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Endawkie A, Kebede SD, Kebede N, Mihiretu MM, Bekele Enyew E, Ayele K, Asmare L, Bayou FD, Arefaynie M, Tsega Y. Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis. PLoS One 2024; 19:e0306052. [PMID: 39190745 DOI: 10.1371/journal.pone.0306052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/10/2024] [Indexed: 08/29/2024] Open
Abstract
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.
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Affiliation(s)
- Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mengistu Mera Mihiretu
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermias Bekele Enyew
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kokeb Ayele
- Department of Health Promotion, School of Public Health College of Medicine Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lakew Asmare
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fekade Demeke Bayou
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Balis B, Bekele H, Hunde AD, Abdisa L, Lami M. Trend, prevalence and predictors of successful vaginal birth after caesarean section in Ethiopia: a systematic review and meta-analysis. Int Health 2024; 16:371-379. [PMID: 37449453 PMCID: PMC11218884 DOI: 10.1093/inthealth/ihad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Vaginal birth after caesarean section (VBAC) is an alternative to a caesarean section (CS) in the absence of repeat or new indications for primary CS. There is a knowledge gap regarding the trend and successful VBAC in Ethiopia. Therefore this systematic review and meta-analysis aimed to assess the trend, pooled prevalence of successful VBAC and its predictors in Ethiopia. METHODS Electronic databases (SCOPUS, CINAHL, Embase, PubMed and Web of Science), Google Scholar and lists of references were used to search works of literature in Ethiopia. Stata version 14 was used for analysis and the odds ratios of the outcome variable were determined using the random effects model. Heterogeneity among the studies was assessed by computing values for I2 and p-values. Also, sensitivity analyses and funnel plots were done to assess the stability of pooled values to outliers and publication bias, respectively. RESULTS A total of 12 studies with a sample size of 2080 were included in this study. The overall success rate of VBAC was 52% (95% confidence interval 42 to 65). Cervical dilatation ≥4 cm at admission, having a prior successful vaginal delivery and VBAC were the predictors of successful VBAC. CONCLUSIONS Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios and the funnel plots did not show publication bias. The pooled prevalence of successful VBAC was relatively low compared with existing evidence. However, the rate was increasing over the last 3 decades, which implies it needs more strengthening and focus to decrease maternal morbidity and mortality by CS complications. Promoting VBAC by emphasizing factors favourable for its success during counselling mothers who previously delivered by CS to enhance the prevalence of VBAC.
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Affiliation(s)
- Bikila Balis
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aboma Diriba Hunde
- Department of Midwifery, College of Health Sciences, Mettu University, Mettu, Oromia, Ethiopia
| | - Lemesa Abdisa
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Magarsa Lami
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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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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Amoah EJ, Aklie R, Hinneh T, Asare A, Amegah KE. Caesarean section delivery rates and associated factors in a faith-based referral hospital in Ghana: A retrospective analysis. PLoS One 2024; 19:e0301634. [PMID: 38753814 PMCID: PMC11098510 DOI: 10.1371/journal.pone.0301634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION The global incidence of caesarean section (CS) deliveries has exceeded the recommended threshold set by the World Health Organization. This development is a matter of public health concern due to the cost involved and the potential health risk to the mother and the neonate. We sought to investigate the prevalence, indications, maternal and neonatal outcomes and determinants of CS in private health facilities in Ghana. METHOD A retrospective cross-sectional analysis was conducted using data from women who delivered at the Holy Family Hospital from January to February 2020 using descriptive and inferential statistics, with a significance level set at p<0.05. RESULTS The prevalence of CS was 28.70%. The primary indications of C/S include previous C/S, foetal distress, breech presentation, pathological CTG and failed induction. Significant associations were found between CS and breech presentation (AOR = 4.60; 95%CI: 1.22-17.38) p<0.024, previous CS history (AOR = 51.72, 95% CI: 11.59-230.70) p<0.00, and neonates referred to NICU (AOR = 3.67, 95% CI: 2.10-6.42) p<0.00. CONCLUSION The prevalence of caesarean section (CS) deliveries was higher than the WHO-recommended threshold. Major indications for CS included previous CS, fetal distress, and failed induction. Significant risk factors for CS were previous CS history, breech presentation, and neonates referred to NICU.
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Affiliation(s)
- Ebenezer Jones Amoah
- Gomoa Fetteh Kakraba, KAAF University College, Kasoa, Ghana
- Ghana Health Service, Jaman North Health Directorate, Sampa, Ghana
| | - Rita Aklie
- Nursing and Midwifery Training College, Pantang, Ghana
| | - Thomas Hinneh
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Kinglsey E. Amegah
- Department of Data Science and Economic Policy, University of Cape Coast, Cape Coast, Ghana
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Begum J, Mitra S. Preference and Associated Factors for Cesarean Delivery Among Pregnant Women: A Cross-Sectional Study. J Family Reprod Health 2024; 18:20-29. [PMID: 38863842 PMCID: PMC11162879 DOI: 10.18502/jfrh.v18i1.15435] [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] [Indexed: 06/13/2024] Open
Abstract
Objective A cesarean delivery is regarded as a comparatively favourable and secure approach to childbirth when contrasted with vaginal delivery. Over the past decade, its frequency has risen in both industrialized and developing nations. Maternal request for cesarean delivery has been explained for the escalating rate along with other factors like anxiety, fear of childbirth, previous cesarean delivery, previous negative vaginal birth experience, maternal age, maternal education, and socioeconomic factors. Hence, this study was undertaken to assess pregnant women's tendency to have a cesarean birth and to investigate the factors associated with the inclination for cesarean delivery. Materials and methods A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, a systematic sampling procedure was utilized, and 368 antenatal mothers after 36 weeks of gestation, who do not have any specific medical reasons against vaginal delivery were included in the study. Data collection was done by questionnaire. The information regarding socio-demographic factors, preexisting comorbidities, current obstetric risk factors, emotional factors, previous delivery experience, and their information preference toward the mode of delivery were collected. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. Results The preference for cesarean delivery and non-preference for cesarean delivery was 114 (30.9%) and 201 (54.6%), respectively whereas 53 (14.4%) participants remained neutral. The Chi-square analysis revealed a notable connection between the inclination towards a preference for cesarean delivery and factors such as obstetric score, parity, comorbidities, and among obstetric risk factors such as pregnancy after in-vitro fertilization (IVF), with a history of abortion, and having a prior history of cesarean delivery. Nevertheless, no meaningful association was observed between the preference for cesarean delivery and the remaining variables. On multivariate logistic analysis, independent variables like preexisting anxiety or depression, pregnancy through IVF, and having a history of previous cesarean delivery have increased the odds of preferring cesarean delivery. The independent variables like increasing gestational age, graduates, and unemployed have decreased the odds of preferring a cesarean delivery. Conclusion In conclusion, the prevalence of cesarean delivery is influenced by a complex interplay of medical, cultural, socioeconomic, and healthcare system factors. While cesarean delivery is essential in cases of medical necessity, efforts should be made to avoid unnecessary cesarean delivery that does not provide clear benefits over vaginal delivery. Balancing the risks and benefits of cesarean delivery and promoting evidence-based obstetric practices are crucial for ensuring optimal maternal and infant outcomes.
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Affiliation(s)
- Jasmina Begum
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Subarna Mitra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
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Fente BM, Asaye MM, Gudayu TW, Mihret MS, Tesema GA. Prediction of unplanned cesarean section using measurable maternal and fetal characteristics, Ethiopia, a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:161. [PMID: 38395796 PMCID: PMC10885460 DOI: 10.1186/s12884-024-06308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND When a pregnant woman experiences unusual circumstances during a vaginal delivery, an unplanned cesarean section may be necessary to save her life. It requires knowledge and quick assessment of the risky situation to decide to perform an unplanned cesarean section, which only occurs in specific obstetric situations. This study aimed to develop and validate a risk prediction model for unplanned cesarean sections among laboring women in Ethiopia. METHOD A retrospective follow-up study was conducted. The data were extracted using a structured checklist. Analysis was done using STATA version 14 and R version 4.2.2 software. Logistic regression was fitted to determine predictors of unplanned cesarean sections. Significant variables were then used to develop a risk prediction model. Performance was assessed using Area Under the Receiver Operating Curve (AUROC) and calibration plot. Internal validation was performed using the bootstrap technique. The clinical benefit of the model was assessed using decision curve analysis. RESULT A total of 1,000 laboring women participated in this study; 28.5% were delivered by unplanned cesarean section. Parity, amniotic fluid status, gestational age, prolonged labor, the onset of labor, amount of amniotic fluid, previous mode of delivery, and abruption remained in the reduced multivariable logistic regression and were used to develop a prediction risk score with a total score of 9. The AUROC was 0.82. The optimal cut-off point for risk categorization as low and high was 6, with a sensitivity (85.2%), specificity (90.1%), and accuracy (73.9%). After internal validation, the optimism coefficient was 0.0089. The model was found to have clinical benefits. CONCLUSION To objectively measure the risk of an unplanned Caesarean section, a risk score model based on measurable maternal and fetal attributes has been developed. The score is simple, easy to use, and repeatable in clinical practice.
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Affiliation(s)
- Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mengstu Melkamu Asaye
- Department of Women's and Family Health, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Worku Gudayu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Eshetu B, Balis B, Daba W, Mekonnen B, Getachew T, Roga EY, Habte S, Bekele H, Ketema I, Debella A. Magnitude of cesarean-section and associated factors among diabetic mothers in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A cross-sectional study. Front Public Health 2022; 10:888935. [PMID: 36187662 PMCID: PMC9523533 DOI: 10.3389/fpubh.2022.888935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Background Gestational diabetes is associated with multiple adverse pregnancy outcome as a result of unfavorable labor and delivery process with a consequent increase in obstetric interventions including cesarean-section. Even though diabetes mellitus increases the cesarean-section rate; there is no study conducted in Ethiopia. therefore, this study aimed to assess the magnitude of cesarean-section and associated factors among diabetic mothers in Tikur Ambessa Specialize Hospital, Addis Ababa, Ethiopia. Methods A facility-based retrospective cross-sectional study was conducted in Tikur Anbessa Specialized Hospital from 1 February to 30 April 2018 among 346 diabetic mothers. All required data were extracted from patients' charts using checklists, and incomplete records were excluded. The collected data were entered into Epi data version 4.2 and exported to SPSS version 20 for analysis. Multiple logistic regression models were fitted to identify factors associated with cesarean section. Adjusted odds ratios along with 95% CI were estimated to measure the strength of the association and declared statistical significance at a p-value <0.05. Results The magnitude of cesarean-section was 57.8% (95% CI: 51.7, 63.3). Pregnancy-induced hypertension [AOR: 3.35, (95% CI: (1.22, 9.20)], previous C/S [AOR: 1.62, (95% CI: (2.54, 4.83)], and fetal distress [AOR: 4.36, (95% CI: 1.30, 14.62)] were factors significantly associated with cesarean-section. Conclusion A considerable number of diabetic mothers gave birth by cesarean-section. Pregnancy-induced hypertension, previous cesarean-section, and fetal distress were factors more likely to increase the rate of cesarean-section. Most of the factors were modifiable by following the WHO recommendation for cesarean-section.
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Affiliation(s)
- Bajrond Eshetu
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,*Correspondence: Bikila Balis
| | - Woreknesh Daba
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bazie Mekonnen
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamirat Getachew
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ephrem Yohanes Roga
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Ambo University, Ambo, Ethiopia
| | - Sisay Habte
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Habtamu Bekele
| | - Indeshaw Ketema
- Department of Emergency and Critical Care Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mohammadi A, Pishgar E, Salari Z, Kiani B. Geospatial analysis of cesarean section in Iran (2016-2020): exploring clustered patterns and measuring spatial interactions of available health services. BMC Pregnancy Childbirth 2022; 22:582. [PMID: 35864462 PMCID: PMC9302231 DOI: 10.1186/s12884-022-04856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lives of babies and mothers are at risk due to the uneven distribution of healthcare facilities required for emergency cesarean sections (CS). However, CS without medical indications might cause complications for mothers and babies, which is a global health problem. Identifying spatiotemporal variations of CS rates in each geographical area could provide helpful information to understand the status of using CS services. METHODS This cross-sectional study explored spatiotemporal patterns of CS in northeast Iran from 2016 to 2020. Space-time scan statistics and spatial interaction analysis were conducted using geographical information systems to visualize and explore patterns of CS services. RESULTS The temporal analysis identified 2017 and 2018 as the statistically significant high clustered times in terms of CS rate. Five purely spatial clusters were identified that were distributed heterogeneously in the study region and included 14 counties. The spatiotemporal analysis identified four clusters that included 13 counties as high-rate areas in different periods. According to spatial interaction analysis, there was a solid spatial concentration of hospital facilities in the political center of the study area. Moreover, a high degree of inequity was observed in spatial accessibility to CS hospitals in the study area. CONCLUSIONS CS Spatiotemporal clusters in the study area reveal that CS use in different counties among women of childbearing age is significantly different in terms of location and time. This difference might be studied in future research to identify any overutilization of CS or lack of appropriate CS in clustered counties, as both put women at risk. Hospital capacity and distance from population centers to hospitals might play an essential role in CS rate variations and spatial interactions among people and CS facilities. As a result, some healthcare strategies, e.g., building new hospitals and empowering the existing local hospitals to perform CS in areas out of service, might be developed to decline spatial inequity.
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Affiliation(s)
- Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Elahe Pishgar
- Department of Human Geography, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran
| | - Zahra Salari
- Jahrom University of Medical Sciences, Jahrom, Iran
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. .,Centre de Recherche en Santé Publique, Université de Montréal, 7101, Avenue du Parc, Montréal, Canada.
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Biru YB, Lemelem GA, Solomon N. Length of stay in health facilities after childbirth and associated maternal and neonatal factors in Ethiopia: a cross-sectional study from a national survey. BMJ Open 2021; 11:e055327. [PMID: 34876438 PMCID: PMC8655577 DOI: 10.1136/bmjopen-2021-055327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to assess the length of stay in health facilities after childbirth and associated maternal and neonatal factors in Ethiopia. DESIGN A cross-sectional study. SETTING Ethiopia. PARTICIPANTS 2260 mothers who participated in the 2016 Ethiopian Demographic and Health Survey were included in the study. OUTCOME Length of stay in health facilities after childbirth was the outcome variable of the study. RESULT In Ethiopia, the mean duration of postpartum stay for mothers in health facilities was 21.96 (19.97-23.94) hours. Nine hundred and sixty-eight (34.80%) women remained in health institutions for ≥24 hours after delivery. Gestational age, birth weight and mode of delivery were significantly associated with length of stay. Gestational age was found to be inversely associated with length of stay. Mothers who had a vaginal delivery were 8.89% (adjusted HR (AHR) 8.89, 95% CI (4.28 to 18.46), p<0.001) more likely to discharge earlier from health facilities after delivery, compared with those who had a caesarian section. Women with larger size neonates during birth were 19% (AHR=0.81, 95% CI (0.67 to 0.96), p=0.019) more likely to stay longer in health facilities than women with average size neonates. Women with a smaller size neonate during birth were 16% (AHR=0.84, 95% CI (0.70 to 0.99), p=0.040) more likely to stay longer at a health facility, compared with those with an average size neonate. CONCLUSION A small percentage of Ethiopian mothers stayed in health facilities for 24 hours or more after delivery. Encouraging mothers to stay in health facilities for the recommended period after childbirth can play a significant role in reducing maternal and neonatal deaths.
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Affiliation(s)
| | | | - Nahom Solomon
- Public Health, Mizan-Tepi University, Mizan, Ethiopia
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Hailegebreal S, Gilano G, Seboka BT, Ahmed MH, Simegn AE, Tesfa GA, Yehualashet DE. Prevalence and associated factors of caesarian section in Ethiopia: a multilevel analysis of the 2019 Ethiopia Mini Demographic Health Survey. BMC Pregnancy Childbirth 2021; 21:798. [PMID: 34847876 PMCID: PMC8630861 DOI: 10.1186/s12884-021-04266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Caesarian section is a vital emergency obstetric intervention for saving the lives of mothers and newborns. However, factors which are responsible for caesarian section (CS) were not well established in the country level data. Therefore, this study aimed to assess the prevalence and associated factors of caesarian section in Ethiopia. METHODS Data from the Ethiopian Mini Demographic and Health survey 2019 were used to identify factors associated with the caesarian section in Ethiopia. We applied multi-level logistic regression and a p-value of <0.25 to include variables before modeling and a p-value<0.05 with 95% confidence interval (CI) for final results. RESULT The prevalence of caesarian section in Ethiopia was 5.44% (95% CI; 0.048-0.06) in2019. Women in age group of 30-39 and 40-49 years had a higher odd of caesarian section (AOR = 2.14, 95%CI = 1.55-2.94) and (AOR = 2, 95%CI = 1.20-3.97) respectively compared to women in age group of 15-29 years. Women with secondary and higher educational level had higher odds of caesarian section (AOR = 2.15, 95%CI = 1.38-3.34) and (AOR = 2.8, 95%CI = 1.73-4.53) compared to those in no education category. Compared to Orthodox, Muslims and Protestant religions had lower odds of caesarian section with AOR of 0.50 (0.34-0.73) and 0.53 (0.34-0.85). Having <2 births was also associated with the low caesarian section 0.61(0.52-1.22). Using modern contraceptive methods, having ANC visits of 1-3, 4th, 5 plus, and urban residence were associated with higher odds of caesarian section as 1.4 (1.05-1.80]), 2.2 (1.51-3.12), 1.7 (1.12-2.46), and 2.4 (1.65-3.44) 1.6(1.04-2.57) respectively. CONCLUSION Although evidence indicates that the caesarian deliveries increased both in developed and underdeveloped countries, the current magnitude of this service was very low in Ethiopia which might indicate missing opportunities that might costing lives of mothers and newborns. Women's age, religion, educational status, parity, contraceptive method, and ANC visit were individual level factors influenced caesarian section. whereas, region and place of residence were community level factors affected caesarian section in the country. Depending on these factors, the country needs policy decisions for further national level interventions.
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Affiliation(s)
- Samuel Hailegebreal
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Arba Minch University, Arba Minch, Ethiopia.
| | - Girma Gilano
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Binyam Tariku Seboka
- Department of Health Informatics, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | | | - Atsedu Endale Simegn
- Department of Anesthesia, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Getanew Aschalew Tesfa
- Department of Health Informatics, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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11
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Mose A, Abebe H. Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study. Arch Public Health 2021; 79:158. [PMID: 34470668 PMCID: PMC8411533 DOI: 10.1186/s13690-021-00682-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Ayenew Mose
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, P.O.Box; 07, Wolkite, Ethiopia
| | - Haimanot Abebe
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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12
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Gedefaw G, Waltengus F, Demis A. Does Timing of Antenatal Care Initiation and the Contents of Care Have Effect on Caesarean Delivery in Ethiopia? Findings from Demographic and Health Survey. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:7756185. [PMID: 34422065 PMCID: PMC8371644 DOI: 10.1155/2021/7756185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Background Antenatal care (ANC) is an important preventive set of core healthcare services through pregnancy. Caesarean deliveries are significantly increasing in many low-, middle-, and high-income countries. However, overuse of the caesarean section service interferes with the quality and cost of the procedure. Hence, this study aimed to assess the effect of timing of first antenatal care initiation and the contents of care on caesarean delivery. Methods A population level cross-sectional study was conducted with a total of 4757 study participants. The multivariable analysis was computed using the setup of 3 models. Results The rate of caesarean section among women who initiated antenatal care in the first trimester was 1.32% (95% CI = 0.91-4.21). Women initiated antenatal care in the first trimester (AOR = 2.74; 95% CI = 1.49-6.2) and received contents of care (AOR = 1.98; 95% CI = 1.24-3.78])were more likely to have caesarean section delivery as compared to their counterparts. Conclusion Caesarean section among women who initiated ANC in the first trimester is low. The finding suggests ANC initiated early (within 16 weeks) can have a positive impact on caesarean section delivery. In addition, being urban residents, primipara women, initiating antenatal care before 16 weeks, received contents of care, and having antenatal care visits three and more increase the odds of having caesarean section. As a result, different obstetric, medical, and surgical complications are detected and managed as early as possible.
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Affiliation(s)
- Getnet Gedefaw
- School of Midwifery, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Fikadu Waltengus
- Department of Midwifery, College of Medicine and Health Sciences, School of Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Asmamaw Demis
- School of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
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13
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Taye MG, Nega F, Belay MH, Kibret S, Fentie Y, Addis WD, Fenta E. Prevalence and factors associated with caesarean section in a comprehensive specialized hospital of Ethiopia: A cross-sectional study; 2020. Ann Med Surg (Lond) 2021; 67:102520. [PMID: 34276980 PMCID: PMC8264103 DOI: 10.1016/j.amsu.2021.102520] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Caesarean section is one of the lifesaving procedures of medical interventions attributed to the decrease of maternal and newborn mortality and morbidity rates. The World Health Organization (WHO) shows a cesarean rate between 5% and 15%. However, the prevalence of cesarean section is increasing globally as well as in Ethiopia. Different scholars argue that the prevalence and factors of the caesarian section vary in different countries and health institutions. The aim of this study was to assess the prevalence and factors associated with cesarean section in Debre Tabor Comprehensive Specialized Hospital. METHOD An institutional-based cross-sectional study was conducted on a total of 320 mothers who gave birth at Debre Tabor Comprehensive Specialized Hospital from July 01, 2020, to October 30, 2020. The samples were selected using the convenience sampling technique. The Data were collected using a structured checklist. Bivariable and multivariable logistic regressions were used to check the association. P-values less than 0.05 were considered statistically significant. RESULTS The overall prevalence of cesarean section was 39.1% in the current study. Mothers age 35-39 years, educational level college and above, employed, mothers with a monthly income of >6000, and mothers with a previous history of cesarean section were significantly associated with an increased risk of cesarean section. CONCLUSION The prevalence of cesarean section was high in Debre Tabor Comprehensive Specialized Hospital. Age of the mothers, educational status, occupation, monthly income, and previous history of cesarean section were significantly associated with an increased occurrence of cesarean section.
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Affiliation(s)
- Moges Gelaw Taye
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Firehiwot Nega
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Metages Hunie Belay
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Simegnew Kibret
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yewlsew Fentie
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wondimnew Desalegn Addis
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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