Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-20T17:31:34.057Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk factors for Caesarean sections in Ghana: evidence from the Ghana Maternal Health Survey

Published online by Cambridge University Press:  12 November 2020

Emmanuel Banchani Open the ORCID record for Emmanuel Banchani [Opens in a new window]  and
Eric Y. Tenkorang
Emmanuel Banchani*
Affiliation:
Department of Sociology, Memorial University, St John’s, NL, Canada
Eric Y. Tenkorang
Affiliation:
Department of Sociology, Memorial University, St John’s, NL, Canada
*
*Corresponding author. Email: eb1043@mun.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15–49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10–5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14–0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08–3.14). The findings suggest that beyond maternal complications, women’s socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.

Keywords

Elective Caesarean sectionGhanaProlonged/obstructed labour
Type
Research Article
Information
Journal of Biosocial Science , Volume 54 , Issue 1 , January 2022 , pp. 21 - 38
Copyright
© The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abu-Heija, A, Rasheed, R and el-Qaraan, O (1998) Effect of age and parity on primary caesarean section rates. Clinical & Experimental Obstetrics & Gynecology 25(1–2), 38–39.Google ScholarPubMed
Al Rowaily, MA, Alsalem, A and Abolfotouh, MA (2014) Cesarean section in a high-parity community in Saudi Arabia: clinical indications and obstetric outcomes. BMC Pregnancy and Childbirth 14, 92.CrossRefGoogle Scholar
Alkire, BC, Vincent, JR, Burns, CT, Metzler, IS, Farmer, PE and Meara, J (2012) Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention. PLoS One 7(4), e34595.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynecologists (2019) Cesarean delivery on maternal request. Obstetrics and Gynecology 133(1), e73–e77.CrossRefGoogle Scholar
Apanga, PA and Awoonor-Williams, JK (2018) Predictors of caesarean section in Northern Ghana: a case-control study. Pan African Medical Journal 29, 20.CrossRefGoogle Scholar
Barrett, JFR, Hannah, ME, Hutton, EK, Willan, AR, Allen, AC, Armson, BA et al. (2013) A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. New England Journal of Medicine 369(14), 1295–1305.CrossRefGoogle ScholarPubMed
Barros, AJD, Victora, CG, Horta, BL, Wehrmeister, FC, Bassani, D, Silveira, MF et al. (2019) Antenatal care and caesarean sections: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015. International Journal of Epidemiology 48 (supplement 1), i37–i45.CrossRefGoogle Scholar
Betrán, AP, Y, J, Moller, A, Zhang, J, Gülmezoglu, AM and Torloni, MR (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 11(2), e0148343.CrossRefGoogle ScholarPubMed
Biccard, BM, Madiba, TE, Kluyts, HL, Munlemvo, DM, Madzimbamuto, FD, Basenero, A et al. (2018) Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet 391(10130), 1589–1598.CrossRefGoogle ScholarPubMed
Bickford, CD and Janssen, PA (2015) Maternal and newborn outcomes after a prior birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study. Canadian Medical Association Journal Open 3(2), E158–E165.Google ScholarPubMed
Bishop, D, Dyer, RA, Maswime, S, Rodseth, RN, van Dyk, D, Kluyts, HL et al. (2019) Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. The Lancet 7(4), e513–e522.Google ScholarPubMed
Boatin, AA, Schlotheuber, A, Betran, AP, Moller, A, Barros, AJD, Boerma, T et al. (2017) Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries. British Medical Journal Open 360, k55.Google Scholar
Boerma, T, Ronsmans, C, Melesse, DY, Barros, AJD, Barros, FC, Juan, L et al. (2018) Global epidemiology of use of and disparities in caesarean sections. The Lancet 392, 1341–1348.CrossRefGoogle ScholarPubMed
Butwick, AJ and Palanisamy, A (2018) Mode of anaesthesia for caesarean delivery and maternal morbidity: can we overcome confounding by indication? British Journal of Anaesthesia 120(4), 621–623.CrossRefGoogle ScholarPubMed
Cai, M, Loy, SL, Tan, KH, Godfrey, KM, Gluckman, PD, Chong, Y et al. (2018) Association of elective and emergency cesarean delivery with early childhood overweight at 12 months of age. Journal of American Medical Association Network Open, 1(7), e185025.Google ScholarPubMed
Cantone, D, Lombardi, A, Assunto, DA, Piccolo, M, Rizzo, N, Pelullo, CP et al. (2018) A standardized antenatal class reduces the rate of cesarean section in southern Italy: a retrospective cohort study. Medicine 97(16), e0456.CrossRefGoogle ScholarPubMed
Danso, KA, Schwandt, HM, Turpin, CA, Seffah, JD, Samba, A and Hindin, MJ (2009) Preference of Ghanaian women for vaginal or caesarean delivery postpartum. Ghana Medical Journal 43(1), 29–33.Google ScholarPubMed
Diejomaoh, MFE, Al-Jassar, W, Bello, Z, Karunakaran, K and Mohammed, A (2018) The relevance of the second cesarean delivery in the reduction of institutional cesarean delivery rates. Medical Principles & Practice 27, 555–561.CrossRefGoogle ScholarPubMed
Dong, Y, Luo, Z, Yang, Z, Chen, L, Guo, Y, Branch, W et al. (2016) Is cesarean delivery preferable in twin pregnancies at >=36 weeks gestation? PLoS One 11(5), e0155692.CrossRefGoogle ScholarPubMed
Feng, XL, Xu, L, Guo, Y and Ronsmans, C (2012) Factors influencing rising caesarean section rates in China between 1988 and 2008. Bulletin of the World Health Organization 90, 30–39.CrossRefGoogle ScholarPubMed
Gamble, JA and Creedy, DK (2001) Women’s preference for a cesarean section: incidence and associated factors. Birth 28(2), 101–110.CrossRefGoogle ScholarPubMed
GHS (2017) Ghana Health Service 2016 Annual Report. GHS, Accra. URL: https://www.ghanahealthservice.org/downloads/GHS_ANNUAL_REPORT_2016_n.pdf (accessed 15th March 2019).Google Scholar
GSS, GHS and ICF (2018) Ghana Maternal Health Survey 2017. Ghana Statistical Service (GSS), Ghana Health Service (GHS) and Macro ICF, Accra.Google Scholar
Harrison, MS and Goldenberg, RL (2016) Cesarean section in sub-Saharan Africa. Maternal Health, Neonatology, and Perinatology 2, 6.CrossRefGoogle ScholarPubMed
Harrison, MS, Pasha, O, Saleem, S, Ali, S, Chomba, E, Carlo, WA et al. (2017) A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries. Acta Obstetricia et Gynecologica Scandinavica 96(4), 410–420.CrossRefGoogle ScholarPubMed
He, Z, Cheng, Z, Wu, T, Zhou, Y, Chen, J, Fu, Q and Feng, Z (2016) The costs and their determinant of cesarean section and vaginal delivery: an exploratory study in Chongqing Municipality, China. BioMedical Research International 2016, 5685261.CrossRefGoogle ScholarPubMed
Herstad, Klungsøyr K, Skjærven, R, Tanbo, T, Forsén, L, Åbyholm, T et al. (2016) Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low risk primiparous women. BMC Pregnancy and Childbirth 16, 230.CrossRefGoogle ScholarPubMed
International Surgical Outcomes Study Group (2016) Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. British Journal of Anaesthesia 117(5), 601–609.CrossRefGoogle Scholar
Janoudi, G, Kelly, S, Yasseen, A, Hamam, H, Moretti, F and Walker, M (2015) Factors associated with increased rates of caesarean section in women of advanced maternal age. Journal of Obstetrics and Gynaecology Canada 37(6), 517–526.CrossRefGoogle ScholarPubMed
Kim, SJ, Kim, SJ, Han, K and Park, E (2017) Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea. PLoS One 12(11), e0188612.CrossRefGoogle ScholarPubMed
Kingdon, C, Downe, S and Betran, AP (2018) Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: systematic review of qualitative studies. PLoS One 13(9) e0203274.CrossRefGoogle ScholarPubMed
Kok, N, Ruiter, L, Hof, M, Ravelli, A, Mol, BW, Pajkrt, E et al. (2014) Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 121, 216–223.CrossRefGoogle Scholar
Kolås, T, Øian, P and Skjeldestad, E (2010) Risks for peroperative excessive blood loss in cesarean delivery. Acta Obstetricia et Gynecologica 89, 658–663.CrossRefGoogle ScholarPubMed
Kyu, HH, Shannon, S, Georgiades, K and Boyle, MH (2013) Caesarean delivery and neonatal mortality rates in 46 low- and middle-income countries: a propensity-score matching and meta-analysis of Demographic and Health Survey data. International Journal of Epidemiology 42, 781–791.CrossRefGoogle ScholarPubMed
Leonard, SA, Main, EK and Carmichael, SL (2019) The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC Pregnancy and Childbirth 19(1), 16.CrossRefGoogle Scholar
Liu, A, Yung, WK, Yeung, HN, Lai, SF, Lam, MT, Lai, FK et al. (2012) Factors influencing the mode of delivery and associated pregnancy outcomes for twins: a retrospective cohort study in a public hospital. Hong Kong Medical Journal 18, 99–107.Google ScholarPubMed
Long, Q, Kingdon, C, Yang, F, Renecle, MD, Jahanfar, S, Bohren, MA et al. (2018) Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: a mixed-methods systematic review. PLoS Medicine 15(10), e1002672.CrossRefGoogle ScholarPubMed
McClelland, S, Gorfinkle, N, Arslan, AA, Benedetto-Anzai, MT, Cheon, T and Anzai, Y (2017) Factors associated with cesarean delivery rates: a single-institution experience. Maternal Health, Neonatology, and Perinatology 3, 8.CrossRefGoogle ScholarPubMed
Maslow, AS and Sweeny, AL (2000) Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstetrics Gynecology 95(6), 917–922.Google ScholarPubMed
Merchant, KM, Villar, J and Kestler, E (2001) Maternal height and newborn size relative to risk of intrapartum caesarean delivery and perinatal distress. BJOG: An International Journal Of Obstetrics And Gynaecology 108(7), 689–696.Google ScholarPubMed
Moaddab, A, Dildy, GA, Brown, HL, Bateni, ZH, Belfort, MA, Sangi-Haghpeykar, H et al. (2016) Health care disparity and state-specific pregnancy-related mortality in the United States, 2005–2014. Obstetric Gynecology 128(4), 869–875.CrossRefGoogle ScholarPubMed
Morisaki, N, Ganchimeg, T, Ota, E, Vogel, JP, Souza, J, Mori, R et al. (2014) Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG: An International Journal of Obstetrics & Gynaecology 121 (Supplement 1), 66–75.CrossRefGoogle ScholarPubMed
Parrish, KM, Holt, VA, Easterling, TR, Connell, FA and LoGerfo, JP (1994) Effect in changes in maternal age, parity, and birth weight distribution on primary cesarean delivery rates. Journal of the American Medical Association 271(6), 443–447.CrossRefGoogle ScholarPubMed
Prah, J, Kudom, A, Afrifa, A, Abdulai, M, Sirikyi, I and Abu, E (2017) Caesarean section in a primary health facility in Ghana: clinical indications and feto-maternal outcomes. Journal of Public Health in Africa 8(704), 155–159.Google Scholar
Raudenbush, SW and Bryk, AS (2002) Hierachical Linear Models. Applications and Data Analysis Methods. Sage Publications Inc., CA, USA.Google Scholar
Rydahl, E, Declercq, E, Juhl, M and Maimburg, RD (2019) Cesarean section on a rise – does advanced maternal age explain the increase? A population register-based study. PLoS One 14(1), e0210655.CrossRefGoogle ScholarPubMed
Sandall, J, Tribe, RM, Avery, L, Mola, G, Visser, GHA, Homer, CSE et al. (2018) Short-term and long-term effects of caesarean section on the health of women and children. The Lancet 392, 1349–1357.CrossRefGoogle ScholarPubMed
Schmitz, T, Carnavalet, CC, Azria, E, Lopez, E, Cabrol, D and Goffinet, F (2008) Neonatal outcomes of twin pregnancy according to the planned mode of delivery. Obstetrics & Gynecology 111(3), 695–703.CrossRefGoogle Scholar
Singh, SK, Vishwarma, D and Sharma, SS (2020) Prevalence and determinants of voluntary caesarean deliveries and socioeconomic inequalities in India: evidence from National Family Health Survey (2015–16). Clinical Epidemiology & Global Health 8, 335–342.CrossRefGoogle Scholar
Souza, JP, Gülmezoglu, A, Lumbiganon, P, Laopaiboon, M, Carroli, G, Fawole, B et al. (2010) Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on Maternal and Perinatal Health. BMC Medicine 8, 71.CrossRefGoogle ScholarPubMed
Stulp, G, Verhulst, S, Pollet, TV, Nettle, D and Buunk, AP (2011) Parental height differences predict the need for an emergency caesarean section. PLoS One 6(6), e20497.CrossRefGoogle ScholarPubMed
Tollanes, MC, Thompson, JMD, Daltveit, AK and Irgens, LM (2007) Cesarean section and maternal education; secular trends in Norway, 1967–2004. Acta Obstetricia et Gynecologica 86, 840–848.CrossRefGoogle Scholar
Visser, GHA, Ayres-de-Campos, D, Barnea, ER, de Bernis, L, Renzo, GCD, Vidarte et al. (2018) FIGO position paper: how to stop the caesarean section epidemic. The Lancet 392, 1286–1287.CrossRefGoogle ScholarPubMed
WHO (2015) WHO Statement on Caesarean Section Rates. World Health Organization, Geneva. URL: https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf;jsessionid=9BA3695FA834F7806CCB047B0EBB505B?sequence=1 (accessed 15th March 2019).Google Scholar
WHO (2018) WHO Recommendations: Non-Clinical Interventions to Reduce Unnecessary Caesarean Sections. World Health Organization, Geneva. URL: https://apps.who.int/iris/bitstream/handle/10665/275377/9789241550338-eng.pdf?ua=1 (accessed 15th March 2019).Google Scholar
Williams, KP and Galerneau, F (2003) Intrapartum influences on cesarean delivery in multiple gestation. Acta Obstetricia et Gynecologica Scandinavica 82(3), 241–245.CrossRefGoogle ScholarPubMed
Yaya, S, Uthman, OA., Amouzou, A and Bishwajit, G (2018) Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries. Global Health Research and Policy 3,19.CrossRefGoogle ScholarPubMed
Yidana, A and Issahaku, M (2014) Contextualising women decision making during delivery: socio-cultural determinant of choice of delivery sites in Ghana. Public Health Research 4(3), 92–97.Google Scholar
Zanardo, V, Soldera, G, Volpe, F, Giliberti, L, Parotto, M, Giustardi, A et al. (2016) Influence of elective and emergency cesarean delivery on mother emotions and bonding. Early Human Development 99, 17–20.CrossRefGoogle Scholar
Zgheib, SM, Kacim, M and Kostev, K (2017) Prevalence of and risk factors associated with cesarean section in Lebanon – retrospective study based on a sample of 29,270 women. Women and Birth 30, e265–e271.CrossRefGoogle Scholar
Zhang, H, Wu, J, Norris, J, Guo, L and Hu, Y (2017) Predictors of preference for caesarean delivery among pregnant women in Beijing. Journal of International Medical Research 45(2), 798–807.CrossRefGoogle ScholarPubMed