Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India

Abstract

BackgroundEven though the caesarean section is an essential component of comprehensive obstetric and newborn care for reducing maternal and neonatal mortality, there is a lack of data regarding caesarean section rates, its determinants and health outcomes among tribal communities in India.ObjectiveThe aim of this study is to estimate and compare rates, determinants, indications and outcomes of caesarean section. The article provides an assessment on how the inequitable utilization can be addressed in a community-based hospital in tribal areas of Gujarat, India.MethodProspectively collected data of deliveries (N = 19923) from April 2010 to March 2016 in Kasturba Maternity Hospital was used. The odds ratio of caesarean section was estimated for tribal and non-tribal women. Decomposition analysis was done to decompose the differences in the caesarean section rates between tribal and non-tribal women.ResultsThe caesarean section rate was significantly lower among tribal compared to the non-tribal women (9.4% vs 15.6%, p-value < 0.01) respectively. The 60% of the differences in the rates of caesarean section between tribal and non-tribal women were unexplained. Within the explained variation, the previous caesarean accounted for 96% (p-value < 0.01) of the variation. Age of the mother, parity, previous caesarean and distance from the hospital were some of the important determinants of caesarean section rates. The most common indications of caesarean section were foetal distress (31.2%), previous caesarean section (23.9%), breech (16%) and prolonged labour (11.2%). There was no difference in case fatality rate (1.3% vs 1.4%, p-value = 0.90) and incidence of birth asphyxia (0.3% vs 0.6%, p-value = 0.26) comparing the tribal and non-tribal women.ConclusionSimilar to the prior evidences, we found higher caesarean rates among non-tribal compare to tribal women. However, the adverse outcomes were similar between tribal and non-tribal women for caesarean section deliveries.

Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis

“…Antepartum hemorrhage, non-reassuring fetal heart rate pattern, malpresentation, and malposition, failed induction, obstructed labor, multiple gestations, cephalopelvic disproportion were the most common indications of Caesarean section in Ethiopia. This study finding is supported by the study done in low and middle-income countries [46], Saudi Arabia [42], Ghana [6,8], Jordan [4] and India [5].…”

“…46-33.65). This report is higher than the study done in Saudi Arabia [42], Nigeria [43], Pakistan [44], India [5], Brazil [45] and low and middleincome countries analysis [46]. This discrepancy might be due to the age of the mother elapses the ideal birth time, significantly increasing, non-communicable disease, increasing electronic fetal monitoring availability and accessibility in referral and general hospitals.…”

“…Despite Caesarean section a life saving medical intervention and procedures to the decrease adverse birth outcome, controlling different postoperative neonatal and maternal complications are challenging in terms of patient safety, long duration of hospital stay, cost and psychological trauma. Maternal outcomes of Caesarean section included: postpartum fever, surgical site infection, puerperal sepsis, maternal mortality whereas neonatal sepsis, early neonatal death, stillbirth, perinatal asphyxia, low Apgar score, and prematurity were the most common complication of the newborn [4][5][6].…”

“…Previous Caesarean scar, malpresentation and malposition, antepartum hemorrhage, obstructed labor, cephalopelvic disproportion, non-reassuring fetal heart rate pattern, and multiple pregnancies are the most common indications of Caesarean section [4][5][6]8].…”

Examining fine-scale tribal health inequalities around three forested sites in India: Results of a cross-sectional survey

“…There are few studies that examine ST and non-ST inequalities in a given landscape. [25][26][27][28] Rather, most studies (such as those based on NFHS data) allow for ST-non-ST comparisons at state or higher levels (up to districts from NFHS-4 onwards). [4,29] The high prevalence of tobacco and alcohol consumption among tribal populations is documented in many reports and studies.…”