Factors Associated with Caesarean Section among Women Delivering at Mbeya Zonal Referral Hospital

Abstract

Background: The rate of caesarean section has been rising in most of countries around the world. World Health Organization (WHO) has recommended the limit of caesarean section rate to be 15%, as rate beyond this limit have negative consequences to both mother and the baby. Tanzania is among the countries with limited resources settings, caesarean section rate is 6% but the rate of Referral Hospitals is more than 30% which is beyond WHO recommended limit. The factors associated with caesarean section need to be explored so as to complement with other studies and provide specific recommendations on appropriate interventions to improve obstetric practice particularly in reducing caesarean section. Objectives: To assess the factors associated with caesarean section deliveries. Methodology: Quantitative approach using analytical cross sectional study design. A total of 400 post natal mothers were randomly selected in post natal ward. Data was collected from patient records and interview using a structured questionnaire. Descriptive statistical analysis using mean, frequency and proportion was computed. Chi-square test (P<0.05) and odds ratio with corresponding 95% confidence interval was used to determine the association between dependent and independent variables as well as predictors of caesarean section deliveries. The ethical clearance was acquired from MUHAS – IRB and MMREC, also written informed consent was used to obtained consent from all participants. Results: The proportion of caesarean section among participants was 186 (46.5%), N = 400. The obstetric factors associated with caesarean deliveries was maternal age (P<0.001, OR = 4.456), parity (P<0.05), birth weight (P<0.05) and co morbid illness such as Pregnancy Induced Hypertension (PIH), Pre-eclampsia /eclampsia and Genital warts (P<0.001). Non obstetric factors identified were marital status and socio economic status (P<0.05, OR = 2.303). Conclusion: The rate of caesarean section at Mbeya Zonal Referral hospital is high. To maintain optimum rate, there a need to reduce unnecessary cesarean section among women with low risks. Health care providers should be aware of the risks of unnecessary caesarean section as well as women should be fully informed on benefits and risks of caesarean section. Recommendations: MOHCDGEC may incorporate Midwives Model of Care in antenatal and postal services, Mbeya Zonal Referral hospital need to develop and operationalise guideline for safe conduct of vaginal birth after Caesarean section delivery, regular coaching of staff on proper foetal monitoring as well as conducting audit of caesarean section deliveries.