Prevalence and factors associated with caesarean section in Rwanda: a trend analysis of Rwanda demographic and health survey 2000 to 2019–20

Abstract

Background Caesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades. Methods We used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019–20. All births in the preceding 3 years to the survey were assessed for the mode of delivery. The participants’ characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys. Results The population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8–2.6) in 2000 to 15.6% (95% CI 13.9–16.5) in 2019–20. Despite increasing in all health facilities over time, the rate of CS was about four times higher in private (60.6%) compared to public health facilities (15.4%) in 2019–20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies. Conclusion Over the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

“…Finally, we found that the more children women had, the less likely they were to undergo CS delivery. Our results align with other studies conducted in Rwanda [ 6 ], Kenya [ 39 ], and Ethiopia [ 24 , 77 ]. A possible explanation is that women who had 5 or more children had previously given birth successfully or experienced fewer complications requiring CS [ 24 , 69 , 78 ].…”

“…Children with big size at birth had higher odds of CS compared to those with an average size. Former studies [ 6 , 55 ] affirmed this association between size of child at birth and CS. Big babies often have difficulties during deliveries (birth complications) due to insufficient passage and prolonged labor [ 6 , 56 ].…”

“…In Haiti, CS is a high-cost procedure, especially in private health facilities [ 70 ]. When women are covered by health insurance, it allows them to partially or totally cover the fees related to this surgical procedure [ 6 , 70 ].…”

Prevalence of Cesarian Delivery and Associated Factors Among Mothers Who Gave Birth at Public Hospitals, Jigjiga, Ethiopia

“…7 As shown study carried out in Kigali City, Rwanda the rate of CS significantly increased. 8 Sub-Saharan Africa (SSA); although the mean Cesarean delivery rate in SSA (5%) was shown the lowest rise, this rate is not representative of all regions. 9 Nationally; studies on cesarean delivery conducted in different settings showed substantial variations across administrative regions and places of delivery.…”

Does Obesity Influence Women’s Decision Making about the Mode of Delivery?

“…In some countries, such as Thailand, the rate of cesarean section in private care is almost ten-fold higher than in the public sector. In others, such as Rwanda, it is four times higher, and in India it is three times higher [ 6 , 7 ]. The situation is even more alarming in Bangladesh, where among the 50% of deliveries that take place in medical facilities, almost two-thirds are in private care facilities, where the CS ratio is 83% [ 8 ].…”