Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample

Abstract

Background Caesarian sections (CS) are life-saving management for a pregnant mother and fetus subject to obstetric complications. The World Health Organization (WHO) expected CS rates not to exceed 10 to 15 per 100 live births in any country. This study aimed to assess the prevalence of CS and its associated factors from the 2016 Nepal Demographic and Health Survey (NDHS), building on previous studies mentioned in detail in the latter part of the paper. Methods This study analyzed the secondary data from the 2016 Nepal Demographic and Health Survey (NDHS), conducted from June 19, 2016, to January 31, 2017. The survey is undertaken every five years; consequently, the data capture the information in the previous five years from the data collection period. We used the 2016 NDHS, which is implemented by the new Enumeration Area (EA) under the support of the Ministry of Health (MOH) and funded by the U.S. Agency for International Development (USAID). In the rural areas, the sample is stratified and selected in two stages. In the first stage, wards are selected as the primary sampling units (PSU), with households subsequently chosen from the PSUs. In the urban areas, the sample is nominated in three stages. In the first stage, wards are selected as PSUs; in the second stage, one EA is chosen from each PSU, and finally, households are selected from the EAs. Then data were collected from the women in the reproductive age group within the selected households. Results The prevalence of CS in Nepal conforms to the WHO standard with 7.8, 7.5, and 8.1 per 100 deliveries, or 9.8, 8.9, and 9.1 per women’s last births in the previous one, three, and five years, respectively. Older mothers of 30 years old or more, having high incomes, being overweight and obese, using the internet, ante-natal care (ANC) visits of more than four times, ANC by doctors, twin delivery, and having babies of 4 kg or more, had higher odds for a CS while having two or more children seemed to be protective towards CS. Conclusion These findings can be used to update health policies surrounding CS delivery to limit unnecessary CS and ensure better health as CS is not without complications.

Predominant Maternal Risk Factors Increase the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study in a Reproductive-Aged Women Population

“…However, some of the existing findings seem inconsistent and inconclusive, providing rather contradictory results at least for certain maternal risk factors. Currently, there is substantial evidence that older maternal age, i.e., 35 years or more, considerably increases the rate of caesarean sections and their adverse outcomes [15,30]. In line with the above findings, we found a significantly higher age in women performing caesarean section compared to those delivering vaginally, independently of multiple confounding factors which are also linked with raised probability of caesarean section delivery.…”

“…In support of this view, prepregnancy maternal obesity has been considered as a significant risk factor for caesarean delivery, even if some studies were characterized by certain limitations [13,14]. Moreover, mothers' age lower than 30 years was shown to decrease the risk of comorbidities related with caesarean section, whereas older maternal age, i.e., 35 years or more, was shown to considerably enhanced the rate of caesarean sections and their adverse outcomes [15]. Several previous studies also indicated that residency, women's education, wealth, and parity may considerably increase caesarean section rates; however, there are also studies which did not confirm these associations [16].…”

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study

“…The prevalence of CS in this hospital at the time of study was 33.04%, which is higher than that recommended by WHO and the national statistics of Nepal i.e.2016 Nepal Demographic and Health Survey report (NDHS) 5 , 9 . WHO recommends the national CS rate to be between 10 and 15% with less than 10 and greater than 15% representing underuse and overuse of maternal and child health care services, respectively and beyond this recommended level there is no additional reduction in maternal and neonatal mortality and morbidity 5 , 11 .…”

Prevalence and Associated Factors of Cesarean Section in Dhulikhel Hospital, Kathmandu University Hospital

“…This correlates with the study conducted by Das et al in 2021 (p=0.002). 18 Multiple studies worldwide have also reported similarly that the mothers' age remains a significant factor in determining childbirth through CS. [18][19][20][21][22][23] In contrast, study done in Eastern Ethiopia does not show the association age with Cesarean Section.…”

“…But the study conducted by Das et al shows the association of parity (COR = 1.61) and ANC visit (COR=2.50) with Cesarean Section. 18 Non-institutional births were not taken into consideration in determining the extent of normal birth, which is one of the study's weaknesses. This study was conducted at a single center therefore it cannot be applied to all hospitals.…”