Prevalence and Indications for Caesarean Delivery at Mbuya Nehanda Maternity Hospital, Harare, Zimbabwe

Abstract

Caesarean section is a lifesaving surgical procedure when medically indicated. However, overuse of this procedure is associated with poor health outcomes including an increase in maternal and neonatal mortality especially in low-to-middle income countries. WHO has established an optimum caesarean section rate of between 10 to 15% in which the best possible outcomes have been observed at population level. A preliminary review of records at Mbuya Nehanda Maternity Hospital in Harare, Zimbabwe, revealed a caesarean section rate that was 2 times higher than the WHO recommended threshold. The aim of this study was to assess the prevalence of and obstetric indications for caesarean delivery at Mbuya Nehanda Maternity Hospital over a year (September 2021 to August 2022). An analytical cross-sectional study design was conducted on 1668 participants who delivered at Mbuya Nehanda Maternity Hospital. Data on sociodemographic characteristics, obstetric indications and delivery method were collected using a structured questionnaire and from birth registers. Descriptive statistics were presented as frequencies whereas analytical statistics were based on logistic regression, odds ratio, and p-values as analysed using Stata version 16. Overall, the prevalence of caesarean section over the 12-month period was 39.3%. The highest prevalence was in September 2021 (71.2%) and the lowest was in January 2022 (18.7%). Sociodemographic factors such as residence, age, past obstetric complications and booking status were associated with delivery through caesarean section. Participants who were greater or equal to 40 years old had 7 times the odds of delivering through caesarean section compared to younger participants (OR 7.0, 95% CI = 2.9-17.1, p-value <0.000). The likelihood of delivering through CS for participants with a history of pregnancy complications was 6.1 times higher than that of participants without any past obstetric indications (OR = 6.1: 95% CI 0.0 – 0.01, p < 0.005). The odds of delivering through CS were more than double among those who did not book compared to those who had booked to deliver at Mbuya Nehanda Maternity Hospital (OR= 2.5: 95% CI = 1.7 – 3.8). Participants who resided within the Harare catchment area were 56.0% less likely to deliver through CS compared to those who resided outside the Harare catchment area (OR=0.4: 95% CI = 0.3-0.6, p < 0.001). The majority (67.4%) of participants with a history of pregnancy complications delivered through caesarean section. By proportion, the most common obstetric indications for caesarean delivery were having a previous caesarean section (40.1%), eclampsia (10.2%), foetal distress (10.1%), and prolonged labour (7.9%). Relative indications accounted for 58.4% of all caesarean deliveries during the study period. Primary caesarean sections accounted for 59.9% of all caesarean deliveries. In conclusion, there was a high caesarean section rate at Mbuya Nehanda Maternity Hospital during the study period. The researcher recommends a high alert on patients with sociodemographic characteristics associated with caesarean delivery.