Cesarean Section Rates and Indications in Sub-Saharan Africa: A Multi-Country Study from Medecins sans Frontieres

Kathryn Chu, Hilde Cortier, Fernando Maldonado, Tshiteng Mashant, Nathan Ford, Miguel Trelles

Research output: Contribution to journalArticle

Abstract

Objectives: The World Health Organization considers Cesarean section rates of 5-15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality. Methods: Women undergoing Cesarean section from August 1 2010 to January 31 2011 were included in this prospective study. Logistic regression was used to model determinants of maternal and early neonatal mortality. Results: 1276 women underwent a Cesarean section, giving a frequency of 6.2% (range 4.1-16.8%). The most common indications were obstructed labor (399, 31%), poor presentation (233, 18%), previous Cesarean section (184, 14%), and fetal distress (128, 10%), uterine rupture (117, 9%) and antepartum hemorrhage (101, 8%). Parity >6 (adjusted odds ratio [aOR] = 8.6, P = 0.015), uterine rupture (aOR = 20.5; P =. 010), antepartum hemorrhage (aOR = 13.1; P =. 045), and pre-eclampsia/eclampsia (aOR = 42.9; P =. 017) were associated with maternal death. Uterine rupture (aOR = 6.6, P

Original languageEnglish (US)
Article numbere44484
JournalPLoS One
Volume7
Issue number9
DOIs
StatePublished - Sep 4 2012

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cesarean section
Africa South of the Sahara
Sub-Saharan Africa
Cesarean Section
Logistics
odds ratio
Health
Personnel
Uterine Rupture
Odds Ratio
neonatal mortality
Infant Mortality
hemorrhage
eclampsia
Burundi
Sierra Leone
Mothers
Hemorrhage
pre-eclampsia
Democratic Republic of the Congo

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Cesarean Section Rates and Indications in Sub-Saharan Africa : A Multi-Country Study from Medecins sans Frontieres. / Chu, Kathryn; Cortier, Hilde; Maldonado, Fernando; Mashant, Tshiteng; Ford, Nathan; Trelles, Miguel.

In: PLoS One, Vol. 7, No. 9, e44484, 04.09.2012.

Research output: Contribution to journalArticle

Chu, Kathryn ; Cortier, Hilde ; Maldonado, Fernando ; Mashant, Tshiteng ; Ford, Nathan ; Trelles, Miguel. / Cesarean Section Rates and Indications in Sub-Saharan Africa : A Multi-Country Study from Medecins sans Frontieres. In: PLoS One. 2012 ; Vol. 7, No. 9.
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abstract = "Objectives: The World Health Organization considers Cesarean section rates of 5-15{\%} to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2{\%} reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality. Methods: Women undergoing Cesarean section from August 1 2010 to January 31 2011 were included in this prospective study. Logistic regression was used to model determinants of maternal and early neonatal mortality. Results: 1276 women underwent a Cesarean section, giving a frequency of 6.2{\%} (range 4.1-16.8{\%}). The most common indications were obstructed labor (399, 31{\%}), poor presentation (233, 18{\%}), previous Cesarean section (184, 14{\%}), and fetal distress (128, 10{\%}), uterine rupture (117, 9{\%}) and antepartum hemorrhage (101, 8{\%}). Parity >6 (adjusted odds ratio [aOR] = 8.6, P = 0.015), uterine rupture (aOR = 20.5; P =. 010), antepartum hemorrhage (aOR = 13.1; P =. 045), and pre-eclampsia/eclampsia (aOR = 42.9; P =. 017) were associated with maternal death. Uterine rupture (aOR = 6.6, P",
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