Prevalence, indications, and complications of caesarean section in health facilities across Nigeria: a systematic review and meta-analysis

Abstract

Background Over 80,000 pregnant women died in Nigeria due to pregnancy-related complications in 2020. Evidence shows that if appropriately conducted, caesarean section (CS) reduces the odds of maternal death. In 2015, the World Health Organization (WHO), in a statement, proposed an optimal national prevalence of CS and recommended the use of Robson classification for classifying and determining intra-facility CS rates. We conducted this systematic review and meta-analysis to synthesise evidence on prevalence, indications, and complications of intra-facility CS in Nigeria. Methods Four databases (African Journals Online, Directory of Open Access Journals, EBSCOhost, and PubMed) were systematically searched for relevant articles published from 2000 to 2022. Articles were screened following the PRISMA guidelines, and those meeting the study’s inclusion criteria were retained for review. Quality assessment of included studies was conducted using a modified Joanna Briggs Institute’s Critical Appraisal Checklist. Narrative synthesis of CS prevalence, indications, and complications as well as a meta-analysis of CS prevalence using R were conducted. Results We retrieved 45 articles, with most (33 (64.4%)) being assessed as high quality. The overall prevalence of CS in facilities across Nigeria was 17.6%. We identified a higher prevalence of emergency CS (75.9%) compared to elective CS (24.3%). We also identified a significantly higher CS prevalence in facilities in the south (25.5%) compared to the north (10.6%). Furthermore, we observed a 10.7% increase in intra-facility CS prevalence following the implementation of the WHO statement. However, none of the studies adopted the Robson classification of CS to determine intra-facility CS rates. In addition, neither hierarchy of care (tertiary or secondary) nor type of facility (public or private) significantly influenced intra-facility CS prevalence. The commonest indications for a CS were previous scar/CS (3.5–33.5%) and pregnancy-related hypertensive disorders (5.5–30.0%), while anaemia (6.4–57.1%) was the most reported complication. Conclusion There are disparities in the prevalence, indications, and complications of CS in facilities across the geopolitical zones of Nigeria, suggestive of concurrent overuse and underuse. There is a need for comprehensive solutions to optimise CS provision tailor-made for zones in Nigeria. Furthermore, future research needs to adopt current guidelines to improve comparison of CS rates.

Prevalence and associated factors of caesarean section among mothers who gave birth across Eastern Africa countries: Systematic review and meta-analysis study

“…The results of the present meta-analysis were higher than meta-analysis results from the studies conducted in 9 developing countries in South East Asia which is 13 % [ 69 ] and another two systematic review and meta-analysis from Africa: 17.6 % in Nigeria [ 70 ] and 9.9 % in Cameron [ 71 ]. However, lower than a systematic review and meta-analysis conducted in Iran found 48 % prevalence of caesarean section [ 72 ].…”

“…The evidence from the reported prevalence estimate of caesarean section in developed and developing countries shows that the prevalence of caesarean section in the range of 23.5 %–63.27 % [ [24] , [25] , [26] , [27] , [28] , [29] , [30] ] and 2.1 %–29.55 % [ [31] , [32] , [33] , [34] , [35] , [36] , [37] ] respectively. Various studies undertaken in various sections of East African countries reveal varying in the prevalence of caesarean section such as: 14 % in Uganda [ 38 ], 15.6 % in Rwanda [ 39 ], 20.7 % in Zambia [ 40 ], 28.9 % in Tanzania [ 41 ] and 27.6 % in Ethiopia [ 42 ].…”