Factors associated with caesarean section delivery in Kisenyi Health Centre IV in Kampala District

Abstract

Introduction: Globally, at least 160 million women become pregnant annually, of which only 15% of them develop pregnancy related complications with some ending up in death. Caesarean Section is one of the lifesaving medical procedures which have proved as an effective intervention to decrease maternal mortality and morbidity. However, the rate of caesarean section in Uganda has significantly increased and was estimated to be 24.5 % in 2016 compared to the 15% recommended by WHO putting both physical and financial burden to mothers undergoing it. Objective: To determine the rate and factors associated with caesarean section delivery in Kisenyi health centre IV in order to inform policies on maternal health, neonatal health and EMOC service delivery. Methods: The study employed a mixed methods approach involving a review of records and key informant interviews. Quantitative data was extracted from the files of mothers who had caesarean section at Kisenyi Health Centre IV in 2017 using a data extraction tool. Qualitative data was collected through Key informant interviews using a key informant guide. Epi info software was used to enter data which was later exported into STATA (version 13) for analysis. Thematic content analysis was used to analyse the qualitative data. This was done by reading through the transcribed material to get familiar with it.

Results: The CS rate at Kisenyi HCIV was 3294/10186 (32.3%). Foetal-placental unit indications were indicated in 242/307 (78.8%) of the Caesarean section deliveries. The most common foetal factors associated with CS delivery included fetal distress (139/303, 45.9%), big baby (70/303, 23.1%) and mal-presentation (40/303, 13.2%). Maternal factors included previous CS (52/303, 17.2%), CPD (42/303, 13.9%) and hypertensive disorders (34/303, 11.2%) while foetal-placental unit factors included oligo-hydramnios (152/242, 62.8%), placenta praevia (40/242, 16.5%), Abruption placenta (28/242, 11.6%) and PROM (28/242, 11.6%). The non-obstetric factors included demand from patients (86/305; 28.2%), medical conditions complicating pregnancy (63/305; 20.7%), fear of HIV transmission to the baby (55/305, 18.0%).

Conclusion: The rate of CS delivery at Kisenyi HCIV of 3294/10186 (32.3%) is much higher than 10-15% rate deemed beneficial by WHO. Varous factors were associated with CS delivery with fetal distress being the commonest factor. Recommendations: KCCA health department should come up with guidelines to be followed by doctors in sanctioning CS in Kisenyi HCIV in order to address the high levels of CS.