Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries

Sanni Yaya, Olalekan A. Uthman, Agbessi Amouzou, Ghose Bishwajit

Access to safe Cesarean section (C-section) in resource-constrained settings such as sub-Sahara Africa (SSA) region is a foremost approach to reduce maternal mortality. C-section is an obstetric operative procedure used appropriately to improve delivery outcomes. However, errors in the procedure have enormous potential harm that may outweigh the benefits. This study assessed the prevalence and determinants of C-section in several SSA countries. This study examined the prevalence and determinants associated with cesarean delivery in SSA countries. Secondary data of women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 34 SSA countries was utilized in this study. The mode of delivery among women was the primary outcome variable. Percentage and descriptive statistics were used to conduct univariate analyses. Furthermore, multivariable multilevel logistic regression was used to investigate correlates of C-section among SSA women. Results showed disparities in the percentage of C-section among women from 34 SSA countries. C-section at public healthcare settings ranged from 3% in Burkina Faso to 15.6% in Ghana. However, in private healthcare settings, C-section ranged from 0% in Sao Tome and Principe to 64.2% in Rwanda. Overall, C-section was 7.9% from public healthcare and 12.3% from private healthcare facilities respectively. In the adjusted regression model; women aged 35-49 had increase in the odds of C-section, while a unit increase in the number of children ever born had 17 and 20% significant reduction in the odds of C-section in public and private healthcare respectively. Assessing public healthcare settings; women from richer/richest households, male and large size children at birth had increase in the odds of C-section, while those from rich neighbourhood had reduction in the odds of C-section. In private healthcare settings, women with high decision making power and multiple births had increase in the odds of C-section, while those who attended ANC visits had significant reduction in the odds of C-section. The findings from this study would help formulate health policies and implement actions that would improve the outcome of C-section care. Monitoring of emergency obstetric care services is necessary to address issues connected to poor C-section outcomes in resource-constrained settings. Also training of medical personnel including midwives and nurses in emergency obstetric care, ensuring accessibility to life-saving drugs and supplies should be encouraged in health care system.