Regional Differences and Sociodemographic Factors Associated with Cesarean Section Delivery in Bangladesh through Multilevel Poisson Regression Model

Abstract

Cesarean section is the most challenging issue not only in developing countries but also in developed countries because it is increasing at an alarming rate worldwide, where the majority of cesarean sections are unnecessary. Unnecessary cesarean delivery in Bangladesh is widespread and is responsible for long-term and short-term health complications for both mothers and children. This study aimed to assess regional differences and sociodemographic factors associated with cesarean section delivery in Bangladesh. The most recent Bangladesh Demographic and Health Survey 2017-18 data was used in this study. A total of 5,299 ever-married women who gave birth within the three years preceding the survey were analyzed. A multilevel Poisson regression model was used to identify the sociodemographic factors associated with cesarean section deliveries in Bangladesh. The prevalence of cesarean section deliveries was about 33.0%. The result showed that women’s aged 30-36 years (IRR = 1.11, 95% CI = 1.01–1.22), women’s secondary education (IRR = 1.52, 95% CI = 1.14–2.02), higher secondary education (IRR = 1.82, 95% CI = 1.35–2.47), partner’s secondary education (IRR = 1.28, 95% CI = 1.05–1.57), higher secondary education (IRR = 1.54, 95% CI = 1.25–1.91), women living in the Dhaka division (IRR = 1.22, 95% CI = 1.04–1.43), women living in the Khulna division (IRR = 1.36, 95% CI = 1.15–1.60), and women living in the Rajshahi division (IRR = 1.26, 95% CI = 1.06–1.51), middle wealth index (IRR = 1.31, 95% CI = 1.13-1.52), richest wealth index (IRR=1.59, 95% CI=1.37-1.84) and exposure to mass media (IRR = 1.45, 95% CI = 1.27–1.64) were significantly more to deliver by cesarean section. Therefore, attention to women’s age, education, partner’s education, division, wealth index, and exposure to mass media might help policymakers make appropriate strategies and policies that would contribute to avoiding unnecessary cesarean section deliveries in Bangladesh.