A case-control study of factors associated with caesarean sections at health facilities in Kabarole District, Western Uganda, 2016

Abstract

IntroductionWorld Health Organization estimates that the appropriate caesarean section rates should range from 10% to 15% at the population level. There is limited access and utilisation of caesarean section services in Uganda. This case-control study explored factors associated with caesarean section delivery, focusing on service-related and individual level factors.Methodswe interviewed 134 cases that had a caesarean section and 134 controls that had a “normal” vaginal delivery. The study was conducted at health facilities in Kabarole district during March to May 2016. Multivariable logistic regression was used to determine individual factors associated with caesarean sections, at a significance level of p < 0.05. Key Informant (KI) data obtained from health workers was analysed using MAXQDA (version 12) software to determine health service factors affecting caesarean section service delivery.Resultsthe mean age of the overall sample was 26 years (SD ± 6.5 years). Cases had 5% more women who belonged to the eldest age group (> 35 years) compared to the controls. The factors associated with caesarean section delivery were: having a previous caesarean section delivery (adjusted odds ratio (AOR): 4.5 CI: 2.22-9.0), attendance of four or more ANC visits (AOR: 2.0 CI: 1.04-3.83). Inadequate human resource, medicines and supplies affected access to the service. Misconceptions such as negative branding of women that have caesarean section deliveries as “lazy” reduced its acceptance thus low utilisation of the service.Conclusionhealth system inadequacies and misconceptions about caesarean section delivery contributed to the low access and utilisation of the service.

Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study

“…In the Ngora district, it accounted for 9.3%. In FRRH, it accounted for 17%, while it made up 35% of the cases in Bangladesh [ 13 , 17 ]. This could be attributed to the presence of specialists in the latter two areas, and thus high-risk mothers such as with previous scars are likely to seek care from there.…”

“…ese findings are echoed in another study in Uganda by Dusabe et al in which women that underwent CS were considered lazy [17]. e findings could shade light on why although 82% of the women said they would accept a C-section in a study in Nigeria, they would do so if the husband consented despite their disapproval because he is the head of the family and therefore wants the best for the mother and the baby [39].…”

“…A study in Kabarole, Western Uganda, in 2016, established a caesarean rate of 25% with disparities at low- and high-level facilities with the former having a rate of 6–8% and the latter 18–16%. In this study, factors such as having a previous CS, complications during pregnancy, ANC attendance of 4 or more times, inadequate human resource, inadequate medicines and supplies, and myths and misconceptions about CS affected access and utilization of CS services [ 17 ]. This rise in the trend has not come without fears, and some countries like Italy have used it to gauge the quality of services provided; the low rate, being commendable as a marker of high-quality services.…”

High proportion of caesarean section at a rural hospital in south western Uganda:&nbsp;A cross sectional study

“…The other reason for the high proportion of CS in this study, maybe attributed to the fact that most of the rural health centres have inadequate resources and the shortage of healthcare staff such including midwives, nurses, general doctors and obstetricians (Dusabe et al, 2018), and this may lead to women preferring to deliver from this rural hospital compared to other health facilities within the region. This is because the study rural hospital has 2 obstetricians, 5 medical o cers, 2 intern doctors and 33 midwives and this sta ng, in particular, which may contribute to the high proportion of CS, put other studies related (Hospital records, 2018 .…”

“…Several studies have attempted to determine the factors that contribute to CS delivery including social demographics such as age, occupation , obstetric factors (number of ANC visits, parity, timing of rst ANC visit) and health system factors like referral status and distance (3,(10)(11)(12)(13)(14). There are few studies which focus on factors associated with CS in Uganda and these are limited to urban settings (9,15).…”