Prevalence and determinants of caesarean section in South and South-East Asian women

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Abstract

Background

Caesarean section is considered a relatively preferable and safe method of delivery as compared to normal delivery. Since the last decade, its prevalence has increased in both developed and developing countries. In the context of developing countries viz., South Asia (the highest populated region) and South-East Asia (the third-highest populated region), where a significant proportion of home deliveries were reported,however, the preference for, caesarean delivery and its associated factors are not well understood.

Objective

To study the caesarean delivery in the South and South-East Asian countries and to determine the factors associated with the preference for caesarean delivery.

Methodology

Demographic and Health Survey Data on from ever-married women of nine developing countries of South and South-East Asia viz., Vietnam, India, Maldives, Timor-Leste, Nepal, Indonesia, Pakistan, Bangladesh, and Cambodia have been considered. Both bivariate and binary logistic regression models were used to estimate the propensity of a woman undergoing for caesarean delivery and to assess the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery.

Results

Obtained results have shown an inclination of caesarean delivery among urban than rural women and are quite conspicuous, but is found to be underestimated mostly among rural women. Caesarean delivery in general is mostly predisposed among women whose baby sizes are either very large or smaller than average, have a higher level of education and place of delivery is private medical institutions. The logistic regression also revealed the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. Based on nine South and South-East Asian countries an overall C-section prevalence of 13%, but based on institutional births its increase to 19%. The forest plot demonstrated that a significant inclination of C-section among urban than rural regions. In Meta-Analysis, very high and significant heterogeneity among countries is observed, but confirms that in terms of prevalence of C-section all of the countries follow independent pattern.

Conclusion

Study of seven urban and four rural regions of nine South and South- East Asian countries showed, a significant inclination towards the caesarean delivery above the more recent outdated WHO recommended an optimal range of 10–15%and are associated maternal socioeconomic characteristics. In order to control unwanted caesarean delivery, the government needs to develop better healthcare infrastructure and along with more antenatal care related schemes to reduce the risks associated with increased caesarean delivery.

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Most cited references 17

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Timing of elective repeat cesarean delivery at term and neonatal outcomes.

Alan Tita, Mark Landon, Catherine Y. Spong … (2009)

Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes. We studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU). Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome (adjusted odds ratio for births at 37 weeks, 2.1; 95% confidence interval [CI], 1.7 to 2.5; adjusted odds ratio for births at 38 weeks, 1.5; 95% CI, 1.3 to 1.7; P for trend <0.001). The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks. Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes. 2009 Massachusetts Medical Society

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Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study.

Fernando Althabe, Claudio Sosa, José M Belizán … (2006)

Cesarean section rates show a wide variation among countries in the world, ranging from 0.4 to 40 percent, and a continuous rise in the trend has been observed in the past 30 years. Our aim was to explore the association of cesarean section rates of different countries with their maternal and neonatal mortality and to test the hypothesis that in low-income countries, increasing cesarean section rates were associated with reductions in both outcomes, whereas in high-income countries, such association did not exist. We performed a cross-sectional multigroup ecological study using data from 119 countries from 1991 to 2003. These countries were classified into 3 categories: low-income (59 countries), medium-income (31 countries), and high-income (29 countries) countries according to an international classification. We assessed the ecological association between national cesarean section rates and maternal and neonatal mortality by fitting multiple linear regression models. Median cesarean section rates were lower in low-income than in medium- and high-income countries. Seventy-six percent of the low-income countries, 16 percent of the medium-income countries, and 3 percent of high-income countries showed cesarean section rates between 0 and 10 percent. Three percent of low-income countries, 36 percent of medium-income countries, and 31 percent of high-income countries showed cesarean section rates above 20 percent. In low-income countries, a negative and statistically significant linear correlation was observed between cesarean section rates and neonatal mortality and between cesarean section rates and maternal mortality. No association was observed in medium- and high-income countries for either neonatal mortality or maternal mortality. No association between cesarean section rates and maternal or neonatal mortality was shown in medium- and high-income countries. Thus, it becomes relevant for future good-quality research to assess the effect of the high figures of cesarean section rates on maternal and neonatal morbidity. For low-income countries, and on confirmation by further research, making cesarean section available for high-risk pregnancies could contribute to improve maternal and neonatal outcomes, whereas a system of care with cesarean section rates below 10 percent would be unlikely to cover their needs.

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Searching for the optimal rate of medically necessary cesarean delivery.

Jiangfeng Ye, Ana Betran, Miguel Guerrero Vela … (2014)

Over the past three decades, the World Health Organization expert panel proposed cesarean delivery rate of 10-15 percent was used as a doctrine for an optimal rate of cesarean delivery despite the lack of concrete evidence. We set out to compile cesarean delivery rates, socioeconomic indicators, and health outcomes by countries in the last three decades to explore the optimal rates for medically necessary cesarean delivery.

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Author and article information

Contributors

Vivek Verma: Role: ConceptualizationRole: Writing – original draft

Ramesh K. Vishwakarma: Role: Formal analysis

Dilip C. Nath: Role: Data curation

Hafiz T. A. Khan:

ORCID: http://orcid.org/0000-0002-1817-3730

Role: Writing – review & editing

Ram Prakash: Role: Methodology

Omer Abid: Role: Resources

Russell Kabir: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 12 March 2020

Publication date Collection: 2020

Volume: 15

Issue: 3

Electronic Location Identifier: e0229906

Affiliations

[1 ] Departments of Neurology, All India Institute of Medical Sciences, New Delhi, India

[2 ] Department of Biostatistics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

[3 ] King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

[4 ] Ministry of the National Guard—Health Affairs, Riyadh, Saudi Arabia

[5 ] Assam University, Silchar, Assam, India

[6 ] The Graduate School, University of West London, London, United Kingdom

[7 ] Department of Quality Assurance Unit, Eurofins Therapeutics Limited, Bangalore, India

[8 ] Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

Anglia Ruskin University, UNITED KINGDOM

Author notes

Competing Interests: The authors have read the journal's policy and the authors of this study have the following competing interests: RP is a paid employee of Eurofins Limited ( https://www.eurofins.com/agroscience-services/about-us/latest-news/eurofins-scientific-to-acquire-advinus-therapeutics/). There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

* E-mail: hafiz.khan@ 123456uwl.ac.uk

Author information

Hafiz T. A. Khan http://orcid.org/0000-0002-1817-3730

Article

Publisher ID: PONE-D-20-00874

DOI: 10.1371/journal.pone.0229906

PMC ID: 7067459

PubMed ID: 32163440

SO-VID: 976e6c60-152d-4b90-81fb-e19a98f3b70d

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 18 January 2020

Date accepted : 28 January 2020

Page count

Figures: 8, Tables: 5, Pages: 15

Funding

Eurofins Limited provided support in the form of salary for author: RP. The specific role of this author is articulated in the ‘author contributions’ section.

Custom metadata

Data Availability All relevant data are from The DHS Program ( https://dhsprogram.com/data/).

Prevalence and determinants of caesarean section in South and South-East Asian women

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Abstract

Background

Objective

Methodology

Results

Conclusion

Related collections

PLOS Climate

Most cited references 17

Timing of elective repeat cesarean delivery at term and neonatal outcomes.

Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study.

Searching for the optimal rate of medically necessary cesarean delivery.

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