Prevalence, outcomes, and factors associated with caesarian section deliveries among women who delivered in selected health facilities in Njombe region, Tanzania

Abstract

ABSTRACT Background: Caesarean section (CS) reduces maternal and fetal morbidities and mortality when done appropriately. However, excessive caesarean section utilization carries significant maternal and neonatal health risks. In Tanzania, the CS rate is estimated at 13%. But Njombe region reported a 29% CS rate in 2022, exceeding the World Health Organization's recommended threshold of 15%. Broad objective: We aimed to study CS prevalence, outcomes, and associated factors among Post-Delivery Women (PDW) in selected facilities in the Njombe region. Methodology: We conducted the facility-based cross-sectional study using quantitative methods. Multistage cluster sampling techniques were employed to select 567 PDWs who delivered in six selected heath facilities in Njombe region. Data was collected by closed-ended questions designed in the Kobo Collector toolbox and analyzed using Stata version 15. Means and standard deviations were used for summarizing of continuous variables while frequencies and proportions were used to summarize categorical variables. The results were presented in frequency distribution tables and graphs. The Modified Poisson regression analysis was used to assess association between CS delivery and the independent variables where variables with p values <0.2 in bivariable analysis were added into the multivariable analysis model. Variables with p values ≤ 0.05 were considered to be statistically significant associated with CS. Results: The prevalence of CS in the selected facilities in Njombe region was found to be 45.50%. Notably, 1.6% of neonates died, post-CS maternal and fetal complications of 12.8% and 32.6%, respectively. The CS was associated with Marital status, where women who were single were 1.25 more likely to delivered by CS compared to married women (aPR = 1.25 [95% CI: 1.01–1.74]), women who delayed ANC booking were1.52 more like to delivery by CS compared to early booking (aPR = 1.51 [95% CI: 1.10.1.42]), Height of the mother also showed significant association with CS where women who had Maternal height ≤150 cm were 1.24 more likely to undergo CS compared to ones with height above 150 cm(aPR = 1.24 [95% CI: 0.90-1.60]). In terms of delivery factors , Baby weight was associated with CS were by women who delivered babies with weight above 4.1 Kg were1.67 more likely to delivered by CS compared with ones with babies with weight below 2.5Kg (aPR = 1.67 [95% CI: 1.07–2.27]), There was association between gestation age during delivery where by women with gestation age of 43+ at delivery were 1.49 more likely to reliever by CS compared to ones with gestation age below 37 week during delivery (aPR = 1.49 (aPR = 1.49 [1.25-1.73]), Number of babies born was associated with CS where by women with twin deliveries were 1.15 more likely to delivered by CS compared to single ones with single babies (aPR = 1.15 [95% CI: 1.03–1.68]). There was a significant association between CS and referral status where women who referred from health centers were 2.10 more likely to delivered by CS compared to ones who come from home (aPR = 2.10 [95% CI: 1.50–3.80]), Women who delivered in Private owned health facilities were 1.13 more likely to delivery by CS compared to ones delivered in public health facilities (aPR = 1.13[95% CI: 0.75-1.67]), and Women who used NHIF financing method were 1.12 more likely to undergo CS compared to ones who paid cash for labor and delivery services (aPR = 1.12 [95% CI: 1.40-1.90]). Conclusion: The prevalence of CS among PDW in the selected health facilities in Njombe region was found to be 45.5% (95% CI: 41%-49%). The leading fetal and maternal indications for caesarian section were previous scars and fetal distresses. Notably, there was a neonatal death rate of 1.6% and post-CS maternal and fetal complications of 12.8% and 32.6%, respectively. The CS deliveries and newborns factors was associated with social demographics (marital status), Maternal characteristics (timing of ANC visits, maternal height), health facility-related factors (admission from, health facility ownership, and health financing method), delivery and newborn characteristics (baby sex, birth weight, multiple pregnancies, and gestational at delivery).