Annual trends of caesarean section rates, indications, fetal and maternal outcomes at Mandera county referral hospital, Mandera county Kenya, 2013 -2017

Abstract

Background: Caesarean section (CS) is the most common surgical procedure performed in obstetrics practice, with the sole aim of reducing feto-maternal morbidity and mortality. Worldwide and institutional based studies have shown increasing trend in CS. The aim of the study was to determine the annual trends in caesarean section rates, indications, fetal and maternal outcomes at Mandera County Referral Hospital (MCRH), Mandera County, Kenya. Methodology: A hospital based descriptive cross-sectional study of women (n=783) who underwent caesarean section at Mandera County Referral Hospital, Mandera County, Kenya from 1st January 2013 to 31 st December 2017, was performed. Data on socio demographic and obstetric characteristics, indications for CS, fetal and maternal outcomes were extracted from the women’s medical records using a structured checklist by two trained research assistants. Analysis was done using the Statistical Package for Social Sciences (SPSS) version 23.0. Categorical variables were summarized using frequency and proportions, the linear trend over time was determined by chi-square using the statistical software EpiInfo, with a p-value of less than 0.05, considered to be statistically significant. Results: During the period under review (2013-2017), a total of 7,613 deliveries were recorded, amongst them, 783 were caesarean sections (10.3%). Emergency caesarean section was more prevalent than elective caesarean section (96.3% vs 3.7%). The most common indication for CS was previous caesarean section at (23.7%). The most frequent adverse fetal and maternal outcomes were new born unit admission (13.2%) and blood transfusion (35.9%), the overall case fatality rate was (2.1%).Trend analysis for blood transfusion over the 5 years was significantly decreasing with a p-value of 0.007*. Conclusion: The average caesarean section rate at Mandera County Referral Hospital, Mandera County, Kenya, over the study period under review stands at 10.3%. The key findings of the study were the high frequency of adverse feto-maternal outcomes among participants who underwent caesarean sections.