Is the 14% cesarean section rate in Gulu Regional Referral Hospital justifiable?

Abstract

Worldwide, cesarean section (CS) rates have increased tremendously in recent years, especially among high-income countries, raising concerns about the over-utilization of CS without added benefits, and in the sub-Saharan African region, the rate is at its lowest (7.3%). In Uganda, the CS rate stands at 6% and is seen to be higher (11%) among first-order births indicating a high incidence of primary CS. Despite the low rate of CS in Uganda, there are massive gaps in the provision of obstetric procedure with some women receiving unnecessary surgeries, and the facility-based CS rate is projected to increase to 32% by end of 2021. Notwithstanding the increasing facility rates of CS, Gulu Regional Referral Hospital (GRRH) rate has remained low in the years 2017-2019, with lower levels maternal mortality ratio and fresh stillbirths´ rates compared to the national average. Prolonged labor is one of the commonest indications for primary CS accounting for more than 50% among nulliparous women and this is linked to progress of labor usually measured using cervical dilatation. World Health Organization (WHO) recommended a change in cervical dilatation from 4cm to 5cm as a threshold for the active phase of the first stage of labor, as a way to reduce unnecessary labor intervention including the CS. Lack of standard reporting tools such as the WHO Robson´s ten group classification in Uganda make comparisons of CS rate between/within facility/facilities worrisomely difficult.