: 2.12, 95% CI 1.08 to 4.11), large birth size (AOR: 1.39, 95% CI 1.10 to 1.74) and multiple births (AOR: 4.96, 95% CI 2.84 to 8.62). Greater odds of CS were equally associated with maternal obesity (AOR: 3.16, 95% CI 2.30 to 4.32), Christianity (AOR: 2.06, 95% CI 1.58 to 2.68), birth order of one (AOR: 3.86, 95% CI 2.66 to 5.56), husband's secondary/higher education level (AOR: 2.07, 95% CI 1.29 to 3.33), health insurance coverage (AOR: 2.01, 95% CI 1.37 to 2.95) and ≥4 antenatal visits (AOR: 2.84, 95% CI 1.56 to 5.17). CONCLUSIONS The prevalence of CS was low, indicating unmet needs in the use of caesarean delivery in Nigeria. Rural-urban, regional and socioeconomic differences were observed, suggesting inequitable access to the obstetric surgery. Intervention efforts need to prioritise women living in rural areas, the North-East and the North-West regions, as well as women of the Islamic faith.
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Affiliation(s)
- Emmanuel O Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Pharmacy Department, 2 Division Hospital, Ibadan, Oyo State, Nigeria
| | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | | | - Samson J Tapshak
- Department of Obstetrics and Gynaecology, Chivar Specialist Hospital, and Urology Centre Ltd, Abuja, Nigeria
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Western Australia, Australia
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Abbas F, Amir-Ud-Din R. Correlates of C-section in Punjab: a disaggregated analysis at the level of rural-urban residential status and place of delivery. Women Health 2019; 59:997-1014. [PMID: 30894083 DOI: 10.1080/03630242.2019.1587663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The World Health Organization-recommended rate of delivery by Caesarean section (C-Section) is 10-15% of all live births, but in Punjab, the largest province of Pakistan, this rate was 23% in 2014. The perception is that an inadequate public health sector forces women toward the private sector where C-Section is routinely conducted without valid medical reasons, posing risks to women's health and incurring catastrophic out-of-pocket expenditures. This study identified the correlates of C-section delivery and whether they differed by the urban/rural residence of women and place of delivery (public vs. private). Using multivariate logistic regression analyses of data from the Multiple Indicators Cluster Survey (MICS) collected from June-October, 2014 for all women who gave birth in the prior two years (N = 10,558), we found that rich women were statistically no different from poor women in their odds of delivery by C-section in the generally more expensive private health facilities (adjusted odds ratio [aOR] 1.23; 95% confidence interval [CI] 0.88-1.71); rich women were more likely to deliver by C-section in the less expensive public health facilities (aOR 2.03; 95% CI 1.13-3.63). This paradox may reflect the inefficiency of the health system and suggests limited affordable alternatives for poor women in the public sector.
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Affiliation(s)
- Faisal Abbas
- Center for Poverty, Equity and Growth in developing and transition countries, George August University , Goettingen , Germany
| | - Rafi Amir-Ud-Din
- Department of Economics, COMSATS University Islamabad , Lahore , Pakistan
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18
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Hoxha I, Braha M, Syrogiannouli L, Goodman DC, Jüni P. Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open 2019; 9:e025356. [PMID: 30833323 PMCID: PMC6443081 DOI: 10.1136/bmjopen-2018-025356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/14/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women. RESULTS 12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ2=0.01); and 0.92 times lower odds for CS in uninsured as compared with publicly insured women (95% CI 0.80 to 1.07), with no relevant heterogeneity between studies (τ2=0.02). We found 0.70 times lower odds in uninsured as compared with privately and publicly insured women (95% CI 0.69 to 0.72). CONCLUSIONS CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
| | - Medina Braha
- International Business College Mitrovica, Mitrovica, Kosovo
| | | | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Hanson C, Betrán AP, Opondo C, Mkumbo E, Manzi F, Mbaruku G, Schellenberg J. Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population‐based surveys in a low‐resource setting. BJOG 2018; 126:690-700. [DOI: 10.1111/1471-0528.15534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- C Hanson
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
- Department of Disease Control London School of Hygiene and Tropical Medicine London UK
| | - AP Betrán
- Department of Reproductive Health and Research UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction World Health Organization Geneva Switzerland
| | - C Opondo
- Department of Disease Control London School of Hygiene and Tropical Medicine London UK
| | - E Mkumbo
- Ifakara Health Institute Dar‐es‐Salaam Tanzania
| | - F Manzi
- Ifakara Health Institute Dar‐es‐Salaam Tanzania
| | - G Mbaruku
- Ifakara Health Institute Dar‐es‐Salaam Tanzania
| | - J Schellenberg
- Department of Disease Control London School of Hygiene and Tropical Medicine London UK
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Manyeh AK, Amu A, Akpakli DE, Williams J, Gyapong M. Socioeconomic and demographic factors associated with caesarean section delivery in Southern Ghana: evidence from INDEPTH Network member site. BMC Pregnancy Childbirth 2018; 18:405. [PMID: 30326869 PMCID: PMC6191905 DOI: 10.1186/s12884-018-2039-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/03/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In recent years, caesarean section rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate caesarean section rate and the associated short- and long-term risks. This study sought to identify the rate of caesarean section and associated factors in two districts in rural southern Ghana. METHODS Pregnancy, birth, and socio-demographic information of 4948 women who gave birth between 2011 and 2013 were obtained from the database of Dodowa Health and Demographic Surveillance System. The rate of C-section was determined and the associations between independent and dependent variables were explored using logistic regression. The analyses were done in STATA 14.2 at 95% confidence interval. RESULTS The overall C-section rate for the study period was 6.59%. Women aged 30-34 years were more than twice likely to have C-section compared to those < 20 year (OR: 2.16, 95% CI: 1.20-3.90). However, women aged 34 years and above were more than thrice likely to undergo C-section compared to those < 20 year (OR: 3.73, 95% CI: 1.45-5.17). The odds of having C-section was 65 and 79% higher for participants with Primary and Junior High level schooling respectively (OR: 1.65, 95% CI: 1.08-2.51, OR:1.79, 95%CI: 1.19-2.70). The likelihood of having C-section delivery reduced by 60, 37, and 35% for women with parities 2, 3 and 3+ respectively (OR:0.60, 95% CI: 0.43-0.83, OR: 0.37, 95% CI: 0.25-0.56, OR:0.35, 95% CI: 0.25-0.54). There were increased odds of 36, 52, 83% for women who belong to poorer, middle, and richer wealth quintiles respectively (OR: 1.36, 95%CI: 0.85-2.18, OR: 1.52, 95% CI: 0.97-2.37, OR: 1.83, 95% CI: 1.20-2.80). Participants who belonged to the richest wealth quintile were more than 2 times more likely to have C-section delivery (OR: 2.14, 95%CI: 1.43-3.20). The odds of having C-section delivery reduced by 76% for women from Ningo-Prampram district (OR: 0.76, 95% CI: 0.59.0.96). Women whose household heads have Junior High level and above of education were 45% more likely to have C-section delivery (OR: 1.45, 95% CI: 1.09-1.93). CONCLUSION Age of mother, educational level, parity, household socioeconomic status, district of residence, and level of education of household head are associated with caesarean section delivery.
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Affiliation(s)
- Alfred Kwesi Manyeh
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Alberta Amu
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Ghana Health Service, Accra, Ghana
| | - David Etsey Akpakli
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Ghana Health Service, Accra, Ghana
| | - John Williams
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Ghana Health Service, Accra, Ghana
| | - Margarete Gyapong
- Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra Ghana
- Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Volta Region, Ho, Ghana
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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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Amjad A, Amjad U, Zakar R, Usman A, Zakar MZ, Fischer F. Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the Demographic and Health Survey, 2012-13. BMC Pregnancy Childbirth 2018; 18:113. [PMID: 29685129 PMCID: PMC5914047 DOI: 10.1186/s12884-018-1743-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing rate of caesarean deliveries has become a serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Pakistan as well. Therefore, there is a need to investigate the factors behind this increase. This study aims to assess the determinants associated with caesarean deliveries among child-bearing women aged 15-49 years in Pakistan. METHODS Secondary data analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2012-2013. The analysis was limited to mothers aged 15-49 years, who had given birth to at least one child during the 5 years immediately preceding the survey (n = 7461). Maternal socio-demographic characteristics and pregnancy-related variables, including antenatal care utilisation, place of delivery and pregnancy complications were considered as independent variables. The association between caesarean section deliveries (outcome variable) and its determinants was assessed by calculating unadjusted and adjusted odds ratios with 95% confidence intervals using a multivariable binary logistic regression. RESULTS Of the women who had given birth to at least one child during the previous 5 years, the percentage of mothers who delivered their babies through caesarean section was found to be 13.6%. The likelihood of caesarean deliveries was associated with mothers aged more than 24 years, women residing in Punjab province, women belonging to the richest class, women with higher education, women employed at professional/managerial/technical level, and women residing in an urban setting. Additionally, the women who had pregnancy complications, a high utilisation of antenatal care and delivered their babies in private hospitals were found to have higher chances of caesarean deliveries. CONCLUSIONS The study revealed that there are a high percentage of women delivering babies through caesarean section in Pakistan. Therefore, strict measures need to be taken to deal with this concern. For example, detailed medical justifications by doctors for performing caesarean sections and awareness among women regarding the reduction of pregnancy complications can help to reduce the chances of malpractice related to caesarean deliveries.
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Affiliation(s)
- Aaisha Amjad
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Uzair Amjad
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Ahmed Usman
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
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Apanga PA, Awoonor-Williams JK. Predictors of caesarean section in Northern Ghana: a case-control study. Pan Afr Med J 2018; 29:20. [PMID: 29662605 PMCID: PMC5899779 DOI: 10.11604/pamj.2018.29.20.13917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Caesarean section rates have become a global public health. This study investigated obstetric and socio-demographic factors associated with caesarean section in northern Ghana. Methods This was a case-control study comparing 150 women who had caesarean section (cases) and 300 women who had vaginal delivery (controls). Data were collected retrospectively from delivery registers, postpartum and postnatal registers in the Bolgatanga Regional Hospital. Univariate and multivariate analysis of data were done using SPSS 22. Results The study revealed that women who had higher odds of having a caesarean section were women who; attended Antenatal care (ANC) ≥ 4 times (Adjusted OR= 2.99, 95% CI1.762-5.065), were referred from other health facilities (Adjusted OR = 1.19, 95% CI 1.108-1.337) and had a foetal weight of ≥ 4000 grams (Adjusted OR = 1.21, 95% CI 1.064-1.657). There was a slight increase in odds of having a caesarean section among women who had a gestational age > 40 weeks (Adjusted OR = 1.09, 95% CI 1.029-1.281). Women who had secondary/higher education (Adjusted OR = 0.55, 95% CI 0.320-0.941), gestational age < 37 weeks (Adjusted OR = 0.20, 95% CI: 0.100-0.412) and women who had a foetal weight of 1500 grams to 2499 grams (Adjusted OR = 0.17, 95% CI 0.086-0.339) were associated with a lower odds of having a caesarean section. Conclusion There was an increase in odds of having a caesarean section among pregnant women who had a foetal weight of ≥ 4000 grams and women who attended ANC ≥ 4 times. Pregnant women who were referred also had increase odds of having a caesarean section.
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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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25
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Mathias VA, Holroyd E, Edwards G. Tanzanian Mothers' Cultural Beliefs and Misinformation Regarding the Reasons for Their Cesarean Sections. INTERNATIONAL JOURNAL OF CHILDBIRTH 2018. [DOI: 10.1891/2156-5287.8.3.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDIn Tanzania, cesarean section (CS) rates have been steadily increasing, yet little is known about mothers' understanding of the medical rationale for their CSs.AIMTo identify mothers' cultural understandings of the rationale for their CSs.METHODSDesign: A qualitative descriptive design was employed.Setting: A government hospital in the western region in Tanzania.Participants: A total of 117 mothers were interviewed using convenience sampling post CS.FINDINGSForty percent of the mothers were younger than 18 years, with more than 50% having had five or more live babies. Among multigravida women, 40.2% had had one or more previous CSs.The emergent themes were lack of dietary knowledge, use of local herbs, delays in coming to hospital, avoiding stressful labor pains and no ability to exercise, and no personal preferences of “push or go for an operation.”CONCLUSIONPregnant women in Tanzania need improved health education to make informed choices about childbirth and be involved all processes of antepartum care decision making to achieve optimal birth outcomes.
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Vissoci JRN, Shogilev DJ, Krebs E, de Andrade L, Vieira IF, Toomey N, Batilana AP, Haglund M, Staton CA. Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies. TRAFFIC INJURY PREVENTION 2017; 18:767-773. [PMID: 28448753 PMCID: PMC6350910 DOI: 10.1080/15389588.2017.1314470] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate, through a systematic review of hospital-based studies, the proportion of road traffic injuries and fatalities in sub-Saharan Africa (SSA). METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology guidelines, we searched the following electronic databases: PubMed, Embase, Africa-Wide Information, Global Health, and Web of Science. Articles were eligible if they measured proportion of road traffic injuries (RTIs) in SSA by using hospital-based studies. In addition, a reference and citation analysis was conducted as well as a data quality assessment. RESULTS Up to 2015, there were a total of 83 hospital-based epidemiologic studies, including 310,660 trauma patients and 99,751 RTI cases, in 13 SSA countries. The median proportion of RTIs among trauma patients was 32% (4 to 91%), of which the median proportion of death for the included articles was 5% (0.3 to 41%). CONCLUSION The number of studies evaluating RTI proportions and fatalities in SSA countries is increasing but without the exponential rise expected from World Health Organization calls for research during the Decade of Action for Road Traffic Injuries. Further research infrastructure including standardization of taxonomy, definitions, and data reporting measures, as well as funding, would allow for improved cross-country comparisons.
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Affiliation(s)
- João Ricardo N. Vissoci
- Division of Emergency Medicine, Department of Surgery, Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University, Durham USA,
| | | | | | | | | | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, USA,
| | | | - Michael Haglund
- Duke School of Medicine, Duke Global Health Institute, Duke University, Durham USA,
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Rebnord T, Østbye T, Mmbaga BT, Mchome B, Lie RT, Daltveit AK. Time trends in management of HIV-positive pregnant women in Northern Tanzania: A registry-based study. PLoS One 2017; 12:e0184362. [PMID: 28957345 PMCID: PMC5619723 DOI: 10.1371/journal.pone.0184362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/22/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To examine time trends in antenatal factors and delivery characteristics in Northern Tanzania, and relate these to national guidelines for HIV in pregnancy. Design Registry-based study. Setting Northern Tanzania, 2000–2014. Population or sample Deliveries (n = 33 346). Methods HIV-positive women were compared with HIV-negative women during four periods spanning changing national guidelines. Main outcome measures Known maternal HIV status, HIV treatment for woman, number of antenatal care (ANC) visits, routine folate/iron in pregnancy, anemia, delivery complications/interventions. Results We observed an increase in deliveries with known maternal HIV status and women receiving HIV treatment, and a decline in deliveries with positive maternal HIV status (p-values for trend <0.001). The proportion of women with less than four ANC visits increased to above 30 percent irrespective of HIV status. Use of routine folate/iron increased, corresponding to a decrease in anemia which was strongest in HIV-negative women. Incidence of elective caesarean section (CS) and emergency CS remained unchanged for HIV-positive women (7.1% and 25.5%, respectively, in the last period). Use of invasive procedures declined in both groups of women. Mothers who were young, single, had low education, high parity or lived in the rural area more often had indicators of poor antenatal care. Conclusions Increasing adherence to national guidelines over time was found for most selected outcomes. Still, a high occurrence of insufficient ANC, anemia and emergency CS call for efforts to explore and identify barriers that hinder optimal care.
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Affiliation(s)
- Tormod Rebnord
- Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- * E-mail:
| | - Truls Østbye
- Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Duke University, Durham, North Carolina, United States of America
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Bariki Mchome
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rolv Terje Lie
- Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
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Harrison MS, Goldenberg RL. Cesarean section in sub-Saharan Africa. Matern Health Neonatol Perinatol 2016; 2:6. [PMID: 27398224 PMCID: PMC4937522 DOI: 10.1186/s40748-016-0033-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/17/2016] [Indexed: 12/24/2022] Open
Abstract
Cesarean section is an essential maternal healthcare service. Its role in labor and delivery care in low- and middle-income countries is complex; in many low-resource settings it is underutilized in the most needy of populations and overused by the less needy, without clear methods to ensure that universal access is available. Additionally, even if universal access were available, it is not evident that these countries would have the capacity or the finances to appropriate meet demand for the procedure, or that patients would want to utilize the care. This review summarizes the literature and illustrates the complicated relationship that cesarean section, which is rapidly on the rise around the world, has with individuals, communities, and nations in sub-Saharan Africa.
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Affiliation(s)
- Margo S Harrison
- Columbia University Medical Center, 622 W 168th St, PH16, New York, NY 10032 USA
| | - Robert L Goldenberg
- Columbia University Medical Center, 622 W 168th St, PH16, New York, NY 10032 USA
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