Cesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study

Emmanuel O Adewuyi; Asa Auta; Vishnu Khanal; Samson J Tapshak; Yun Zhao

doi:10.1136/bmjopen-2018-027273

Cesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study

BMJ Open. 2019 Jun 17;9(6):e027273. doi: 10.1136/bmjopen-2018-027273.

Authors

Emmanuel O Adewuyi^{1

2}, Asa Auta³, Vishnu Khanal⁴, Samson J Tapshak⁵, Yun Zhao⁶

Affiliations

¹ Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
² Pharmacy Department, 2 Division Hospital, Ibadan, Oyo State, Nigeria.
³ School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK.
⁴ Nepal Development Society, Bharatpur, Nepal.
⁵ Department of Obstetrics and Gynaecology, Chivar Specialist Hospital, and Urology Centre Ltd, Abuja, Nigeria.
⁶ Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Western Australia, Australia.

Abstract

Objective: To investigate the prevalence and factors associated with caesarean delivery in Nigeria.

Design: This is a secondary analysis of the nationally representative 2013 Nigeria Demographic and Health Survey (NDHS) data. We carried out frequency tabulation, χ² test, simple logistic regression and multivariable binary logistic regression analyses to achieve the study objective.

Setting: Nigeria.

Participants: A total of 31 171 most recent live deliveries for women aged 15-49 years (mother-child pair) in the 5 years preceding the 2013 NDHS was included in this study.

Outcome measure: Caesarean mode of delivery.

Results: The prevalence of caesarean section (CS) was 2.1% (95% CI 1.8 to 2.3) in Nigeria. At the region level, the South-West had the highest prevalence of 4.7%. Factors associated with increased odds of CS were urban residence (adjusted OR (AOR): 1.51, 95% CI 1.15 to 1.97), maternal age ≥35 years (AOR: 2.12, 95% CI 1.08 to 4.11), large birth size (AOR: 1.39, 95% CI 1.10 to 1.74) and multiple births (AOR: 4.96, 95% CI 2.84 to 8.62). Greater odds of CS were equally associated with maternal obesity (AOR: 3.16, 95% CI 2.30 to 4.32), Christianity (AOR: 2.06, 95% CI 1.58 to 2.68), birth order of one (AOR: 3.86, 95% CI 2.66 to 5.56), husband's secondary/higher education level (AOR: 2.07, 95% CI 1.29 to 3.33), health insurance coverage (AOR: 2.01, 95% CI 1.37 to 2.95) and ≥4 antenatal visits (AOR: 2.84, 95% CI 1.56 to 5.17).

Conclusions: The prevalence of CS was low, indicating unmet needs in the use of caesarean delivery in Nigeria. Rural-urban, regional and socioeconomic differences were observed, suggesting inequitable access to the obstetric surgery. Intervention efforts need to prioritise women living in rural areas, the North-East and the North-West regions, as well as women of the Islamic faith.

Keywords: Nigeria; caesarean section; epidemiology; maternal health; public health; reproductivemedicine.

MeSH terms

Adolescent
Adult
Cesarean Section / statistics & numerical data*
Circumcision, Female / statistics & numerical data
Cross-Sectional Studies
Female
Health Services Accessibility / statistics & numerical data
Health Surveys
Humans
Middle Aged
Nigeria / epidemiology
Poverty / statistics & numerical data
Pregnancy
Prevalence
Rural Population / statistics & numerical data
Urban Population / statistics & numerical data
Young Adult