Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population Based Ecological Study

Abstract

Background: The relationship of caesarean section rate (CSR) with maternal and neonatal mortality (MMR, NMR) has previously been explored in various regions with conflicting results. The Eastern Mediterranean Region (EMR) with extreme trends of CSR and mortality outcomes needs a high quality research to explore the relationship of these health variables. Methods: We performed a population based ecological study using data from 22 Member States (MSs) of the EMR from 2005 to 2014. A multivariate analysis was performed with adjustment of four indicators; a) Antenatal clinic (ANC visits %), b) Skilled birth attendance% (SBA) c) Total health expenditure (THE) per capita and d) Female literacy rate % (FLR). Findings: The mean CSR was 21.20±13.38, 1.8-52. The NMR and MMR range from 1.0 to 46.0 (median =10.5), and 4.0 to 732.0 (median =47.5) respectively. The CSR% of 15% exhibited the highest rates of all four indicators. A significant interaction effect for CSR-SBA, CSR-LR, CSR-THE was observed on the NMR. The most predictable variables for NMR and MMR were SBA % [B=-0.875; p< .001; R2=0.766 and adjusted R2=0.754] and FLR (F=15-24) [B=0.877; P<0.001; R2=0.77 and adjusted R2=0.758] respectively. Interpretation: The Regional CS rate of 15% of CSR were linked with their better socioeconomic and health indicators. Funding Statement: The authors state: No funding was sought for this study Declaration of Interests: The authors have no conflict of interest. Ethics Approval Statement: The authors declared: Not needed.