Please use this identifier to cite or link to this item:
http://ir.mu.ac.ke:8080/jspui/handle/123456789/6880
Title: | Socioeconomic differences in caesarean section – are they explained by medical need? An analysis of patient record data of a large Kenyan hospital |
Authors: | Van der Spek, Lisa Sanglier, Sterre Mabeya, Hillary M. Van den Akker, Thomas Mertens, Paul L. J. M. Houweling, Tanja A. J. |
Keywords: | Delivery Caesarean section Maternity services Developing countries Obstetrics and gynaecology Epidemiology General obstetric Pregnancy Health equity Socioeconomic factors Clinical category General obstetrics |
Issue Date: | 8-Jul-2020 |
Publisher: | BMC |
Abstract: | Background: Caesarean section (C-section) rates are often low among the poor and very high among the better- off in low- and middle-income countries. We examined to what extent these differences are explained by medical need in an African context. Methods: We analyzed electronic records of 12,209 women who gave birth in a teaching hospital in Kenya in 2014. C-section rates were calculated by socioeconomic position (SEP), using maternal occupation (professional, small business, housewife, student) as indicator. We assessed if women had documented clinical indications according to hospital guidelines and if socioeconomic differences in C-section rates were explained by indication. Results: Indication for C-section according to hospital guidelines was more prevalent among professionals than housewives (16% vs. 9% of all births). The C-section rate was also higher among professionals than housewives (21.1% vs. 15.8% [OR 1.43; 95%CI 1.23–1.65]). This C-section rate difference was largely explained by indication (4.7 of the 5.3 percentage point difference between professionals and housewives concerned indicated C-sections, often with previous C-section as indication). Repeat C-sections were near-universal (99%). 43% of primary C-sections had no documented indication. Over-use was somewhat higher among professionals than housewives (C-section rate among women without indication: 6.6 and 5.5% respectively), which partly explained socioeconomic differences in primary C-section rate. Conclusions: Socioeconomic differences in C-section rates can be largely explained by unnecessary primary C- sections and higher supposed need due to previous C-section. Prevention of unnecessary primary C-sections and promoting safe trial of labor should be priorities in addressing C-section over-use and reducing inequalities. |
URI: | https://doi.org/10.1186/s12939-020-01215-2 http://ir.mu.ac.ke:8080/jspui/handle/123456789/6880 |
Appears in Collections: | School of Medicine |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.