Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999–2005

Abstract

BackgroundPrevious studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania.MethodsWe conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value < 0.05 was considered significant.ResultsThe proportion of teenage mothers (12–19 years) progressively decreased over time while that of 30–34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6–1.8)] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71–0.82). The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30–34 years age group had no impact on this.ConclusionThe population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.

Pregnancy outcomes in the extremes of reproductive age: A seven-year experience in Tanzania

“…This increase was purely contributed by the progressive rise in the proportion of deliveries by women at the age of 35 -50 years in the background of a progressive decrease in proportions of teenage deliveries. A similar trend was reported at the same hospital from 1999 [15] indicating that the delivering population at MNH has progressively continued to become older for more than a decade now. These results, albeit hospital based, somehow reflects fertility trends in the general society in Tanzania whereby according to the National survey data, the age specific fertility rate for teenagers (15 -19 [25].…”

“…These results, albeit hospital based, somehow reflects fertility trends in the general society in Tanzania whereby according to the National survey data, the age specific fertility rate for teenagers (15 -19 [25]. Although MNH is a tertiary hospital, over 80% of deliveries come directly from home without referrals [15], thus mimicking that of district level hospitals. Such a shift in demographic properties of a population in favor of high risk age groups has been observed elsewhere.…”

“…S. Muganyizi, B. Balandya / Open Journal of Obstetrics and Gynecology 3 (2013) 51-57 52 design problem. Some studies treat the age below 20 years as generally risky for obstetric complications [4,[6][7][8][11][12][13] while others hold that older teenagers (17 -18 years) have comparable outcomes to low risk controls [2,14,15]. The arbitrary assignment of heterogeneous age groups as risky or as controls may seriously interfere with the interpretation of results.…”

Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako - Mali)

“…A large ecological cross-sectional study reported that, in low income countries where cesarean deliveries rates are less than 10%, as section rates increase, neonatal and maternal mortality decrease [Althabe et al, 2006]. Our database revealed a sharp increase in the rates of hospital cesarean delivery, similar to those observed in many teaching hospital maternity wards in Africa [Muganyizi & Kidanto, 2009;Geidam et al, 2009;. However, countrywide cesarean delivery rates remain under the minimum level of 5% advised by the WHO for optimal obstetric care (table 12).…”

Trends in cesarean section rates at a large East African referral hospital from 2005-2010

“…Examination of local trends in CS is needed to assess the data gaps and explore ways for improvements because of suboptimal representation of how CS rates can be much higher at select hospitals. To our knowledge this is the third study in the past decade performed in SSA to examine hospital-specific trends in frequency of CS [13,14]. Our study adds to this literature by evaluating the trend in CS rates and indications from 2005-2010 at a referral institution for a large region of Tanzania.…”