Risk Ratio Differences in the Exposure to Caesarean Section in the Central Area of the Western Highlands of Yemen

Abstract

Compared to vaginal deliveries, caesarean section (C-section) is a major surgery that could be associated with higher risks of maternal and infant mortality and morbidity. In Yemen, some recent reports indicated overuses of C-section. This was a cross-sectional study aimed to assess the risk ratio difference in C-section exposure between Yemeni mothers according to their demographic variables. A total of 400 participants of reproductive age visiting health centers for obstetric care in the central area of the western highlands of Yemen were randomly interviewed using a pretested questionnaire. The results found that the prevalence of C-section exposure among the study participants was 22%. Mothers' demographic variables showed significant differences in the risk ratio of C-section exposure. Among these variables, large differences in the risk ratio of C-section exposure were estimated between urban versus rural (RR = 3.9, ER = 2.9, P ˂ 0.001) and literate versus illiterate mothers (RR = 3.8, ER = 2.8, P ˂ 0.001). Relatively moderate differences were revealed by parity and maternal age variables (RR = 2.7; ER = 1.7; P ˂ 0.001, RR = 2.6; ER = 1.6; P ˂ 0.001, respectively). Age at marriage, employment status, and visiting health services practice, however, were associated with low differences in the C-section exposure. To strengthen the mother and infant health programs in Yemen, maternal variables including place of residence and educational status should be considered as predictors for either an unnecessary or additionally needed C-section.

Indications of Cesarean Section at Al-Wahdah Teaching Hospital, Dhamar, Yemen

“…According to the WHO, the recommended rate of cesarean section should be within 10-15% (AlSheeha., 2018), thus this study showed a higher rate. The observed rate of cesarean section in this study was higher than the previously reported rate in Dhamar Governorate which was 22% (Mehrass et al, 2016), and also higher than the reported rate in Hajjah, 2013 which was 30% (Al-Rukeimi et al, 2013). This high rate in Al-Wahdah Teaching Hospital may be because we didn't take into consideration mothers delivered at home or in a private clinic or the nearby hospitals, therefore, the actual rate of cesarean section for the area the hospitals serve is much lower, this is partly due to lack of health facilities in rural areas and also due to lack of knowledge or antenatal care.…”

“…The available literature suggests that the incidence of the cesarean section had considerably increased over the last decade, from 1.4 in 1997to 30% in 2013(Al-Rukeimi et al, 2013. In a study published in 2016 about the risk ratio differences in the exposure to cesarean in the central area of the Western Highlands of Yemen, the rate of cesarean section was found to be 22% which is higher than the rate recommended by WHO (Mehrass et al, 2016). Because of the lack of information about the incidence of cesarean section and its indicators in Yemen, particularly in the Dhamar Governorate, this study aimed to evaluate the incidence of cesarean section and identify the most common indications for cesarean section at Al-Wahdah Teaching Hospital, in Dhamar Governorate, Yemen.…”