Rising cesarean section rates, a patient's perspective: experience from a high birth rate country

PURPOSE OF INVESTIGATION

To investigate the effect of social class, education and antenatal care on cesarian section (CS) rate and women's preference for CS.

MATERIALS AND METHODS

This is a descriptive study performed on 509 women attending postnatal clinics in three primary care units in Ismailia governorate, Egypt. The study performed via a structured questionnaire including questions related to background socio-demographic data, questions related to obstetrical history for the last pregnancy and delivery, and questions related to economic standards.

RESULTS

The study included 266 participants (52.3%) that delivered by CS in their last delivery. CS rate was significantly higher in highly educated women and high economic standard. Only 29 (7.7%) reported that they had preferred CS as a method of delivery. Educational level and economic standards significantly affected the proportion of women preferring CS as a method of delivery (p = 0.02 and p = 0.01, respectively). In a stepwise logistic regression model, significant factors affecting CS rate were: the method of delivery preferred (p < 0.005) and educational level (p < 0.05).

CONCLUSION

Educational level and economic standards significantly affected women's preference towards CS and CS rate.

Road traffic injuries and data systems in Egypt: addressing the challenges

OBJECTIVE

Road traffic injuries (RTIs) are a major cause of global mortality and morbidity, killing approximately 1.3 million people and injuring 20 to 50 million each year. The significance of this public health threat is most pronounced in low- and middle-income countries where 90 percent of the world's road traffic-related fatalities take place. Current estimates for Egypt show a road traffic fatality rate of 42 deaths per 100,000 population-one of the highest in the Eastern Mediterranean Region. RTIs are also responsible for 1.8 percent of all deaths and 2.4 percent of all disability-adjusted life years (DALYs) lost in the country. Despite this, studies surrounding this topic are scarce, and reliable data are limited. The overall goal of this article is to define the health impact of RTIs in Egypt and to identify the strengths and weaknesses of each data source for the purpose of improving the current RTI data systems.

METHODS

A 2-pronged approach was undertaken to assess the burden of RTIs in Egypt. First, a thorough literature review was performed using PubMed, Embase, ISIS Web of Knowledge, and Scopus databases. Articles pertaining to Egypt and road traffic injuries were selected for screening. With assistance from Egyptian colleagues, a comprehensive exploration of data sources pertaining to RTIs in Egypt was undertaken and secondary data from these sources were procured for analysis.

RESULTS

The literature review yielded a total of 20 studies, of which 6 were multi-country and 5 were hospital-based studies. None examined risk factors such as speeding, alcohol, or seat belt use. Secondary data sources were acquired from national hospital-based injury surveillance; a community-based health survey; pre-hospital injury surveillance; the Ministry of Transport; the General Authority for Roads, Bridges and Land Transport; death certificates; and the central agency for public motorization and statistics. Risk factor data are also limited from these sources.

CONCLUSION

The results of this article clearly highlight the significant burden that road traffic injuries pose on the health of the Egyptian population. The hospital-based injury surveillance system that has been established in the country and the use of International Classification of Diseases (ICD-10) coding brings the system very closely in line with international guidelines. There is, however, some considerable room for improvement, including the need to extend the coverage of the surveillance system, the inclusion of injury severity scores and disability indicators, and standardization of the sometimes rather disparate sources from various sectors in order to maximally capture the true burden of RTIs.