Abstract
BackgroundThe continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery.MethodsThis study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies.ResultsInstitutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15–3.80, Ptrend < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25–2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73–4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27–3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21–0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33–0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12–2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94–4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62–0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65–1.04 in EDHS-2014, P > 0.05).ConclusionsResults showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.
Highlights
The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide
The three Egypt Demographic and Health Surveys (EDHS) were based on a nationally representative sample of 57,763 ever-married women aged 15 to 49 years, of which, 29,107 mothers reported on the mode of delivery of their last birth born within five years preceding each survey (Fig. 1)
Obtained results demonstrated that the proportion of csections in Egypt has been increasing steadily in recent years and has reached an alarming level
Summary
The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. Caesarean delivery without a medical need places mothers and their babies at-risk of short- and longterm health consequences [1]. It is associated with increased risk of blood transfusion, hysterectomy, maternal and child death [2,3,4], uterine rupture, placenta accreta, and placenta previa [5, 6]. It costs more and requires longer hospitalization than vaginal delivery [7]
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