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Socioeconomic and Demographic Factors Associated with Caesarean Manyeh et al. BMC Pregnancy and Childbirth (2018) 18:405 https://doi.org/10.1186/s12884-018-2039-z RESEARCH ARTICLE Open Access Socioeconomic and demographic factors associated with caesarean section delivery in Southern Ghana: evidence from INDEPTH Network member site Alfred Kwesi Manyeh1,2* , Alberta Amu1,3, David Etsey Akpakli1,3, John Williams1,3 and Margarete Gyapong1,4 Abstract Background: In recent years, caesarean section rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate caesarean section rate and the associated short- and long-term risks. This study sought to identify the rate of caesarean section and associated factors in two districts in rural southern Ghana. Methods: Pregnancy, birth, and socio-demographic information of 4948 women who gave birth between 2011 and 2013 were obtained from the database of Dodowa Health and DemographicSurveillanceSystem.TherateofC-sectionwas determined and the associations between independent and dependent variables were explored using logistic regression. TheanalysesweredoneinSTATA14.2 at 95% confidence interval. Results: The overall C-section rate for the study period was 6.59%. Women aged 30–34 years were more than twice likely to have C-section compared to those < 20 year (OR: 2.16, 95% CI: 1.20–3.90). However, women aged 34 years and above were more than thrice likely to undergo C-section compared to those < 20 year (OR: 3.73, 95% CI: 1.45–5.17). The odds of having C-section was 65 and 79% higher for participants with Primary and Junior High level schooling respectively (OR: 1.65, 95% CI: 1.08–2.51, OR:1.79, 95%CI: 1.19–2.70). The likelihood of having C-section delivery reduced by 60, 37, and 35% for women with parities 2, 3 and 3+ respectively (OR:0.60, 95% CI: 0.43–0.83, OR: 0.37, 95% CI: 0.25–0.56, OR:0.35, 95% CI: 0.25–0.54). There were increased odds of 36, 52, 83% for women who belong to poorer, middle, and richer wealth quintiles respectively (OR: 1.36, 95%CI: 0.85–2.18, OR: 1.52, 95% CI: 0.97–2.37, OR: 1.83, 95% CI: 1.20–2.80). Participants who belonged to the richest wealth quintile were more than 2 times more likely to have C-section delivery (OR: 2.14, 95%CI: 1.43–3.20). The odds of having C-section delivery reduced by 76% for women from Ningo-Prampram district (OR: 0.76, 95% CI: 0.59.0.96). Women whose household heads have Junior High level and above of education were 45% more likely to have C-section delivery (OR: 1.45, 95% CI: 1.09–1.93). Conclusion: Age of mother, educational level, parity, household socioeconomic status, district of residence, and level of education of household head are associated with caesarean section delivery. Keywords: Caesarean section, INDEPTH network, Dodowa, Ghana * Correspondence: [email protected] 1Dodowa Health Research Centre, P. O. Box. DD1, Dodowa, Accra, Ghana 2Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Manyeh et al. BMC Pregnancy and Childbirth (2018) 18:405 Page 2 of 9 Background Ghana Demographic and Health Survey (GDHS) survey, the Accessibility of comprehensive emergency obstetric care C-section rate in Ghana increased from 4.5 to 6.4% between (including caesarean section) is crucial to averting the 1990 and 2005 [51]. In 2014, the GDHS reported that 13% estimated 2.9 million neonatal and 287,000 maternal of births are delivered by C-section, an increase from 7% in mortalities that occur worldwide every year [1, 2]. 2008 [52]. Delivery by C-section is highest among births to Caesarean section (C-section), is one of the oldest and women aged 35–49 (17%); first-parity births (18%); births for regularly used surgical procedures in Obstetrics by which whom women had more than three Antenatal Care (ANC) fetus is delivered through an abdominal and uterine inci- attendance (15%); deliveries in urban areas (19%) and in the sion [3–5]. It has been shown that, when C-section is ap- Greater Accra region (23%); births to women with secondary propriately used, it can improve both infant and maternal school level and above education (27%), and those with rich- health outcomes [6, 7]. According to the World Health est socioeconomic status (28%) [52]. Organization (WHO), C-section is a vital treatment in Primary C-section usually determines the future obstetric pregnancy [8]. However, the potential risk of C-section may course of any woman [53]. Hence there is a need to assess outweigh the benefits when it is used inappropriately [6, 7]. the rate of C-sections and factors contributing to C-section In recent years, the number of C-section deliveries has delivery in the context of Ghana using population based been increasing in developed and developing countries data. The existence of a Health and Demographic Surveil- [9–11]. This increase has however not been clinically justi- lance System provided a unique opportunity to study the fac- fied. This worldwide increase in C-section has become a tors contributing to C-section delivery at the population major public health issue due to potential maternal and level. This is because most studies on C-section used hospital perinatal risks, inequality of access and cost involved [12– based data which were subject to selection bias. The study of 17]. According to the WHO guidelines, no region is justi- determinants of C-section in a population makes it possible fied for having the rate of C-section more than 10–15% [6, to explore how different elements contribute to the decision 18]. Despite this WHO guidelines, studies show that the to perform a C-section. Therefore, this study aimed to exam- rates of C-sections are high in developing countries [17, ine the rate of C-section delivery and to explore factors asso- 19, 20]. A WHO reports shows that, the global average of ciated with the procedure in two rural districts in Ghana. C-section rate between 1990 and 2014 increased from 12.4 to 18.6% [21]. While the C-sections rate varies be- Methods tween 12 and 86% across studies done in developed coun- Study area tries [22–25] that of developing countries ranges between This study used secondary data from the Dodowa Health 2and39%[8, 22, 26–29]. This again shows the cause for and Demographic Surveillance System (DHDSS). The concern and hence the need to explore the reasons for the DHDSS site is in the Shai-Osudoku and Ningo-Prampram increasing rates in C-section delivery [6, 18]. districts of the Greater Accra Region of Ghana. The two Although there is no evidence of benefits of C-section to districts together have a total population of 115, 754 people mothers or babies who do not need it [30], however, in 380 communities living in 23, 647 households. A detailed C-section like any surgery, has complications which may per- description of the DHDSS and its operations can be found sist for a long period after the current delivery and affect the elsewhere [54–56]. Health care service delivery in the health of the woman, her child, and future pregnancies. Ac- DHDSS is provided from government hospitals, health cen- cording to literature, the global increase in C-section is asso- tres, clinics, community-based health and planning services ciated with uterine rupture such that, women with prior (CHPS) compounds/zones, and non-governmental health who undergo the procedure are more likely to have uterine facilities [54]. rupture in future pregnancies [31–35]. The risk of uterine rupture due to prior C-section are higher in population with Study population limited access to comprehensive obstetric care [17, 36, 37]. All mothers who were resident in study area and had a deliv- Studies have attribute the increase in C-sections to mul- ery between January 1, 2011 to December 31, 2013 were in- tiple factors ranging from the type of health facility, cluded in the study. Therefore, all mothers who were outside socio-demographic characteristics to maternal health of the study area and those who delivered outside the study women [38–43]. These factors include maternal age [38– date were excluded. A total of 4, 948 women were included 40], birth order [44], birth weight [45], place of residence in the study. [14], socioeconomic status, maternal educational level [38, 46–48], former C-section [41–43], obstetric complications Variables [49], maternal request [50], and income level [38, 48]. Dependent variable These factors also vary among different populations [16]. The dependent variable is type of delivery and it was di- The global increase in the rate of the provision of chotomous (coded as 1 if the respondents underwent C-section is reflected in Ghana. According to the 2014 C-section delivery and 0 if otherwise). Manyeh et al. BMC Pregnancy and Childbirth (2018) 18:405 Page 3 of 9 Table 1 Socio-Demographic Characteristics of the study Table 1 Socio-Demographic Characteristics of the study
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