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Christian View on 4 Csections and Reccomended Not to Get Pregnant Again

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Not but numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study

BMC Pregnancy and Childbirth volume 20, Article number:114 (2020) Cite this article

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Abstruse

Groundwork

The increasing rate of caesarean deliveries (CD) has get a serious concern for public health experts globally. Despite this health concern, research on factors associated CD in many depression- and -eye countries like Ghana is sparse. This written report, therefore, assessed the prevalence and determinants of CD among child-begetting women aged 15–49  in Ghana.

Methods

The study used data from the 2022 Republic of ghana Demographic and Health Survey. The analysis was limited to mothers (due north = 2742) aged 15–49 , who had given nascency in health facilities v years preceding the survey. Association between CD and its determinants was assessed past computing adjusted odds ratios (AOR) with their respective 95% conviction intervals using a binary logistic regression.

Results

The percentage of mothers who delivered their babies through caesarean section (CS) was 18.v%. Using multivariable logistic regression, the results showed that women anile 45–49 (AOR = 10.5; 95% CI: 3.0–37.4), and women from a household that are headed by a female (AOR = ane.three; 95% CI = one.i–1.7) had higher odds to deliver through CS. Women from the Upper East (AOR =0.four; 95% CI = 0.2–0.7) and Upper W (AOR = 0.4; 95% CI = 0.2–0.8) regions had lower odds to evangelize their children through CS. Women with parity 4 or more (AOR = 0.3; 95% CI = 0.2–0.v) had lower odds of CD compared to those with parity 1. Women with female babies had lower odds (AOR = 0.8; CI = 0.7–0.nine) of delivering them through CS compared to those with male children.

Determination

The per centum of women delivering babies through the CS in Republic of ghana is high. The high rates of CD noted practice not substantially betoken good quality intendance or services. Hence, health facilities offer this medical protocol need to adopt comprehensive and strict measures to ensure detailed medical justifications by doctors for performing these caesarean surgeries.

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Groundwork

Caesarean Department (CS) is i of the obstetric interventions introduced to help subtract maternal and foetal mortality and morbidity [one]. This medical protocol is a surgical procedure in which an incision is made through a mother's abdomen and uterus to deliver 1 or more babies, or rarely, to remove a dead foetus [2]. This surgical process is viewed equally 1 of the major World Wellness Organization's (WHO) medically suggested plan towards improving availability, accessibility, quality, and the use of services for the direction and handling of complications of pregnancy, labour, and delivery [3]. CS is as well considered an essential handling for antepartum bleeding, prolonged or obstructed labour, preeclampsia or eclampsia, and intrapartum foetal distress [four]. However, a 2008 WHO survey of 373 facilities beyond 24 countries found that caesareans deliveries (CD) were associated with an increased chance of maternal mortality and serious outcomes for mothers and newborn infants, compared with spontaneous vaginal delivery (VD) [5]. There are 6 to 10 times more than complications amongst women having a CD than a VD, with emergency CDs being two to four times riskier than elective [half-dozen].

WHO review from Northern European countries suggests that proficient maternal and perinatal outcomes are associated with the rate of CS [7]. The WHO concluded that at that place is no justifiable reason to back up caesarean birth rates college than 15% in whatever land. A charge per unit betwixt 5 and 15% of births undergoing a CS is optimal and has medical indications for CD [8], and rates higher up this are unsuitable and unnecessary, imposing financial burden and clinical risks on patients and healthcare systems [9]. A CD rate of less than 5% also indicates the unmet need for skilled delivery service [10].

CS have in recent times been performed upon request for childbirths that could otherwise have been delivered vaginally and these have become a affair of serious concern for public wellness experts globally [two]. The WHO reports that betwixt 1990 and 2014, the global average CD rate increased from 12.4 to xviii.6%, with rates ranging between 6% in low- and -middle-income countries and 27.2% in high income countries [iii] and rising at an boilerplate charge per unit of iv.four% per year [iv]. Still, Africa recorded the lowest rate of 7.3%, followed past Asia with 19.2%, Europe recording 25%, and the highest rates of 40.5% from Latin America and the Caribbean [iv].

In countries with high prevalence of CD, the factors that contribute to the high rates are low priority of enhancing women's own abilities to give nascence, side furnishings of common labour interventions, refusal to offer the informed choice of vaginal birth, casual attitudes nearly surgery and variation in professional practice way, limited sensation of impairment more probable with CD, and incentives to do in a manner that is efficient for providers [1, 4]. Other factors such every bit type of health facility–public or private [1], age [1, 11, 12], birth gild [13,fourteen,15], nascence weight [xi], identify of residence [i, 16], region of residence [1], socioeconomic status, maternal educational level [ane, 17], maternal request [18] and wealth status [ane, 17] have all been found to be associated with CS. Virtually low- and -heart-income countriess (LMICS), even so, report CD rates well below the acceptable minimum standard of five% outlined by the WHO. For many LMICs (e.g., Niger, Ethiopia and Madagascar), the caesarean procedure is scarcely performed, hence the rates of births by CD are around 1.0% [xix]. It has been established that in almost LMICs, factors including inaccessibility to healthcare, weak healthcare arrangement, inadequate health infrastructure, geographical barriers, cultural factors, poverty, and inadequate human being resource are major impediments to providing CD to women who are in dire need of it [xx].

Although there have been some studies on CD in Ghana, some of them focused on socioeconomic and demographic factors associated with CD in southern Ghana [fourteen], preference of Ghanaian women for vaginal or CD postpartum [21], validating women'due south self-report of emergency CD [eighteen], vaginal birth later on a previous CS [22] and clinical indications and feto-maternal outcomes and predictors of CD in Northern Republic of ghana [23]. Every bit far as we know, none of these studies have used a nationally representative sample to assess prevalence and the factors associated with CD amid childbearing women in Ghana despite the state recording an overall rate of 16% [24], higher up the threshold given by WHO. The wellness organisation is structured with most of the deliveries initiated in health facilities that exercise not have the capacity to perform CS and lack ambulances for referrals of clients who demand CS in Ghana [25]. Consequently, a lot of pregnant women who undergo emergency CS at referral hospitals have adverse obstetric outcomes as compared to clients who have been booked for parturient [25]. The central focus of this study was, therefore, to decide the prevalence and assess the factors associated with CD amidst childbearing women in Ghana.

Methods

Study setting

The study was carried out in the Commonwealth of Ghana which is located on the West African Coast and has a full state area of 238, 533 km2 with 16 administrative regions. Ghana is bordered by iii francophone countries; Burkina Faso, Togo and Cote d'Ivoire. These countries lie on the north, Due east and West of Ghana respectively [24]. In Ghana, from the 2010 population and housing census, there are about 8 main ethnic groups. These are: Akan (47.5%), Mole-Dagbani (sixteen.6%), Ewe (13.9%), Ga–Dangme (7.four%), Gurma (5.7%), Guan (3.7%), Grusi (ii.v%), Mande (1.one%), and others (1.4%, [26]. Again, the 2010 demography report stated that 51% of the population in Ghana are found in urban areas whereas 49% are in rural areas. There are almost 3217 functional health facilities, out of which four are teaching hospitals. Additionally, there are 9 regional hospitals, three psychiatric hospitals, eleven polyclinics, 59 Christian Health Association of Ghana (CHAG) hospitals, 10 Islamic hospitals, 96 government hospitals, 156 private hospitals, and 22 quasi-government hospitals, 389 maternity homes, and 379 Community–based Caput Planning and Services (CHPS) compounds, with majority of these health facilities found in the urban areas [26, 27].

Data source

The data used for this study were obtained from the 2022 version of the Ghana Demographic and Health Survey (GDHS). The survey uses a standard DHS model questionnaire adult past the Measure DHS programme [24]. The GDHS is a nationwide survey which covers all the and then 10 regions of Ghana. The survey is carried out past the GSS and Ghana Health Service with support from ICF International. The fundamental focus of the survey is on child and maternal health in social club to provide adequate data to help tract major population and wellness determinants in Ghana. Specifically, it collects data on fertility, contraceptive use, child health, nutrition, malaria, HIV and AIDS, family planning, health insurance and maternal health; antenatal care, commitment care and post-natal intendance [24]. For the purpose of this study, women who take given nascency in wellness facilities 5 years preceding the survey were used, thus, 2742 women. Detailed decription of the sampling procedure has been provided in the survey study [24]. Permission to employ the information set was given by the MEASURE DHS following the assessment of a proposal. Data set is available to the public at world wide web.measuredhs.org.

Description and definition of variables

Dependent variable

The study used CD as the dependent variable. It was derived from the response to the question "was (NAME) delivered by caesarean, that is, did they cut your belly open to have the baby out?" Responses were categorised Yes = 1 or No = 0.

Independent variables

Fourteen independent variables were selected only not chosen capricious. The choice was guided by the varied conclusions fatigued from some previous studies [1, 11, 12, 14, 28, 29] to be having an association with CD. The independent variables that were used in this study were; maternal age, marital status, didactics, occupation, wealth status, residence, region, religion, ethnicity, parity (Nascence order), number of ANC visits, sex of the baby, size of the baby, and household caput's sexual practice. Maternal historic period was captured in the DHS as "fifteen–xix", "twenty – 24", "25 – 29", "20 – 34", "35 – 39", "40 – 44", "45–49". Marital status was recoded as "Single" and "Living together". We recoded educational level as "No education", "Master education", "Secondary education" and "Higher education". Type of Residence was captured as "Urban" or "Rural". The then 10 regions were also captured in the survey every bit "Western", "Cardinal", "Greater Accra", "Volta", "Eastern", "Ashanti", "Brong–Ahafo", "Northern", "Upper Eastward", and "Upper West". Wealth index was measured in quintiles ("poorest", "poorer", "eye", "richer", "richest"). Ethnicity was coded every bit "Akan", "Ga/Adangbe", "Ewe", "Guan", "Mole–Dagbani", "Grussi", "Gruma", "Mande" and "Other". Parity was recoded as "1", "2", "3" and "4+" taking into consideration Ghana'south current total fertility rate of four.2 [24]. The sexual activity of the baby was coded as "male person" and "female". With respect to occupation, someone was considered as not working if the person was non engaging in any income generating venture; principal occupation was considered as an occupation focusing on the extraction of raw materials including all forms of agronomics; secondary occupation referred to the product manufacture which adds value to raw materials extracted through primary occupation whilst tertiary occupation involved provision of services. Size of a child at nativity was originally coded equally "very big", "larger than average", "Average", "smaller than average" and "very small". These were recoded equally "Big" "Average" and "Pocket-size". Because the recommendations of the WHO [seven] and previous studies, a woman should have at least 4 antenatal visits to prevent negative health outcomes. ANC was therefore coded as "0", "1–3" and "4 or more than". The identify of delivery was recoded as "private" or "public sector". Women who had habitation deliveries were not part of the inclusion criteria due to the fact that CD cannot be performed at home [one]. In the Ghanaian context, the public sector includes regime hospitals and rural health centres while the private sector includes private hospitals and clinics [xxx].

Data belittling strategy

STATA fourteen.ane for Mac Os (College Station, TX) Statistical Analytic tool was used for the analysis. The outcome variable, CD was coded 0 = "No", and 1 = "Yes." Both descriptive and inferential statistics were employed for information analyses. Start, a descriptive analysis of socio-demographic characteristics of the participants was carried out and presented as frequencies and percentages in Tabular array 1. Next, a pie chart was used to present results on the prevalence of CD using frequencies and percentages. Third, the association between the independent variables and the outcome variable were presented using a 2 past 2 contingency table and the results presented using chi-square (χ ii ) and p values (run across Tabular array 2). The independent variables that were significant at p < 0.05 at the bivariate level were used for the multivariable analysis. The results are presented in Table three with summary statistics at 95% confidence intervals (CI). Since the outcome variable was a dichotomous variable, the binary logistic regression model was employed. All frequency distributions were weighted while the survey command (svy) in STATA was used to suit for the circuitous sampling structure of the data in the regression analyses.

Table 1 Socio-demographic characteristics of women aged 15–49 years who gave birth in a health facility in Republic of ghana

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Table 2 Bivariate assay on commitment by caesarean amidst women aged fifteen–49 years who gave birth in a health facility in Ghana

Total size tabular array

Table 3 Multivariable logistic regression on factors associated with CD among women aged fifteen–49 years who gave birth in a wellness facility in Ghana

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Results

Maternal socio-demographic characteristics

The survey included the weighted total population of 2742 women who had given nascency in wellness facilities 5 years preceding the survey. Regarding their age distribution, 25% of written report participants were in the age range 25–29 years and 30–34 years respectively. For marital status, 7 out of 10 of the women were married. With teaching, 63% had a secondary level of formal education. Slightly more one-half (51.6%) were working in the tertiary sector while 16.2% were not-working mothers whereas 25.eight% belonged to the richest quintile of wealth. As far as the region and place of residence were concerned, more one-half of the mothers (56.ii%) resided in urban areas, while twenty.iv% were inhabitants of greater Accra region. Akans also constituted one-half (50.4%) of the sample (see Tabular array 1).

Prevalence of caesarean delivery

Effigy 1 shows results on the prevalence of CD amidst changeable women in Ghana. Out of the 2742 women who had given nascency in health facilities v years preceding the survey, 18.5% delivered their babies through CS and 81.5% had VD.

Fig. one
figure 1

Prevalence of caesarean delivery. Source: computed from 2022 GDHS

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Bivariate assay on delivery by caesarean section

From Table two, it was shown that there were statistically significant differences in historic period (χ 2  = 37.5, p < 0.001), education (χ 2  = 50.4, p < 0.001), occupation (χ 2  = 23.vi, p < 0.001), wealth (χ ii  = 95.2, p < 0.001), region (χ 2  = 65.two,p < 0.001), residence (χ 2  = 31.4, p < 0.001), ethnicity (χ 2  = 32.one, p < 0.001), parity (χ ii  = 14.half dozen, p < 0.01), ANC attendance (χ 2  = 5.seven, p < 0.05), sex of baby (χ two  = iv.5, p < 0.05), baby size (χ 2  = half-dozen.0, p < 0.05), and sex of household caput (χ 2  = x.iii, p < 0.01) and CD. The results further revealed that 21% of the respondents aged 35–39 and 45–49 delivered their children through CS. Approximately, a quarter 24.seven% of the respondents with college level of instruction delivered their children through CS, 28.v% of mothers who delivered through CS were in the richest domain, 25.1% were in greater Accra region. It was also plant that xx.2% were Ga/Adagmes, 20.9% had parity 1, 16.1% were those who had four or more ANC visits (see Tabular array 2).

Multivariable assay

Using multivariable logistic regression analysis, the data showed that women aged 45–49 had higher odds of giving birth by CS compared to women aged 15–xix years (AOR = 10.v; 95% CI: 3.0–37.iv), and women from household that are headed by females (AOR = i.3; 95% CI = 1.0–ane.vii) compared to women in households headed by males. Women from the Upper East (AOR =0.4; 95% CI = 0.ii–0.7) and Upper West (AOR = 0.iv; 95% CI = 0.2–0.eight) regions were less likely to deliver children by CS compared to women from the Western region. Similarly, the odds of CD decreased with an increment in parity. For example, women with parity iii (AOR = 0.4; 95% CI = 0.iii–0.6), 4 or more had near 0.3 lower odds of CD deliveries (AOR = 0.3; 95% CI = 0.2–0.5) compared to those with parity i. Women with female babies had lower odds of CD (AOR = 0.8; CI = 0.7–0.ix) compared to those with male children (meet Table 3).

Discussion

CS is a mechanism to salve both the mother and the baby. Even so, filibuster in deciding for it may be detrimental for both. Nonetheless, premature and wrong decision opting for CD may increase maternal and foetal morbidity and bloodshed [31]. This paper sought to assess the factors associated with CD among childbearing women in Ghana. This nowadays written report found that 18.5% of women who delivered in wellness facilities v years preceding the survey delivered their babies through CS, a figure that exceeds the threshold of 5–15% recommended by WHO [7]. This corroborates the findings in previous studies in depression- and -centre income countries such as Pakistan [i], Egypt, [11], People's republic of bangladesh [12], Federal democratic republic of ethiopia [31], India [32], Jordan [33] and Tanzania [34]. An improved propensity toward available medical interventions and continued discouragement of VD after previous CS may take added to the recent increase in CS rates every bit noted in other countries [35]. Despite the fact that the study was non designed to measure the event of changes in other maternal characteristics (e.g. Maternal requests), other determinants such equally temporal changes in maternal pre-pregnancy weight, weight proceeds in pregnancy; and other characteristics may too take accounted for the observed increases in CD rates in Ghana. For example, the fearfulness of childbirth, bug related to control and prophylactic besides as risk associated with VD have been cited in previous studies equally key reasons for CS [36]. However, the proportion is lower than what was found in Ghana by [fourteen]. The possible reason for the inconsistency in study findings could be the study setting, the number of people that were used for the various studies and the years the studies were carried out likewise as methodological designs. These findings imply that there should exist encouragement of VD unless otherwise stated past a medical practitioner. Chiefly, due to logistical constraints in most health facilities, especially in the rural areas of the country, it is equally prudent to raise clients' and health professionals' awareness about the adverse outcomes associated with CD and advantages of VD. Educating mothers virtually risks associated with CD and effective midwifery training could also help encourage mothers to evangelize vaginally [1].

This study found a positive human relationship betwixt the odds of CD and age of mothers. Specifically, the odds of CD increased with their age. Those aged 45–49 had higher odds of CD compared to those aged xv–19. Findings of the electric current study, which involved data from a wider coverage of women beyond Ghana evidence testify that avant-garde maternal age is a higher risk gene for CS and that the extent of the chance surges with advancement in maternal age, a finding that is corroborated in other studies [1, 11, 12, 28, 29, 37,38,39]. Berkowitz et al. [40] reiterated that advanced maternal historic period is generally believed to be associated with increased risk for agin pregnancy consequence. Additionally, biological changes and complications (east.g., malposition, increased risk of hypertension, eclampsia, and diabetes) associated with crumbling meaning women may heighten the risk of CD [41, 42]. Due to the increment in risk, some women voluntary opt for CD [43].

CD in this report was associated with the region of residence. Those in Upper East and Upper West regions had lower odds of CD compared to women in the Western Region. This finding is confirmed in other studies on the relationship betwixt the geographical location and CD [ane, 44]. Mothers staying in less developed regions are less likely to apply CD services compared to those in regions that are more than adult. The reason could be the easy access, availability and utilization of maternal healthcare facilities at private and public hospitals in the southern part of Republic of ghana compared to the limited healthcare facilities in the Northern function of Ghana [14]. Additionally, in that location is meliorate access to CD due to the high numbers of wellness facilities with the capacity to conduct CD in the souther part of Ghana [30].

There was an inverse relationship betwixt parity and the odds of CD. Those with about 4 or more than births had lower odds of delivering their babies through CS. This finding is consistent with previous enquiry [13,fourteen,15]. As explained by Manyeh et al. [fourteen] on CD, women who might accept undergone more than 1 CD do not go pregnant over again to avoid farther CD. Additionally, one time the adult female'due south pelvis has been tested with a previous pregnancy and VD, subsequent deliveries vaginally tend to be less risky [15]. Hence, mothers who have had a lot of experiences with VD may be less likely to go in for CD.

Some other pregnant finding in this current written report was that mothers with female babies had lower odds of CD compared to those who had male children. From a socio-cultural perspective, the incertitude attached to CD by most women of sub-Saharan descent due to its associated unpleasant experiences (e.thousand., physical, psychological and emotional hurting/distress) advise that the mothers with female babies may wish not to have CD considering of a commonly held belief that such painful CD experiences might be transferred to their daughters afterward in life. Related to this households with a female as the head were more likely to become for CD compared to those headed by males, a finding similar to a Ghanaian community-based study [xiv]. What is unclear is whether this particular finding could be associated with the diverse sociocultural differences emanating from varied indigenous background of the women groups used for the study. It is therefore imperative for further studies to consider the association between the sex activity household head and CD to unearth the nuances.

Strength and limitations of the study

Past investigating caesarean outcomes of women from dissimilar accomplice groups, this study realizes the backbreaking responsibleness of discovering CD trends overtime among these diverse women groups. However, this study is not without limitations. Get-go, the information did not capture whatever specific type of pregnancy complexity that resulted in CD which could not help to ascertain whether performed CD was under medical indications (eastward.one thousand., fetal mal-presentation) or based solely on maternal need. Likewise, due to the cross-sectional nature of the study, causality could not be expressed betwixt any of the independent variables and CD. Other limitations may include those commonly related to large database research such as alterations in the coding of procedures in charts, tables and other information abstraction errors. However, no considerable modifications were done during coding and extraction in the conduct of this study. Despite these limitations, this report provides prove-based estimates on the prevalence of CD amid women giving nascence in health facilities in Ghana, equally well as its associated factors.

Conclusion and policy implications

In conclusion, women route of commitment is a potentially modifiable adventure factor that are at two ends of the kid delivery continuum (i.east., caesarean versus vaginal). The foregoing investigation of CD rates and associated factors as well as geographical differences would provide vital information for obstetric decision making on this medical intervention. The written report findings prove that the current CD in Ghana is approximately 18.five% which is to a higher place the WHO recommended proportion of v–15%. The study besides revealed strong associations between maternal age, region, parity, babe's sex, and sexual practice of household head and the probability of CD. Specifically, female babies are less likely to be delivered via CS whereas women with female househild head are more likely to deliver through CS. The high rates of CD noted in the current written report do not essentially indicate good quality care or services. Health institutions with loftier CS charge per unit should behave comprehensive assessment of the associated factors toward obstetric care. Detailed medical justification for performing CS by doctors should also be provided to reduce the proportions of women opting for CD. Additionally, other quantitative and qualitative research ought to be conducted to amend understand the socio-cultural beliefs, psychological factors and perceptions of Ghanaian women that may be contributing to the high uptake of CD in Ghana.

Availability of data and materials

Abbreviations

ANC:

Antenatal Care

AOR:

Adjusted Odds Ratio

CD:

Caesarean Delivery

CI:

Confidence Interval

CS:

Caesarean Department

GDHS:

Ghana Demographic and Health Surveys

MMR:

Maternal Mortality Ratio

WHO:

World Health Organization

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Acknowledgements

We acknowledge Measure DHS for providing us with the data.

Funding

This research did not receive whatsoever specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Writer information

Affiliations

  1. Department of Population and Wellness, Academy of Cape Coast, Cape Declension, Ghana

    Abdul-Aziz Seidu, Wonder Agbemavi & Eugene Budu

  2. Department of Health, Physical Education and Recreation, Academy of Cape Coast, Cape Coast, Ghana

    John Elvis Hagan Jr. & Francis Sambah

  3. Neurocognition and Action-Biomechanics Enquiry Group, Kinesthesia of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Deutschland

    John Elvis Hagan Jr. & Thomas Schack

  4. The Australian Centre for Public and Population Health Enquiry (ACPPHR), Kinesthesia of Health, Academy of Technology Sydney, Ultimo, Australia

    Bright Opoku Ahinkorah

  5. Ghana Wellness Service, Abura Dunkwa Health Directorate, Abura Dunkwa, Ghana

    Edmond Banafo Nartey

Contributions

Every bit conceived the study. AS designed and performed the analysis and write up on information and methods. As, BOA, and WA designed the start typhoon of the manuscript. Every bit, JEH, BOA, WA, EBN, EB, FS, and TS revised the manuscript for intellectual content and gave consent for the version to be published. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Abdul-Aziz Seidu.

Ethics declarations

Ethics approving and consent to participate

The DHS was canonical by the institutional review board of the Ghana Health Service and the ethics committee of the DHS Program. Informed consent, both written and oral were obtained from the respondents before the commencement of interviews with each respondent.

Consent for publication

Not applicative.

Competing interests

The authors declare that they have no competing interests.

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Seidu, AA., Hagan, J.East., Agbemavi, W. et al. Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cantankerous-exclusive report. BMC Pregnancy Childbirth twenty, 114 (2020). https://doi.org/10.1186/s12884-020-2792-vii

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  • DOI : https://doi.org/10.1186/s12884-020-2792-7

Keywords

  • Caesarean
  • Commitment
  • Ghana
  • Women
  • Obstetric

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