Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres

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dc.contributor.authorChu, Kathrynen_ZA
dc.contributor.authorCortier, Hildeen_ZA
dc.contributor.authorMaldonado, Fernandoen_ZA
dc.contributor.authorMashant, Tshitengen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorTrelles, Miguelen_ZA
dc.date.accessioned2015-11-16T04:09:36Z
dc.date.available2015-11-16T04:09:36Z
dc.date.issued2012en_ZA
dc.description.abstractObjectives 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<0.001), anterpartum hemorrhage (aOR = 3.6, P<0.001), and cord prolapse (aOR = 2.7, P = 0.017) were associated with early neonatal death. CONCLUSIONS: This study demonstrates that target Cesarean section rates can be achieved in sub-Saharan Africa. Identifying the common indications for Cesarean section and associations with mortality can target improvements in antenatal services and emergency obstetric care.en_ZA
dc.identifier.apacitationChu, K., Cortier, H., Maldonado, F., Mashant, T., Ford, N., & Trelles, M. (2012). Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. <i>PLoS One</i>, http://hdl.handle.net/11427/14998en_ZA
dc.identifier.chicagocitationChu, Kathryn, Hilde Cortier, Fernando Maldonado, Tshiteng Mashant, Nathan Ford, and Miguel Trelles "Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/14998en_ZA
dc.identifier.citationChu, K., Cortier, H., Maldonado, F., Mashant, T., Ford, N., & Trelles, M. (2012). Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One, 7(9), e44484. doi:10.1371/journal.pone.0044484en_ZA
dc.identifier.ris TY - Journal Article AU - Chu, Kathryn AU - Cortier, Hilde AU - Maldonado, Fernando AU - Mashant, Tshiteng AU - Ford, Nathan AU - Trelles, Miguel AB - 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<0.001), anterpartum hemorrhage (aOR = 3.6, P<0.001), and cord prolapse (aOR = 2.7, P = 0.017) were associated with early neonatal death. CONCLUSIONS: This study demonstrates that target Cesarean section rates can be achieved in sub-Saharan Africa. Identifying the common indications for Cesarean section and associations with mortality can target improvements in antenatal services and emergency obstetric care. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0044484 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres TI - Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres UR - http://hdl.handle.net/11427/14998 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14998
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0044484
dc.identifier.vancouvercitationChu K, Cortier H, Maldonado F, Mashant T, Ford N, Trelles M. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One. 2012; http://hdl.handle.net/11427/14998.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.en_ZA
dc.rights.holder© Chu et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherCesarean sectionen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherHemorrhageen_ZA
dc.subject.otherNeonatesen_ZA
dc.subject.otherObstetrics and gynecologyen_ZA
dc.titleCesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieresen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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