Trends in and socio-demographic factors associated with caesarean section at a Tanzanian referral hospital, 2000 to 2013

Abstract

BackgroundCaesarean section (CS) can prevent maternal or fetal complications. Sub-Saharan Africa has the lowest CS levels in the world but large variations are seen between and within countries. The tertiary hospital, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania has had a high level of CS over years. The aim of this study was to examine trends in the socio-demographic background of babies born at KCMC from year 2000 to 2013, and trends in the CS percentage, and to identify socio-demographic factors associated with CS at KCMC during this period.MethodsThis is a registry-based study. The analyses were limited to singletons born by women from Moshi urban and rural districts. The Chi square test for linear trend was used to examine trends in the CS percentage and trends in the socio-demographic background of the baby. The association between different socio-demographic factors and CS was assessed using logistic regression. The analyses were stratified by the mother’s residence.ResultsThe educational level of mothers and fathers and the age of the mothers of singletons born at KCMC increased significantly from year 2000 to 2013 both among urban and rural residents. Among 29,752 singletons, the overall CS percentage was 28.9%, and there was no clear trend in the overall CS percentage between 2000 and 2013. In the multivariable model, factors associated with higher odds of CS were: having been referred for delivery, maternal age above 25 and no- or primary education level of the baby’s father. Among rural mothers, no- or primary education, being from the Pare tribe and para 2–3 were also associated with higher odds of CS. Being from the Chagga tribe and high parity were associated with lower odds of CS compared to other tribes and parity 1.ConclusionsThe CS percentage remained high but stable over time. Large variations in CS levels between different socio-demographic groups were observed. The educational level of the parents of babies born at KCMC increased over time, possibly reflecting persistent inequitable access to the services offered at the hospital.

Indications for Caesarean Sections in Rundu State Hospital in Kavango East Region, Namibia

“…The findings of this study are similar to those of the study conducted by Janoudi et al (2015) who discovered that women aged 35 or older experienced a greater number of obstetrical complications as compared to women aged between 20 and 34 with such complications putting them at risk of C/S. The findings of this study also concur with the study done by Nilsen (2014) which found that C/S in higher maternal age groups was associated with medical conditions such as hypertension and diabetes. Moreover, in the industrialised world, social, demographic and educational social trends combined with the greater accessibility of birth control and wider solutions to infertility problems has increased the proportion of women experiencing their first pregnancy after the age of 35 (Cohen, 2014).…”

“…Adolescent pregnancy is defined as pregnancy in a young girl between the age of 13 and19 (Spencer, 2011). According to Nilsen (2014), the high C/S percentages in adolescents could be caused by obstructed labour due to an immature birth canal. This means that they became pregnant before the pelvis had matured, resulting in cephalo-pelvic disproportion which plays a central role in obstructed labour.…”

Analysis of caesareansection and neonatal outcome using the Robson classification in a rural district hospital in Tanzania: an observational retrospective study

“…High CS rates have been reported in other studies conducted in Tanzania25 29 (eg,31% at the Muhimbli Hospital and 35% in Kilimanjaro Christian Medical Center(KCMC)) probably because of the role played by a referral hospital in targeting high-risk pregnancies. This hypothesis could be confirmed by the higher CS rate in women referred from other facilities (63.7% in our study).…”

“…Nilsen et al 29 hypothesises that poor quality of care at the dispensary and HC level contributes to increasing the number of preventable CS in women who are referred late and in critical condition, meaning that by the time they get to the medical facility an emergency CS is the only possible action 31. In addition, several studies have highlighted the inadequacy of obstetric and neonatal care services at the primary level in Tanzania 32–34.…”

Tanzanian Mothers' Cultural Beliefs and Misinformation Regarding the Reasons for Their Cesarean Sections

“…In low-resource countries, CS carries a greater risk to mothers when compared to high-resource countries due to numerous environmental and human resources factor implications such as potential for postpartum hemorrhage, wound infections, sepsis, injury to proximal organs, and death (Nilsen et al, 2014). A Tanzanian study found multiple adverse effects caused by CS, including high rates of maternal mortality, major medical impediment, and commonly death for the pregnant mother, at a similar rate to that from other major surgeries (Nilsen et al, 2014). Another adverse effect of CS identified in Tanzania is the high cost to the healthcare system, the woman, and her family (Kruk, Paczkowski, Mbaruku, de Pinho, & Galea, 2009).…”