Abstract
BackgroundOverweight and obese women are at risk of pregnancy and delivery complications. This study investigates the trend and association between maternal overweight and obesity on caesarean births in Malawi.MethodsWe utilised cross-sectional population-based Demographic Health Surveys (DHSs) data collected from mothers aged 18–49 years in 2004/05, 2010, and 2015/16 in Malawi. The outcome measure was caesarian birth within 5 years preceding the surveys. The main independent variable was maternal Body Mass Index (BMI) measured as weight in kilograms by height in meters squared (kg/m2) and categorized according to the World Health Organization (WHO) guidelines. Generalized estimating equations (GEE) regression models were constructed to analyze total samples of 6795, 4474 and 4363 in 2004/05, 2010 and 2015/16 respectively.ResultsThere was an observed increase in the trend of caesarean births as well as maternal overweight and obesity from 2004 to 2015. The results of the multivariate analyses showed that maternal overweight (adjusted odds ratio [aOR] = 1.35; 95% Confidence Interval [CI] 1.01–1.83) in 2015/16 and (aOR = 1.36; 95% CI: 1.10–1.65) from 2004 to 2015 were risk factors for caesarean births in Malawi. In addition, being obese (aOR = 2.15; 95% CI: 1.12–4.11) in 2004/05, (aOR = 1.66; 95% CI: 1.08–2.55) in 2010, (aOR = 2.18; 95% CI: 1.48–3.21) in 2015/16, and (aOR = 2.16; 95% CI: 1.65–2.84) from 2004 to 2015) increased the risk of caesarean births. In addition, women who had one parity, and lived in the northern region were significantly more likely to have undergone caesarean birth.ConclusionsIn order to reduce non-elective cesarean birth in Malawi, specific public health programs should be focus on reducing overweight and obesity among women of reproductive age. More focus attention may be given to women with one parity, particularly in the urban and the northern region of Malawi.
Highlights
Overweight and obese women are at risk of pregnancy and delivery complications
Overweight and obesity in African society is often viewed as a sign of social status, wellness and prosperity [7,8,9] among women
There is limited knowledge about the increased rate of cesarean birth in overweight and obese women, it has been suggested that pregnancy complications such as gestational diabetes, hypertension, increase in maternal pelvic soft tissue, fetal macrosomia, prolonged time of delivery and intrapartum complications might be related to obesity which are known risk factors for caesarian birth [15, 29]
Summary
This study investigates the trend and association between maternal overweight and obesity on caesarean births in Malawi. Overweight and obesity are a major public health concern contributing to more than 2 million preventable deaths each year [1, 2]. According to the World Health Organization (WHO), overweight is defined as body mass index (BMI) of ≥25 kg/m2 and obesity as BMI ≥ 30 kg/m2 [3]. Overweight and obesity in African society is often viewed as a sign of social status, wellness and prosperity [7,8,9] among women. In Malawi, one in five (21%) women aged 15–49 years are overweight or obese [11], similar to 20.9% reported in Nigeria [9]
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