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      Trend and socio-demographic differentials of Caesarean section rate in Addis Ababa, Ethiopia: analysis based on Ethiopia demographic and health surveys data

      research-article
      Author(s): 1 ,
      Publication date (Electronic):
      Journal: Reproductive Health
      Publisher: BioMed Central
      Keywords: Caesarean section, Maternal health, Addis Ababa

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          Abstract

          Background

          According to the World Health Organization, Caesarean Section (CS) rate (percentage of births managed by CS) exceeding 15% lacks medical justification and it could be linked with adverse maternal and child health consequences. Nonetheless, the rate in Addis Ababa city is beyond the aforementioned level. The objectives of the study were to assess the trend and socio-demographic differentials of CS rate in the city.

          Methods

          The study was made based on the three Ethiopia Demographic and Health Surveys (EDHS) data (EDHS 2000, 2005 and 2011). The trend over the period of 1995–2010 was assessed using simple linear regression analysis whereas the differentials of CS rate were identified based on DHS 2011 data. CS rates were compared across categories of various socio-economic variables using chi-square test.

          Results

          The CS rate increased significantly from 2.3% in 1995–1996 to 24.4% in 2009–2010. From 2003 onwards, it persisted above 15%. The rates among women with secondary (32.3%) or higher (33.3%) levels of education were nearly two times higher than the corresponding figures in the illiterates (14.8%) and women with primary education (15.8%) ( P < 0.001). The level among women from the ‘rich’ households (28.6%) was higher than those from the ‘poor’ (16.4%) and ‘middle’ (19.5%) households ( P = 0.016). The rate also significantly increased with rising parity ( P = 0.023). The rate among women who delivered in private health institutions (41.7%) was twice higher than their counterparts who delivered in public institutions (20.6%).

          Conclusion

          The CS rate in Addis Ababa has exceeded beyond the level recommended by the WHO. Accordingly, It should be maintained within the optimum 5-15% range by introducing medical audit for labor management both in the private and public health institutions. Further, during prenatal care pregnant women should be fully informed about the risks of medically unjustified CS.

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          Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health

          JP Souza, AM Gülmezoglu, P Lumbiganon … (2010)
          Background There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. Methods This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. Results A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. Conclusions Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.
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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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              Health consequences of the increasing caesarean section rates.

              Fernando Althabe, Fernando Althabe, Maria Cafferata (2007)
              Caesarean section (C-section) rates are rising in many middle- and high-income countries, with the justification that higher rates of C-section are associated with better outcomes. A review of 79 studies comparing outcomes of elective caesarean sections with vaginal deliveries, including both observational studies and randomized trials, suggests that caesarean sections may have substantially greater risks than vaginal deliveries. In this issue of Epidemiology, Leung and colleagues present data from Hong Kong on morbidity in offspring related to C-section. Such studies are needed to widen the scope of possible health outcomes related to elective C-sections, including such endpoints as maternal satisfaction and women's relationship with their child. Testing of interventions to reduce unnecessary C-sections is also needed, with strategies to enhance the role of women in the process of their obstetric care.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Reprod Health
                Journal ID (iso-abbrev): Reprod Health
                Title: Reproductive Health
                Publisher: BioMed Central
                ISSN (Electronic): 1742-4755
                Publication date Collection: 2014
                Publication date (Electronic): 14 February 2014
                Volume: 11
                Page: 14
                Affiliations
                [1 ]School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
                Article
                Publisher ID: 1742-4755-11-14
                DOI: 10.1186/1742-4755-11-14
                PMC ID: 3925324
                PubMed ID: 24563907
                SO-VID: c62cd5d2-586b-4bb9-a454-4e1b5e8289c4
                Copyright © Copyright © 2014 Gebremedhin; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 28 September 2013
                Date accepted : 10 February 2014
                Categories
                Subject: Research

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: maternal health,caesarean section,addis ababa
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: maternal health, caesarean section, addis ababa

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