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Cesarean section rates and indications in Sub-Saharan Africa: a multi-country study from Medecins sans Frontieres | Journal Article / Research | MSF Science Portal
Journal Article
|Research

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

Chu KM, Cortier H, Maldonado F, Mashant T, Ford NP, Trelles M
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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<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.

Countries

Burundi Democratic Republic of Congo Sierra Leone

Subject Area

women's healthsurgery & trauma care

Languages

English
DOI
10.1371/journal.pone.0044484
Published Date
04 Sep 2012
PubMed ID
22962616
Journal
PLOS One
Volume | Issue | Pages
Volume 7, Issue 9, Pages e44484
Issue Date
2012-09-04
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