Abstract
BackgroundMajority of maternal deaths are avoidable through quality obstetric care such as Cesarean Section (CS). However, in low-and middle-income countries, many women are still dying due to lack of obstetric services. Tanzania is one of the African countries where maternal mortality is high. However, there is paucity of evidence related to the magnitude and trends of disparities in CS utilization in the country. This study examined both the magnitude and trends in socio-economic and geographic inequalities in access to birth by CS.MethodsData were extracted from the Tanzania Demographic and Health Surveys (TDHSs) (1996–2015) and analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. First, access to birth by CS was disaggregated by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference (D), Ratio (R), Slope Index of Inequality (SII) and Relative Index of Inequality (RII). A 95% confidence interval was constructed for point estimates to measure statistical significance.ResultsThe results showed variations in access to birth by CS across socioeconomic, urban-rural and regional subgroups in Tanzania from 1996 to 2015. Among the poorest subgroups, there was a 1.38 percentage points increase in CS coverage between 1996 and 2015 whereas approximately 11 percentage points increase was found among the richest subgroups within same period of time. The coverage of CS increased by nearly 1 percentage point, 3 percentage points and 9 percentage points among non-educated, those who had primary education and secondary or higher education, respectively over the last 19 years. The increase in coverage among rural residents was 2 percentage points and nearly 8 percentage points among urban residents over the last 19 years. Substantial disparity in CS coverage was recorded in all the studied surveys. For instance, in the most recent survey, pro-rich (RII = 15.55, 95% UI; 10.44, 20.66, SII = 15.8, 95% UI; 13.70, 17.91), pro-educated (RII = 13.71, 95% UI; 9.04, 18.38, SII = 16.04, 95% UI; 13.58, 18.49), pro-urban (R = 3.18, 95% UI; 2.36, 3.99), and subnational (D = 16.25, 95% UI; 10.02, 22.48) absolute and relative inequalities were observed.ConclusionThe findings showed that over the last 19 years, women who were uneducated, poorest/poor, living in rural settings and from regions such as Zanzibar South, appeared to utilize CS services less in Tanzania. Therefore, such subpopulations need to be the central focus of policies and programmes implemmentation to improve CS services coverage and enhance equity-based CS services utilization.
Highlights
Majority of maternal deaths are avoidable through quality obstetric care such as Cesarean Section (CS)
This study explored over time trends in socioeconomic and geographic disparities in access to birth by CS over the course of roughly two decades in Tanzania
What is novel in this paper is that, the analysis was carried out in accordance with the World Health Organization (WHO) recommendation for equity studies; simple and complex, as well as relative and absolute summary measures were calculated in order to measure the disparity from different perspectives and viewpoints
Summary
Majority of maternal deaths are avoidable through quality obstetric care such as Cesarean Section (CS). In low-and middle-income countries, many women are still dying due to lack of obstetric services. In 2017, there was a decline in maternal mortality rate from 451,000 in 2000 to 295,000 Despite this decline, globally, more than 800 maternal deaths are recoded every day from pregnancy and childbirth-related complications. Majority of maternal deaths can be avoided through the utilization of quality obstetric services. CS has become a useful medium to curb the menace of maternal deaths through improvement in the quality and use of maternal services for the management and treatment of complications in pregnancy, labor and delivery [7]
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