Abstract
BackgroundInappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it.MethodsData from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities.ResultsOut of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile .ConclusionsThis study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.
Highlights
Caesarean Section (CS) is a life-saving obstetric surgical intervention for mothers and babies [1, 2]
Even though Ghana has achieved a CS rate of 11.4%, which is consistent with World Health Organization (WHO) recommendations, it still has a high maternal mortality rate; this study’s finding of large inequalities in the use of CS based on wealth and education helps provide an explanation for this apparent contradiction
The importance of generating evidence for the presensce of socioeconomic inequalities in the use of CS in Ghana is that it directs public policy to go beyond aggregate level indicators and critically examine caesarean delivery distribution
Summary
Caesarean Section (CS) is a life-saving obstetric surgical intervention for mothers and babies [1, 2]. This vital clinical procedure is often needed as a result of several medical conditions including macrosomia, pregnancy-induced hypertension, maternal weight, among others [3,4,5]. This CS disparity represent underuse or possibly medically unjustified overuse [7, 10,11,12,13]. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it
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