Multilevel analysis to identify the factors associated with caesarean section in Bangladesh: evidence from a nationally representative survey

Ahmed, Md. Sabbir; Islam, M. Mufakharul; Jahan, Ishrat; Shaon, Imran Faisal

doi:10.1093/inthealth/ihac006

Cited by 19 publications

(45 citation statements)

References 29 publications

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“…Consistent with previous studies [ 7 , 8 ], women from rich households were more likely to have caesarean delivery compared to women from poor households. Women from rich households could afford expenses related to caesarean delivery and transportation.…”

Section: Discussionsupporting

confidence: 91%

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Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: Evidence from national population and health facility data

Chojenta¹,

Getachew²,

Smith³

et al. 2022

PLoS ONE

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Background Caesarean section has a significant role in reducing maternal and neonatal mortality. A linked analysis of population and health facility data is valuable to map and identify caesarean section use and associated factors. This study aimed to identify geographic variation and associated factors of caesarean delivery in Ethiopia. Method Linked data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) and the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) survey was performed. Spatial analysis was conducted to identify geographic variations and factors associated with caesarean delivery. Hierarchical Bayesian analysis was also performed to identify factors associated with caesarean delivery using the SAS MCMC procedure. Results Women’s age and education, household wealth, parity, antenatal care (ANC) visits, and distance to caesarean section facility were associated with caesarean delivery use. Women who had ≥4 ANC visits were 4.67 (95% Credible Interval (CrI): 2.17, 9.43) times more likely to have caesarean delivery compared to those who had no ANC visits. Women who had education and were from rich households were also 2.80 (95% CrI: 1.83, 4.19) and 1.80 (95% CrI: 1.08, 2.84) times more likely to have caesarean deliveries relative to women who had no education and were from poor households, respectively. A one-kilometer increase in distance to a caesarean section facility was associated with an 88% reduction in the odds of caesarean delivery (Adjusted Odds Ratio (AOR) = 0.12, 95% CrI: 0.01, 0.78). Hotspots of high caesarean section rates were observed in Addis Ababa, Dire Dawa, and the Harari region. In addition, women’s age at first childbirth and ≥4 ANC visits showed significant spatially varying relations between caesarean delivery use across Ethiopia. Conclusion Caesarean section is a lifesaving procedure, and it is essential to narrow disparities to reduce maternal and neonatal mortality and avoid unnecessary procedures.

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Section: Discussionsupporting

confidence: 91%

“…Consistent with studies in Rwanda [ 6 ], India [ 42 ] and Bangladesh [ 7 ], the odds of caesarean sections were higher among women with more ANC visits. As per the WHO recommendations, ANC visits are for risk identification, prevention and management of complications, and health education and promotion [ 63 ].…”

Section: Discussionsupporting

confidence: 87%

Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: Evidence from national population and health facility data

Chojenta¹,

Getachew²,

Smith³

et al. 2022

PLoS ONE

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show abstract

“…Consistent with studies in Rwanda (6), India (42) and Bangladesh (7), the odds of caesarean sections were higher among women with more ANC visits. As per the WHO recommendations, ANC visits are for risk identification, prevention and management of complications, and health education and promotion (63).…”

Section: Determinants Of Spatial Variations In Caesarean Delivery Usesupporting

confidence: 86%

“…The copyright holder for this this version posted October 10, 2022. ; https://doi.org/10.1101/2022.10.07.22280820 doi: medRxiv preprint Consistent with previous studies (7,8), women from rich households were more likely to have caesarean delivery compared to women from poor households. Women from rich households could afford expenses related to caesarean delivery and transportation.…”

Section: Determinants Of Spatial Variations In Caesarean Delivery Usesupporting

confidence: 79%

“…Inequalities in caesarean sections could be explained by different demand and supplyside factors. The demand-side factors, including individual, household, and community-level factors, are significantly associated with caesarean delivery use (6)(7)(8). The supply-side factors, such as availability and quality of services, facilities' readiness to provide services, and providers' competency and caring behaviour, influence women's use of caesarean sections.…”

Section: Introductionmentioning

confidence: 99%

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Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: evidence from national population and health facility data

Chojenta

Getachew

Smith

et al. 2022

Preprint

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Background: Caesarean section has a significant role in reducing maternal and neonatal mortality. A linked analysis of population and health facility data is valuable to map and identify caesarean section use and associated factors. This study aimed to identify geographic variation and associated factors of caesarean delivery in Ethiopia. Method: Linked data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) and the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) survey was performed. Spatial analysis was conducted to identify geographic variations and factors associated with caesarean delivery. Hierarchical Bayesian analysis was also performed to identify factors associated with caesarean delivery using the SAS MCMC procedure. Results: Women's age and education, household wealth, parity, antenatal care (ANC) visits, and distance to caesarean section facility were associated with caesarean delivery use. Women who had 4 or more ANC visits were 4.67 (95% Credible Interval (CrI): 2.17, 9.43) times more likely to have caesarean delivery compared to those who had no ANC visits. Women who had education and were from rich households were also 2.80 (95% CrI: 1.83, 4.19) and 1.80 (95% CrI: 1.08, 2.84) times more likely to have caesarean deliveries relative to women who had no education and were from poor households, respectively. A one-kilometer increase in distance to a caesarean section facility was associated with an 88% reduction in the odds of caesarean delivery (Adjusted Odds Ratio (AOR) = 0.12, 95% CrI: 0.01, 0.78). Hotspots of high caesarean section rates were observed in Addis Ababa, Dire Dawa, and the Harari region. In addition, women's age at first childbirth and 4 or more ANC visits showed significant spatially varying relations between caesarean delivery use across Ethiopia. Conclusion: Caesarean section is a lifesaving procedure, and it is essential to narrow disparities to reduce maternal and neonatal mortality and avoid unnecessary procedures.

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Low-Value Surgical Procedures in Low- and Middle-Income Countries

Albarqouni,

Abukmail,

MohammedAli

et al. 2023

JAMA Netw Open

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ImportanceOveruse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures.ObjectivesTo assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs.Evidence ReviewWe searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions.FindingsOf 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle–income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders.Conclusions and RelevanceThis systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.

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Multilevel analysis to identify the factors associated with caesarean section in Bangladesh: evidence from a nationally representative survey

Cited by 19 publications

References 29 publications

Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: Evidence from national population and health facility data

Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: Evidence from national population and health facility data

Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: evidence from national population and health facility data

Low-Value Surgical Procedures in Low- and Middle-Income Countries

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