Epidemiology of emergency and elective caesarean section and its association with early neonatal mortality in sub-Saharan African countries.

Autor:	Sandie AB; West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal asandie@aphrc.org., Mutua MK; West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal., Sidze E; Sexual Reproductive, Maternal, Newborn and Child health Research, African Population and Health Research Center, Nairobi, Senegal., Nyakangi V; Kenya Country Office, UNICEF, Nairobi, Kenya., Sylla EHM; West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal., Wanjoya A; Department of Statistics and Acturial Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya., Njom Nlend AE; Hopital de la Caisse Nationale de Prevoyance Sociale, Ministere de la Sante Publique, Yaoundé, Cameroon., Faye C; West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Oct 12; Vol. 13 (10), pp. e074995. Date of Electronic Publication: 2023 Oct 12.
DOI:	10.1136/bmjopen-2023-074995
Abstrakt:	Introduction: Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA. Methods: SSA countries Demographic and Health Surveys data that had collected information on the CS' timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries' level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality. Results: The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4-4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3-3.6). Private health facilities' elective CS prevalence was estimated at 10.2% (95% CI 9.3-11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0-8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8-4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6-2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64-3.41), while no association was found with elective CS. Conclusions: Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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