An analysis of the practices of caesarean section in sub-Saharan Africa: A summary of the literature

Abstract

Introduction:Ensuring access to quality caesarean sections (CS) is a challenge for the next millennium and a sustainable development goal to reduce maternal and infant mortality. A CS involves risks and complications and should therefore be performed in an approved way and not used excessively. The WHO recommends that the CS rate should not exceed 10-15%. Approximately 99% of maternal deaths occur in developing countries where efforts to reduce maternal deaths are still low. This review of the literature aims to provide a summary of CS practices in sub-Saharan Africa and the consequences in terms of morbidity and mortality. Material and Method:The data was collected following the selection criteria on the NCBI's PubMed.Result: Across the four main themes selected for this summary, the frequency of CS varies from 2 to 51%. Indications for caesarean CS are mainly dystocia, foetal distress, scarred uterus, breech presentation, antenatal haemorrhage and hypertensive disorders. Maternal risks related to CS are surgical site infections, obstetric fi stulae, anaesthetic complications, pulmonary embolism, postpartum haemorrhage, haemostatic hysterectomy and maternal death, and the perinatal risks related to CS are respiratory distress, prematurity and perinatal death. Conclusion:In the current working conditions, the risks incurred by the mother and the foetus during a CS are signifi cantly greater than during a vaginal delivery. CS is not yet a factor in reducing maternal and perinatal morbidity and mortality in Sub-Saharan Africa. To reduce maternal and perinatal morbidity and mortality, working conditions at referral centre level, transfer conditions, and improve the training of health staff should be improved. Citation:Dikete M, Coppieters Y, Trigaux P, Englert Y, Simon P, et al. (2019) An analysis of the practices of caesarean section in sub-Saharan Africa: A summary of the literature. Arch Community Med Public Health 5(2): 077-086. DOI: http://dx.References were selected based on the following criteria: the type of study on CS, the target population and the data analysis using the following search terms on PubMed (intraoperative complications, caesarean section, maternal mortality and morbidity, perinatal mortality and morbidity, Africa South of the Sahara) for the period from 2011 to 2016 (the period during which we started missions to support the training of gynaecologists and obstetricians in the east of the Democratic Republic of the Congo). The following inclusion criteria were applied: articles focusing essentially on the CS, the indications for a CS, and maternal and perinatal complications associated with CS in sub-Saharan Africa. The studies selected were retrospective, prospective, clinical trials and ecological studies. Clinical cases were excluded from this review. The target population is the population of sub-Saharan Africa: the population studied was composed of women who had a CS delivery and their new-borns infants. The registrations of the participants involved in the various studies were examined...

Analysis of caesarean section practices and consequences in Goma, DR Congo: Frequency, indications, maternal and perinatal morbidity and mortality

“…One study analysed the proportion of CS in SSA and showed an average CS rate of 19% [13], which is in line with the overall estimate described in the literature [14]. Another study on the analysis of CS practices in SSA described a CS rate of 2 to 52% [15]. This study showed that this rate varies depending on the population studied and on access to healthcare [15,16].…”

“…Intra transfusion, wound suppuration, septicaemia, peritonitis, parting of stitches, urogenital fi stulae and hypertensive disorders. One study described the same maternal risks associated with CS in SSA [15]. Maternal mortality was 0.1%, and 0.1% of patients were transferred.…”

“…Another study on the analysis of CS practices in SSA described a CS rate of 2 to 52% [15]. This study showed that this rate varies depending on the population studied and on access to healthcare [15,16].…”

“…The "once a caesarean always a caesarean" policy is widely applied in SSA, mainly from fear of uterine rupture during labour. This policy helps reduce both the uterine rupture rate and the emergency surgery responsible for the increase in maternal and perinatal mortality and morbidity [15]. These repeat caesareans do not, however, result in the medical benefi ts expected.…”

“…These are common factors in, and features of developing countries, although they vary in degree.Dystocia (diffi cult and protracted labour) was the leading indication for CS in our study. Dystocia is mainly caused by insuffi cient uterine contractions, sometimes due to cephalopelvic disproportion or no progress in foetal descent due to a tumour; however, it is sometimes diffi cult to make this diagnosis prior to labour[15]. Certain authors wondered whether dystocia was being over-diagnosed nowadays, in order to justify more frequent use of CS[26].…”