Cesarean section in sub-Saharan Africa

Abstract

Cesarean section is an essential maternal healthcare service. Its role in labor and delivery care in low- and middle-income countries is complex; in many low-resource settings it is underutilized in the most needy of populations and overused by the less needy, without clear methods to ensure that universal access is available. Additionally, even if universal access were available, it is not evident that these countries would have the capacity or the finances to appropriate meet demand for the procedure, or that patients would want to utilize the care. This review summarizes the literature and illustrates the complicated relationship that cesarean section, which is rapidly on the rise around the world, has with individuals, communities, and nations in sub-Saharan Africa.

A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa

“…The WHO established that CS is an essential procedure in the management of delivery, and recommended a rate of 5-15% of all births worldwide, based on the CS rates in countries with the lowest perinatal mortality and morbidity. 2 CS rates higher than 10% are not associated with a reduction in neonatal and maternal mortality rates. 5 Caesarean section rates vary depending on a multitude of factors, such as foetal, maternal and medical complications in pregnancy, and cultural attitudes towards CS.…”

“…12 In sub-Saharan Africa one third of elective CSs were done at a gestational age of less than 39 weeks. 2 The probability of antepartum stillbirth with an elective CS has been calculated at 0.08% at 38 weeks' gestation, and this figure increases to 0.34% at 41 weeks' gestation. 14 Infants delivered by pre-labour CS between 37 and 42 weeks gestational age were nearly seven times more likely to develop respiratory morbidity than infants who were delivered vaginally.…”

“…2 CS rates vary worldwide, ranging from approximately 10% in Sweden to about 80% in private-sector hospitals in Brazil. 1,3 Although the lowest rates of 6.5-7.3% are seen in Africa, 2,4 rates of approximately 30% are reported in regional and tertiary public hospitals in the Durban Metropolitan area of South Africa. 1,3 CS rates are increasing globally.…”

“…From 1994 to 2014 the global average increased from 12.4% to 18.6%, and this upward trend can also be seen in sub-Saharan Africa. 2 The question has been raised as to whether there is an ideal CS rate. The WHO established that CS is an essential procedure in the management of delivery, and recommended a rate of 5-15% of all births worldwide, based on the CS rates in countries with the lowest perinatal mortality and morbidity.…”

Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study

“…This surgical procedure is viewed as one of the major World Health Organization's (WHO) medically suggested plan towards improving availability, accessibility, quality, and the use of services for the management and treatment of complications of pregnancy, labour, and delivery [3]. CS is also considered an essential treatment for antepartum haemorrhage, prolonged or obstructed labour, preeclampsia or eclampsia, and intrapartum foetal distress [4]. Nevertheless, a 2008 WHO survey of 373 facilities across 24 countries found that caesareans deliveries (CD) were associated with an increased risk of maternal mortality and serious outcomes for mothers and newborn infants, compared with spontaneous vaginal delivery (VD) [5].…”