Factors that contribute to current caesarean section rates in selected hospitals in Nairobi, Kenya

Abstract

Background: Over the past three decades, there has been a sustained increase in caesarean section rates around the world despite the fact that the World Health Organization has indicated that there is no justification for any region to have a caesarean section rate higher than 15% and amidst concerns of unfavorable perinatal and postnatal outcomes associated with caesarean section deliveries. Objective: To assess the factors that contribute to the caesarean section rates in hospitals in Nairobi. Methods: This was a cross-sectional survey in which all the women who delivered during the data collection period in three selected maternity units (Nairobi Women’s Hospital, St. Mary’s Mission Hospital and Pumwani Maternity Hospital) were requested to participate. A total of 513 pregnant women consented and were interviewed. The facilities were selected based on the National Hospital Insurance Fund (NHIF) categorization of hospitals in Kenya as: Category A (Government hospitals), Category B (Private and Mission) and Category C (Private). A questionnaire was used to interview the women while medical charts were used to establish hospital days. Data was analyzed using the SPSS computer software. Descriptive statistics was done on all variables. Bivariate and multivariate analysis were performed to determine the factors that contribute to caesarean-section rates. Study Findings. The mean age of the women was 26.5 years (SD±4.9).Significant associations were shown between age of the women and caesarean section rates (χ2=15.534,p=0.0001),facility type( as defined by the NHIF categorization) and caesarean section rate(χ2=10.20,p=0.006),previous caesarean section and caesarean section rate (χ2=274.3,p<0.001),birth order and caesarean section rate (χ2=15.386,p=0.000),age and type of section(χ2=8.29,p=0.04) and employment status and type of section(χ2=10.4,p=0.006).The recorded caesarean rates were: Private hospital 44%, Mission/Private hospital 25% and Public hospital 29%, Emergency caesarean section 20% and elective caesarean sections 10%.The most common indication for emergency caesarean section was fetal distress and that for elective caesarean section was a previous scar. Conclusion & Recommendations: Factors that contribute to caesarean section rates are age, facility type, previous caesarean section and birth order. The rates observed are higher than the World Health Organization recommendations of 5% to 15%. This study also concludes that it may be had to define an umbrella optimal CS rate for health institutions and thus recommends that such rates should be contextualized.