Conference abstract

Trends in cesarean section deliveries from 2012 2014 in Uganda, 2016

Pan African Medical Journal - Conference Proceedings. 2017:6(3).20 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.3.485

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Keywords: Caesarean section, deliveries, Uganda

Trends in cesarean section deliveries from 2012 2014 in Uganda, 2016

Emily Atuheire1,&, Daniel Kadobera1, Alex Riolexus Ario1, Joseph Matovu2, Blandina Nakiganda3, Frank Kaharuza2

1Uganda Public Health Fellowship Program, Kampala, Uganda, 2Makerere University School of Public Health, Kampala, Uganda, 3Uganda Ministry of Health, Kampala, Uganda

&Corresponding author
Emily Atuheire, Uganda Public Health Fellowship Program, Kampala, Uganda


Introduction: cesarean section (CS) is a lifesaving procedure often recommended for difficult labors. However, unnecessary CS can increase the risk of medical complications and cost of medical care. WHO recommends that CS deliveries should represent 10% -15% of all deliveries in a population. We evaluated temporal trends of CS births in Uganda to inform policy decisions.

Methods: we reviewed data during 2012-2014 for health facilities (HFs) providing comprehensive emergency obstetric care services, reported in the National Health Management Information System. We defined the facility-based CS rate as the proportion of CS deliveries among total live births in the facility. In estimating the population-based CS rate, we used the number of CS deliveries from HFs offering maternity care (numerator), and multiplied the crude birth rate (4.85%) by the 2014 census population to estimate the expected births for each district (denominator). We used logistic regression to determine the significance of trends and estimate the average annual percentage increase in the CS rate.

Results: overall, the facility-based CS rate increased from 8.5% in 2012 to 9.6% in 2014 in Uganda (OR = 1.1, 95% CI: 1.06 - 1.07), for each passing year. Despite the variation in CS rates, the rate of increase per year was higher and similar for both referral hospitals (OR 1.2, 95% CI: 1.2 - 1.3) and HC IVs (OR 1.2, 95% CI: 1.1 - 1.2). The population-based CS rate increased from 3.0% to 4.6% (OR = 1.24, 95% CI: 1.24 - 1.25). The population-based CS rate was < 5% in 77% (86/112) of the districts; Seven (6%) districts reached the WHO-recommended CS rate of 10%. In 15% (13/86) of these districts, no CS delivery was done in the past 3 years.

Conclusion: CS births are increasing in general. HC IVs and referral hospitals had the highest increase in facility-based CS-rate. However, population-based CS rates are still below the WHO-recommended level, potentially endangering the lives of birthing mothers. We recommended expansion of CS services to improve access to pregnant mothers.