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

Abstract

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.

Spatial distribution of caesarean deliveries and their determinants in Bangladesh: evidence from linked data of population and health facility survey

“… 35 , 37 Our findings confirm these multidimensional factors regarding private facilities and are consistent with the findings of a study conducted in Ethiopia. 6 Private facilities are often blamed for inefficient quality control, poor ethical standards, and profit motives. 37 While profit motives and associated ethical standards of private facilities are understandable, the reasons for the poor quality of services remain unclear.…”

“… 4 Although the CS delivery rate is lower in many Sub-Saharan African countries (9% or below), 5 the rates are significantly different in urban and rural areas. For example, the findings of a spatial analysis conducted in Ethiopia show that the delivery through CS rate is more than 20% in urban Ethiopia and less than 5% in rural and regional Ethiopia, 6 indicating a double burden of CS—the unmet need of CS coupled with its overuse. 7 , 8 A massive rise of unnecessary delivery through CS coupled with unavailability to those for whom it is a medical necessity (triple burden) has become a global public health concern.…”

Preference of cesarean delivery and its associated factors among pregnant women attending ante natal care at public health facilities of Debrebrehan City, Ethiopia: Cross-sectional study

“…Based on various attributes, differences continued to exist. Compared to rural areas, which had a cesarean section rate of 0.9%, urban areas had a cesarean section rate of 10.6% in 2016 [18][19][20]. Determining their preferences in terms of mode of delivery will help reduce maternal and prenatal morbidity and mortality [19].…”