Factors associated with caesarean section delivery at Kisiizi Hospital, Rukungiri District, Uganda

Abstract

Background: Caesarian section is a life-saving procedure, however, there is a great concern on the increasing caesarean section rates globally. In Uganda, the caesarean section rate for live births increased from 8.5% in 2012 to 11% in 2016. In 2017, Kisiizi Hospital had a caesarean section rate of 30.2%. This proportion is very high compared to the recommended World Health Organization caesarean section range of 10-15%. There have been no studies done in the rural setting to explain the high rates of CS in Uganda. Objective: The objective of this study was to determine the proportion and factors associated with caesarean section delivery at Kisiizi Hospital. Methods: This was a cross-sectional study that was conducted among 321 immediate postnatal women in Kisiizi Hospital. The interviewer-administered questionnaire and the data abstract forms were used to collect information on the mode of delivery, social demographic, obstetric and health system factors associated with caesarean section. Consecutive sampling was used to select participants. Data were analyzed using SPSS version 23.0 software, bivariate analysis was done to identify the factors associated with caesarean section delivery at Kisiizi Hospital. Results: The mean age of the respondents was 25.8 ±6.086 years, the mean parity of respondents was 2.6 ±1.673 and the mean number of antenatal care visits for the current pregnancy was 4.27 ±1.197. Only 8.4% of the respondents in this study were referrals. The proportion of caesarean section in this study was 38.3% (123/321). Of these, 110 (89.4%) were emergencies and 27 (10.6%) electives. The common indications of caesarean section were fetal distress (28.5%), history of previous caesarean section (18.7%) and poor progress of labour (11.4%). Conclusion and Recommendations: There is a high proportion of caesarean section at Kisiizi Hospital and this is three times higher than the World Health Organisation recommended caesarean section rates. Majority of the caesarean sections are emergencies due to fetal distress, previous caesarean section and poor progress of labour. There is a need for additional studies exploring the reasons for the much higher than expected caesarean section rates in a rural setting.