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

Abstract

Purpose: This study aims to explore the relationship between population-level caesarean section rates (CSRs) with maternal and neonatal mortality rates (MMR, NMR) in the Eastern Mediterranean Region (EMR). Design: A populationbased ecological study was performed with data obtained from the World Health Organization, Global Health Observatory database, 2015, United Nations Inter-agency Group for Child Mortality Estimation (UN-IGME) and the United Nations Maternal Mortality Estimation Inter-Agency Group (UN-MMEIG) 2015). Mean ± standard deviation (SD), range, median and Interquartile range (IQR) were used to describe the quantitative data. We performed multivariate logistic regression analysis to explore the effect (a) of (a) Antenatal clinic visits (ANC %), (b), Skilled Birth Attendance (SBA) rate (% of deliveries attended by SBA), (c) Total Health Expenditure (THE) per capita and (d) Female Literacy Rate (FLR%) on the studied relationship. Spline linear regression was used to find the most predictive variable for MMR, and the NMR. Statistical significance was accepted at P<0.05. Results: The mean CSR was 21.20±13.38, (1.8-52). The CSR of <10% was linked with the highest NMR and MMR, 33.0 (24.0-39.0) and 390.5(329.5-648.0) respectively. 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. Conclusions: We found a statistically significant inverse relationship between CSRs and maternal and neonatal mortality in MSs with <10% of CSR. The improved mortality rates in MSs with >15% of CSR were significantly linked with better socioeconomic and healthcare variables than higher CSRs. Keywords: Caesarean Section, Maternal and Neonatal Mortality, Eastern Mediterranean Region.