TY - JOUR
T1 - Prevalence of Caesarean sections in Enugu, southeast Nigeria
T2 - Analysis of data from the Healthy Beginning Initiative
AU - Gunn, Jayleen K.L.
AU - Ehiri, John E.
AU - Jacobs, Elizabeth T.
AU - Ernst, Kacey C.
AU - Pettygrove, Sydney
AU - Center, Katherine E.
AU - Osuji, Alice
AU - Ogidi, Amaka G.
AU - Musei, Nnabundo
AU - Obiefune, Michael C.
AU - Ezeanolue, Chinenye O.
AU - Ezeanolue, Echezona E.
N1 - Funding Information:
Univariate analyses were based on Pearson's Chi-square test for comparison of proportions for all variables. Fisher's exact tests for contingency tables were used to test for significance in proportions when the expected cell counts were less than 5. Chi-square analyses with p<0.10 were further analyzed using crude and adjusted logistic regression with CS as the main outcome. Having a CS in previous pregnancies is known to predict current CS; therefore, gravida was included in logistic regression models. Because no information was collected specifically regarding previous CS, a sensitivity analysis was performed among those experiencing their first pregnancy. Statistical significance was set at p<0.05. An adjusted trend in the Odds Ratio (OR) was conducted to determine whether there was an increasing trend in the odds of having a CS as a participant’s age and education level increased by using the “tabodds” function in Stata [Stata Corporation, College Station, TX]. Participant’s age was recorded during pregnancy on the baseline survey and was categorized as 17–24, 25–34, and 35–45. Only one women who had a CS had no formal education; therefore, education was categorized as none/primary, secondary and tertiary and above. Age and education were retained as categorical variables for inclusion in multivariable models. Birthweight was collected as part of the parent study; however, because it was self-reported and most newborns were not weighed at birth, birthweight was not deemed reliable. Therefore, birthweight was not included in this analysis. A power analysis was conducted in the parent study []; because mode of delivery was not the main outcome of the trial, no additional power analyses were completed before data collection. No difference was observed in mode of delivery between the control and intervention groups (CS intervention group 7.20%, control group 8.54%; mode of delivery chi-square: p = 0.27). Therefore, data was not restricted to only the control group and all analyses treated the sample as a cohort. Data analyses were conducted using Stata version 12.0. The parent study was approved by the Institutional Review Board of the University of Nevada, Reno, and the Nigerian National Health Research Ethics Committee. This secondary data-analysis was appraised by Research Office of the Mel and Enid Zuckerman College of Public Health, and was considered exempt. This research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Mental Health (NIMH) and the President’s Emergency Plan for AIDS Relief (PEPFAR) under award number R01HD075050 to Echezona Ezeanolue, MD.
Publisher Copyright:
© 2017 Gunn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2017/3
Y1 - 2017/3
N2 - Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17-45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38-0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04-2.28) Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
AB - Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17-45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38-0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04-2.28) Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
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U2 - 10.1371/journal.pone.0174369
DO - 10.1371/journal.pone.0174369
M3 - Article
C2 - 28355302
AN - SCOPUS:85016312242
VL - 12
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 3
M1 - 0174369
ER -