A Quantitative and Qualitative Investigation of Factors Associated with Caesarean Section Deliveries in Sri Lanka Assessing National Trends and Views of Local Healthcare Professionals in Colombo in 2015

Abstract

Background A caesarean section (CS) is an operation to deliver a baby through incisions made to the mother’s abdominal wall and uterus, either before or after labor has started. An emergency CS is performed for certain medical indications such as placenta praevia or umbilical cord prolapse, and it most frequently occurs once labor has started. Elective CS are planned CS. They could be performed for non-medical reasons such as maternal request. Aim CS rates in Sri Lanka have been rising over the past decades. This study investigates reasons for the rise in CS rates through qualitative and quantitative analyses. Methods Qualitative data analysis involved interviews which were conducted in a teaching hospital in Colombo, Sri Lanka. Twenty (20) healthcare professionals in Obstetrics and Gynecology were interviewed. A semi-structured questionnaire, consisting of 15 opened and closed questions, was the basis for the interview. Quantitative analysis was performed on Demographic and Health Survey (DHS) data from 2006-2007. Variables included mother’s age, education level and residence. Chi-squared (χ2) and regression analysis using statistical package for the social sciences version (SPSS) was performed to determine if these variables were associated with CS. Results From qualitative analyses of the interviews, the main themes identified were the healthcare professionals’ views on causes of the rising CS rates, parties involved in the decision-making process, benefits and risks of elective CS and availability of support or alternative options. Quantitative analysis of DHS data showed variables such as residence, province, and education level were significantly associated with CS (p<0.01). Urban residences, living in Colombo and extremes in education levels had the greatest likelihood of a CS. Age, although statistically not significant, is clinically important as literature reviewed showed that CS tend to be more prevalent in extremes of age. Conclusion Analysis revealed the importance of factors associated with CS. Targeting areas that showed the greatest prevalence of CS is an effective strategy to address rising rates