Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population‐based surveys in a low‐resource setting

Abstract

Objective To describe caesarean section rates and neonatal mortality to assess change in access to life‐saving interventions in a rural low‐resource setting between 2007 and 2013. Design Population‐based cross‐sectional study. Setting Southern Tanzania. Population A total of 34 063 women from 384 549 households who gave birth in the previous year. Methods Using data collected in two geo‐referenced household surveys conducted in 2007 and 2013 in the context of two cluster‐randomized controlled trials, we describe trends in caesarean section and neonatal mortality in obstetric risk groups inspired by the 10‐group Robson classification. Main outcome measures Rates of self‐reported birth by caesarean section and neonatal mortality. Results Population‐based caesarean section rates increased from 4.0% in 2007 to 6.4% in 2013. In 2013, the lowest caesarean section rate was found in multipara whose labour was not induced or augmented [4.4%, 95% confidence interval (CI) 3.9–4.9], a group that showed a rate increase of over 50% from 2007 [adjusted prevalence ratio 1.57 (95% CI 1.34–1.82)]. Nullipara whose labour was not induced or augmented had rates of 6.2% in 2007 and 8.5% in 2013. Caesarean rates in multiple pregnancies were low at 8.1% (95% CI 5.6–10.5) in 2007, and 14.6% (95% CI 9.4–19.8) in 2013. Overall neonatal mortality was high: 3.5% in 2007 and 3.2% in 2013, with rates being lowest in multiparous women whose labour was not induced or augmented: 2.4% (95% CI 2.2–2.7) and 1.7% (95% CI 1.4–2.0) in 2007 and 2013, respectively. Conclusion Although use of caesarean section remains insufficient, and higher rates do not necessarily imply better quality of care, our analysis highlights improvements in reaching women with caesarean section. Rates in multiple birth remained low compared with high‐income settings. Tweetable abstract In Southern Tanzania caesarean section rates increased over time, but the rate in high‐risk births remained alarmingly low.

Analysis of cesarean section rates using Robson Ten Group Classification System in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study

“…This adaptation has also been used in other studies that implemented the RTGCS in low-resource settings. For example, Tura AK et al [19] and Schantz C et al [24] used birth weight of ≥ 2,500 g as proxy to term when data on gestational age was not available whereas other studies applied the method to their entire dataset and de ned gestational age solely based on birth weight [14,20,25].…”

“…Birth weight <2,500g was considered preterm and birth weight ≥ 2,500g was considered term [18]. This strategy has been employed in other studies conducted in similar settings [14,19,20].…”

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

“…Since the date of LMP was missing from most of the records (n=2444; 81.1%), we used birth weight ≥2500 g as a proxy for gestational age ≥37 weeks 23. This adaptation has been suggested and previously used for the Robson classification in settings where it is challenging to assign gestational age accurately 24–26…”

Analysis of cesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study

“…Birth weight < 2,500 g was considered preterm and birth weight ≥ 2,500 g was considered term [18]. This strategy has been employed in other studies conducted in similar settings [14,19,20].…”