Abstract
Abstract
Background
Caesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades.
Methods
We used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019–20. All births in the preceding 3 years to the survey were assessed for the mode of delivery. The participants’ characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys.
Results
The population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8–2.6) in 2000 to 15.6% (95% CI 13.9–16.5) in 2019–20. Despite increasing in all health facilities over time, the rate of CS was about four times higher in private (60.6%) compared to public health facilities (15.4%) in 2019–20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies.
Conclusion
Over the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology
Reference64 articles.
1. World Health Organization. Trends in maternal mortality 2000 To 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division. Geneva: World Health Organization; 2019. p. 104.
2. United Nations inter-agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in child mortality: report 2020 - estimates developed by the UN inter-agency Group for Child Mortality Estimation. New York: United Nations Children's Fund; 2020.
3. Lawn JE, Blencowe H, Oza S, You D, Lee ACC, Waiswa P, et al. Every newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189–205.
4. Bullough C, Meda N, Makowiecka K, Ronsmans C, Achadi EL, Hussein J. Current strategies for the reduction of maternal mortality. BJOG. 2005;112(9):1180–8.
5. Campbell OM, Graham WJ, Lancet maternal survival series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.