Magnitude and correlates of caesarean section in urban and rural areas: A multivariate study in Vietnam

Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran's I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff's SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers' age (AOR = 1.07, 95% CI 1.02-1.12), mother's had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother's higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.

Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis

BACKGROUND

Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia.

METHOD

A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported.

RESULT

The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24-35: AOR = 1.98, 95% CI (1.3, 3.1), and 35-49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts.

CONCLUSION

In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions.

Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries

OBJECTIVE

To measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors.

DESIGN

A cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference.

SETTING

Thirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected.

PARTICIPANTS

A total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period.

FINDINGS

The overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and "avoid pain in labour" was the most common perceived benefit of caesarean section.

KEY CONCLUSIONS

Our results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections.

CLINICAL TRIAL REGISTRY

The QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.

A Higher Maternal Education Level Could Be a Critical Factor in the Exceeded Cesarean Section Delivery in Indonesia

Background

Cesarean section (CS) could be life-saving with medically indicated, but without it, both women and children could be at risk. The maximum rate for CS is 15%, but it tends to exceed globally.

Objective

We aimed to analyze the education level's role in the delivery of CS in Indonesia.

Methods

We used the 2017 Indonesia Demographic and Health Survey data. The study sampled 15,357 women who delivered in five last years. Besides delivery mode and education level, the study also used nine control variables: residence, age, marital, employment, parity, wealth, insurance, antenatal care, and birth type. The study employed a binary logistics regression.

Results

The results show women with secondary education (16.5% CS) are 2.174 times (AOR 2.174; 95% CI 1.095-4.316), and higher education (33% CS) are 3.241 (AOR 3.241; 95% CI 1.624-6.469) times more likely to deliver by CS than no-school education (4.4% CS). There was no significant difference between primary (9.1%) and no-education women. Apart from education, primiparous women, age 34-34 yr, attending antenatal care ≥4 times, non-poorest, having insurance, living in the city, and being unemployed also related to higher risk of CS.

Conclusion

Exceeded CS in Indonesia occurs mostly in higher education women. Higher education women were more likely to access more information and technology, therefore health promotion on healthy normal birth on social media or m-Health (mobile device-based health promotion) and involving health authorities at every level were suitable to reduce the overuse of the CS.

Caesarean delivery in Uganda: Do non-clinical factors explain the trend?

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.

A comparative study on behavior, awareness and belief about cervical cancer among rural and urban women in Vietnam

Cervical cancer is the second most common gynecologic cancer in Vietnam but based on the literature, only ~25% of Vietnamese women reported ever being screened for cervical cancer. To inform strategies to reduce the cervical cancer burden in Southern Vietnam where disease incidence is higher than the national average, this study examined behaviors, awareness, barriers, and beliefs about cervical cancer screening among rural and urban women in this geographical region. In October-November 2021, we conducted a cross-sectional study among 196 rural and 202 urban women in Southern Vietnam; participants completed a cervical cancer screening questionnaire. Descriptive analyses and rural-urban differences in screening behavior, awareness, barriers, and beliefs are presented. About half of the rural and urban participants reported ever being screened for cervical cancer. Most participants showed high perceived severity of cervical cancer and benefits of screening. Further, they reported that they would screen if it was recommended by doctors and/or friends/family. However, most women showed low awareness and perceived susceptibility to cervical cancer. Logistical and psychosocial barriers to physician-based screening methods were reported. Based on our results, the World Health Organization 2030 goals for cervical cancer screening are not currently met in Southern Vietnam. Increasing health literacy and engaging doctors and family members/social networks emerged as important avenues to improve screening. HPV (Human papillomavirus) self-sampling is also a potential approach to increase uptake of cervical cancer screening given the identified psychosocial and logistical barriers.

Trend and associated factors of cesarean section rate in Ethiopia: Evidence from 2000-2019 Ethiopia demographic and health survey data

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.

Risk factors of caesarean deliveries in urban-rural areas of Bangladesh

Background and aims

The key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh.

Methods

This study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model.

Results

CS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45-49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67).

Conclusion

The findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country.

Rural–urban disparities in caesarean deliveries in sub-Saharan Africa: a multivariate non-linear decomposition modelling of Demographic and Health Survey data

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.

Factors associated with the very high caesarean section rate in urban areas of Vietnam

Background

Caesarean section and associated factors require detailed investigation globally. This study aims to determine the rate and associated factors of caesarean deliveries in urban areas of Vietnam.

Methods

A cross-sectional study using questionnaire answered by women who had infants aged under 30 months was conducted from March to May 2021. Data were collected in 18 commune health centres in two cities during the day of routine immunization. Multivariable logistic regression was performed to assess factors associated with caesarean section.

Results

The overall caesarean section rate was 49.6%. The caesarean section rate in private hospitals (57.8%) were significantly higher than in public hospitals (49.1%). Caesarean section rate in first-time mothers (47.1%) were as high as this rate among mothers who had given birth before (50.6%). Factors associated with higher rate of caesarean section include increasing in women’s age, pre-pregnancy body mass index, gestational weight gain, and infant’s birth weight; first-time mothers; mothers living in urban areas; and mothers giving birth in private hospitals.

Conclusions

This study revealed a high rate of caesarean deliveries in urban areas of Vietnam. Comprehensive investigations of both medical and non-medical reasons for caesarean deliveries in Vietnam are urgent needs to shape the prioritized interventions.

Incidence of Intrapartum-Related Events at the Largest Obstetric Hospital in Hanoi, Vietnam: A Retrospective Study

Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related events, we aimed to assess the neonatal demographic characteristics, clinical management, and outcomes among neonates born at the largest obstetric hospital in Hanoi, Vietnam. This was a retrospective cross-sectional study that included all the inborn neonates in November 2019, which was selected as a representative month. A total of 4554 neonates were born during the study period. Of these, 1.0% (n = 44) were stillbirths, 0.15% (n = 7) died in hospital, 0.61% (n = 28) received positive pressure ventilation at birth, and 0.15% (n = 7) were diagnosed with hypoxic ischemic encephalopathy. A total of 581 (13%) neonates were admitted to the neonatal unit, among which the most common diagnoses were prematurity (37%, n = 217) and infection (15%, n = 89). Except for the intrapartum-related events, our findings are consistent with the previously documented data on neonatal morbidity. The intrapartum-related events, however, were surprisingly low in number even in comparison to high-income countries. Research on the current clinical practice at Phu San Hanoi Hospital may bring further clarity to identify the success factors.

Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam

Background: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. Methods: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020–2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. Results: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31–0.96, p = 0.034). Conclusions: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.

Whose decision? Caesarean section and women with physical disabilities in Northern Vietnam: A qualitative study

BACKGROUND

Pregnant women with physical disabilities are more likely to have caesarean sections than are women without disabilities. For some women with disabilities, caesarean birth may not be clinically necessary, as they may lack autonomy in decision-making to a greater extent than is the case for other pregnant women.

OBJECTIVE

To explore the relative influence of health staff, family, friends, and the women themselves on key decisions about childbirth of women with physical disabilities in northern Vietnam.

RESEARCH DESIGN/SETTING

A qualitative approach using a phenomenological design was employed. Fifty-six in-depth interviews were conducted with women with physical disabilities who had given birth in the previous three years in two northern provinces in Vietnam (Hanoi and Thaibinh). Twenty-nine women participated in a first interview and 27 completed follow-up interviews several months later. Additionally, semi-structured interviews were conducted with 12 maternal healthcare providers. Interviews were transcribed and thematically analysed.

RESULTS

Twenty-eight of the 29 participants underwent caesarean sections. Two themes were identified: (1) The women reported that caesarean section was mandated by attending doctors "because of their disability". Consistently, the healthcare providers said caesarean section is essential for women with physical disabilities; and (2) The women said that their parents and peers supported caesarean birth. Very few women indicated that they could influence this decision, even though one-third said their personal preference was for vaginal birth.

CONCLUSIONS

Many women with physical disabilities are not given the opportunity to exercise informed choices around childbirth options. Women in Vietnam who live with physical disabilities should be empowered to make informed decisions about childbirth. It is recommended that professional guidelines and training are revised to properly engage women with physical disabilities in joint decision-making for the birth of their children.

Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study

BACKGROUND

Caesarean section is a life-saving comprehensive obstetric procedure of women and newborn performed during childbirth-related complications and should be universally accessible for all pregnant mothers globally. Appropriate use of caesarean section can reduce maternal and perinatal mortality. However, inappropriate use of caesarean section can negatively affect infant health, women health, and future pregnancies. The magnitude and factors associated with caesarean section delivery were not consistent and will vary between different hospitals of Ethiopia. Hence, this study aimed at assessing the magnitude and factors associated with caesarean section deliveries in Southwest Ethiopia.

METHODS AND MATERIALS

An institutional-based cross-sectional study was conducted from January 1 to February 29, 2020. A systematic random sampling technique was used to select 551 study participants. A pretested, structured, and face-to-face interview was used to collect data. Data were entered into Epi-data version 4.2.0 and exported to SPSS version 23 for analysis. Bivariate and multivariate analyses were used to identify factors associated with caesarean section deliveries. P values < 0.05 result were considered as a statistically significant association.

RESULTS

The magnitude of caesarean section deliveries was found to be 32.5 % (95 % CI; 28.6%-36.7 %). Mothers resided in an urban area [AOR = 2.58, (95% CI; 1.66-4.01)], multiple pregnancies [AOR = 3.15, (95% CI; 1.89-5.23), malpresentation [AOR = 3.05, (95% CI; 1.77-5.24)], and previous history of caesarean section [AOR = 3.55, (95% CI; 2.23-5.64) were factors associated with caesarean section deliveries.

CONCLUSIONS

Caesarean section deliveries were found high in the study area. Mothers resided in an urban area, multiple pregnancies, malpresentation, and previous history of caesarean section were factors associated with caesarean section deliveries. Therefore, counselling of mothers on the risk of giving birth through elective caesarean section without absolute and relative medical indications and giving enough time for the trial of vaginal birth after caesarean section are recommended.

Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.

Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.

A Cross-Sectional Study to Assess the Frequency and Risk Factors Associated with Cesarean Section in Southern Punjab, Pakistan

The increasing frequency of cesarean section (CS) is a major public health issue, and it is on the rise in Pakistan. A cross-sectional study approach was used to assess the frequency of CS and its contributing factors, along with the assessment of knowledge in mothers who had undergone CS in one of the under-developed regions of Pakistan. Data collection was done by using a self-developed study questionnaire. The statistical package for social sciences (SPSS) was utilized for the statistical analysis. During the study period, a total of 173 (69.7%) women have given births by CS; among those, 104 (60.1%) were elective/planned CSs while 69 (39.8%) were emergency CSs. The higher CS frequency was significantly associated with younger age (p = 0.03) and pre-term gestational age (p < 0.001). Pregnancy complications, such as gestational diabetes, hypertension, preeclampsia/eclampsia, and vaginal bleeding, were the significant risk factors for CS (p < 0.001). The highlighted contributing factors to CS in the current study were preterm of gestational age, mothers of a younger age (20–24 years), and mothers that belong to urban populations. These risk factors can be addressed by implementing community-focused educational interventions during the gestational period. The sample size in this study was small; therefore, the results cannot be generalized to the whole population.

Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017

INTRODUCTION

Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period.

METHODS

Seven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference.

RESULTS

The proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales.

CONCLUSION

This study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS.

Women's empowerment and elective cesarean section for a single pregnancy: a population-based and multivariate study in Vietnam

Background

Women’s empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women’s empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns.

Methods

We hypothesized that in the context of the developing biomedicalization of childbirth, women’s empowerment increases the use of ECS due to a woman’s enhanced ability to decide her mode of delivery. By using microdata from the 2013–2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women.

Results

Among the indicators of women’s external resources, which include a higher level of education, having worked during the previous 12 months, and having one’s own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women’s empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS.

Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women.

Conclusions

These results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.

Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia-A Prerequisite for Efficient and Fair Comprehensive Obstetric Care

Knowing the cost of health care services is a prerequisite for evidence-based management and decision making. However, only limited costing data is available in many low- and middle-income countries. With a substantially increasing number of facility-based births in Cambodia, costing data for efficient and fair resource allocation is required. This paper evaluates the costs for cesarean section (CS) at a public and a Non-Governmental (NGO) hospital in Cambodia in the year 2018. We performed a full and a marginal cost analysis, i.e., we developed a cost function and calculated the respective unit costs from the provider's perspective. We distinguished fixed, step-fixed, and variable costs and followed an activity-based costing approach. The processes were determined by personal observation of CS-patients and all procedures; the resource consumption was calculated based on the existing accounting documentation, observations, and time-studies. Afterwards, we did a comparative analysis between the two hospitals and performed a sensitivity analysis, i.e., parameters were changed to cater for uncertainty. The public hospital performed 54 monthly CS with an average length of stay (ALOS) of 7.4 days, compared to 18 monthly CS with an ALOS of 3.4 days at the NGO hospital. Staff members at the NGO hospital invest more time per patient. The cost per CS at the current patient numbers is US$470.03 at the public and US$683.23 at the NGO hospital. However, the unit cost at the NGO hospital would be less than at the public hospital if the patient numbers were the same. The study provides detailed costing data to inform decisionmakers and can be seen as a steppingstone for further costing exercises.

Caesarean section rates analysed using Robson's 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia

OBJECTIVE

The aim of this study was to assess the caesarean section (CS) rates using Robson's 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern Ethiopia.

DESIGN

Cross-sectional study design to determine CS rate using Robson's 10-Group Classification System.

SETTING

Hawassa University Referral Hospital in south Ethiopia.

PARTICIPANTS

4004 women who gave birth in Hawassa University Referral Hospital from June 2018 to June 2019.

RESULTS

The 4004 women gave birth to 4165 babies. The overall CS rate was 32.8% (95% CI: 31.4%-34.3%). The major contributors to the overall CS rates were: Robson group 1 (nulliparous women with singleton pregnancy at term in spontaneous labour) 22.9%; group 5 (multiparous women with at least one previous CS) 21.4% and group 3 (multiparous women without previous CS, with singleton pregnancy in spontaneous labour) 17.3%. The most commonly reported indications for CS were 'fetal compromise' (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%).

CONCLUSION

A high proportion of women giving birth at this hospital were given a CS, and many of them were in a low-risk group. Few had trial of labour. More active use of partogram, improving fetal heartbeat-monitoring system, implementing midwife-led care, involving a companion during labour and auditing the appropriateness of CS indications may help to reduce the CS rate.

Differences in the prevalence of cesarean section and associated factors in private and public healthcare systems in Peru

BACKGROUND

Cesarean section rates have been steadily increasing worldwide. Private health facilities are reported as being a major contributor to this rising rate in Latin America.

AIM

To assess the prevalence and determinants of cesarean section rates among public and private health facilities in Peru.

METHODS

We performed a cross-sectional analytical study pooling the data of 52,215 women between 15 and 49 years of age from the 2015-2017 Peruvian Demographic and Family Health Survey (ENDES) database. Sociodemographic and pregnancy-related variables were used to construct adjusted logistic regression models for the indication of cesarean section.

FINDINGS

The prevalence of cesarean births was 73.0% (95%CI: 71.1-74.9) and 30.3% (95% CI: 29.6-31.0) in private and public health facilities, respectively. In private facilities, living in an urban area, having a higher educational level, being in the age group of 35-49 years, and having multiple pregnancies increased the probability of a cesarean section. In public health facilities, living in an urban area, having a higher wealth quintile, higher education level, older maternal age, birth order, newborn size and gender, type of pregnancy, language, and maternal height were all factors associated with cesarean section.

CONCLUSION

The prevalence of cesarean section found in the present study was above the value recommended by the WHO (10%) for both public and private facilities. It is necessary to address the indiscriminate rise in the use of cesarean sections, developing strategies according to the type of health facility.

Socio-demographic factors of cesarean births in Nha Trang city, Vietnam: a community-based survey

Background

The cesarean section rate in Vietnam has been increasing especially in urban area. However, limited evidence identified regarding socio-demographic factors of the cesarean section birth. The objective of this study was to determine the current cesarean birth rate and the associated socio-demographic factors among mothers in Nha Trang city, south-central Vietnam.

Methods

A community-based cross-sectional study was conducted between October and November in 2016 as part of a Streptococcus pneumoniae carriage survey conducted in 27 communes of Nha Trang city. From each commune, 120 mothers and their children less than 2 years old were randomly selected. Mothers were asked to answer standardized questions regarding socio-demographic information and mode of birth. Multivariate logistic regression was adopted to examine associations between socio-demographic variables and mode of birth.

Results

Of 3148 participants, the number of cesarean births was 1396 (44.3 %). Older maternal age (≥ 30 years old), having another child going to school or kindergarten, monthly income more than 644 USD, gestational weeks at birth over 42 weeks, and low (< 2500 g) or high (≥ 3500 g) birth weight were associated with higher likelihood of cesarean births.

Conclusion

The CS rate obtained in this study was more than twice of what is recommended by the World Health Organization, which is consistent with the previous nation-wide study in Viet Nam. Further monitoring is suggested to examine the non-medical reason for the increased CS rate.

Predictors of institutional delivery service utilization among women of reproductive age in Gambia: a cross-sectional analysis

BACKGROUND

Over the last two decades, Gambia has made noticeable progress in the reducing the high maternal mortality rates and improving child survival rates. Nonetheless, numerous infrastructural and financial constraints continue to restrict access to institutional delivery care, a key component of achieving the maternal and child health related Sustainable Development Goals (SDG 3.1). This study assesses factors that predict women's choice of mode and place of delivery in urban and rural Gambia.

METHODS

Cross-sectional data from the latest round of Gambia Demographic and Health Survey (2013) on women aged 15-49 years (n = 5351) were analyzed. The outcome measures were place (home vs health facility) and mode of delivery (caesarean vs normal) in urban and rural Gambia. Data were analyzed using descriptive and multivariate regression methods.

RESULTS

About three-fifth (60.8%) of the participants had their last childbirth at a health facility and 39.2% at their home. There was a significant urban-rural difference in the prevalence of facility delivery with 86.9% of the urban women choosing health facility over home compared with 45.8% among the rural women. In the regression analysis, place of residence, education of participants and the husband, employment, parity and use of antenatal care were significantly associated with the use of health facility delivery services. For instance, having secondary [OR = 1.657, 95%CI = 1.337,2.053] and higher education [OR-2.451, 95%CI = 1.166,5.150] showed higher odds for using facility delivery services; and women from the richest wealth quintile had significantly higher [OR = 2.239, 95%CI = 1.525,3.289] odds of using facility delivery compared with those in the lowest quintile.

CONCLUSION

Our findings suggest a sub-optimal use of professional childbirth services among Gambian women which appears to be driven by various geographical, educational, wealth inequality, parity and low use of ANC services. Addressing the socioeconomic and demographic inequalities may lead to a more widespread usage of maternity services in Gambia.