Rural-urban disparities in caesarean deliveries in sub-Saharan Africa: a multivariate non-linear decomposition modelling of Demographic and Health Survey data

Bright Opoku Ahinkorah; Richard Gyan Aboagye; Abdul-Aziz Seidu; Joshua Okyere; Aliu Mohammed; Vijay Kumar Chattu; Eugene Budu; Faustina Adoboi; Sanni Yaya

doi:10.1186/s12884-022-04992-6

Rural-urban disparities in caesarean deliveries in sub-Saharan Africa: a multivariate non-linear decomposition modelling of Demographic and Health Survey data

BMC Pregnancy Childbirth. 2022 Sep 17;22(1):709. doi: 10.1186/s12884-022-04992-6.

Authors

Bright Opoku Ahinkorah¹, Richard Gyan Aboagye², Abdul-Aziz Seidu^{3

4}, Joshua Okyere⁵, Aliu Mohammed⁶, Vijay Kumar Chattu^{7

8}, Eugene Budu⁹, Faustina Adoboi¹⁰, Sanni Yaya^{11

12}

Affiliations

¹ School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
² Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
³ College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
⁴ Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.
⁵ Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. joshuaokyere54@gmail.com.
⁶ Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.
⁷ Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, 442107, India.
⁸ Department of Transdisciplinary Research, Saveetha Medical College and Hospitals, SIMATS, Saveetha University, TN, Chennai, 600077, India.
⁹ Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
¹⁰ Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana.
¹¹ School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
¹² The George Institute for Global Health, Imperial College London, London, UK.

Abstract

Introduction: Globally, the rate of caesarean deliveries increased from approximately 16.0 million in 2000 to 29.7 million in 2015. In this study, we decomposed the rural-urban disparities in caesarean deliveries in sub-Saharan Africa.

Methods: Data for the study were extracted from the most recent Demographic and Health Surveys of twenty-eight countries in sub-Saharan Africa. We included 160,502 women who had delivered in health facilities within the five years preceding the survey. A multivariate non-linear decomposition model was employed to decompose the rural-urban disparities in caesarean deliveries. The results were presented using coefficients and percentages.

Results: The pooled prevalence of caesarean deliveries in the 28 countries considered in the study was 6.04% (95% CI = 5.21-6.88). Caesarean deliveries' prevalence was highest in Namibia (16.05%; 95% CI = 14.06-18.04) and lowest in Chad (1.32%; 95% CI = 0.91-1.73). For rural-urban disparities in caesarean delivery, the pooled prevalence of caesarean delivery was higher in urban areas (10.37%; 95% CI = 8.99-11.75) than rural areas (3.78%; 95% CI = 3.17-4.39) across the 28 countries. Approximately 81% of the rural-urban disparities in caesarean deliveries were attributable to the differences in child and maternal characteristics. Hence, if the child and maternal characteristics were levelled, more than half of the rural-urban inequality in caesarean deliveries would be reduced. Wealth index (39.2%), antenatal care attendance (13.4%), parity (12.8%), mother's educational level (3.5%), and health insurance subscription (3.1%) explained approximately 72% of the rural-urban disparities in caesarean deliveries.

Conclusion: This study shows significant rural-urban disparities in caesarean deliveries, with the disparities being attributable to the differences in child and maternal characteristics: wealth index, parity, antenatal care attendance, mother's educational level, and health insurance subscription. Policymakers in the included countries could focus and work on improving the socioeconomic status of rural-dwelling women as well as encouraging antenatal care attendance, women's education, health insurance subscription, and family planning, particularly in rural areas.

Keywords: Caesarean deliveries; Decomposition analysis; Global health; Sub-Saharan Africa; Women.

MeSH terms

Africa South of the Sahara / epidemiology
Cesarean Section*
Child
Cross-Sectional Studies
Female
Humans
Pregnancy
Prevalence
Rural Population*