Prevalence and predictors of caesarean section delivery among pregnant women delivering at a tertiary hospital in South-Western Uganda: A cross-sectional study

Abstract

Background Caesarean section delivery has played a key role in reducing maternal and perinatal mortality when offered where it is medically indicated. Caesarean section delivery rates have risen over the last 3 decades across the globe making this a public health concern. Reasons for these high rates are not known especially for South-western Uganda. We therefore aimed to determine the prevalence and predictors of caesarean section delivery among women delivering at a tertiary Hospital in South-western Uganda. Methods This cross sectional study was done between 1st September and 30th November 2023. We reviewed and abstracted secondary data from the from the Uganda health management information system including the Integrated Maternity Register coded as HMIS 072 in the maternity ward at Kabale Regional Referral Hospital, in south-western Uganda. We abstracted data on maternal-related factors including socio-demographic – and pregnancy-related characteristics as well as foetal-related characteristics Data were analysed using Stata version 14.0 (StataCorp, College Station, Texas, USA.). We estimated adjusted prevalence ratios using modified Poisson regression models. Results The prevalence of caesarean section delivery in this study is 47.9% (n=457/955) (95%CI: 44.6% - 51.1%). The indications for a caesarean section were previous uterine scar, prolonged labour, foetal distress, premature rupture of membranes, and inadequate pelvis among others. Predictors for caesarean section delivery include: 1) maternal-related characteristics included: having attained a tertiary level of education (APR=0.74, 95%CI: 0.55 – 0.96), having a careered profession (APR=1.37, 95%CI: 1.05 – 1.77), belonging to other ethnic groups that are not predominant in the study setting (APR=1.33, 95%CI: 1.09 – 1.64). 2) foetal-related factors included: multiple pregnancy (APR=1.89, 95%CI: 1.43 – 2.48) and foetus in a position other than the left or right occipital anterior (APR=1.81, 95%CI: 1.18 – 2.78) Conclusions and recommendations. The prevalence of caesarean section remains alarmingly high. We recommend that keen attention should be given to pregnant women during health education especially those that do not understand the predominantly used language during the sessions. We also recommend caesarean section audits done for all women that have been referred from lower health facilities to deliver at this tertiary hospital especially for women with a previous uterine scar