Factors Associated with High Rates of Caesarean Deliveries in Mengo Hospital Kampala.

Abstract

Caesarean section (CS) rates continue to increase globally. When used appropriately CS can improve infant and/or maternal outcomes. However, when used inappropriately the potential harm may exceed the potential benefit. Objective The aim of the study was to determine the factors associated with high rates of caesarean deliveries in Mengo Hospital. Methods This was a cross sectional study that used mixed methods approach. It involved retrospective review of 1276 casebooks using Robson Ten Group Classification System (RTGCS) for births that occurred in Mengo general Hospital in December 2018, January, and February 2019. Questionnaire with both close and open ended questions were used to collect data from 200 second day post partum mothers. Eight key informants; ward managers, in -charges, senior midwives and Obstetricians were interviewed. Data were analysed using STATA V.14 for quantitative data while thematic analysis was used for qualitative data. Univariate, Bivariate, and Multivariate analyses were performed for quantitative data to determine the association between the predisposing factors and the outcome variable using Chi-square and Modified Poisson analysis. Results Caesarean Section Rate (CSR) from the case books was 49%, and 64% from primary data. Group 5 (Previous CS, single cephalic,>37 weeks) had the highest contribution (35.4%) to the total Caesarean; deliveries followed by Nulliparous, single cephalic,>37 weeks in spontaneous labour which is Group 1(18.4%) and then group 3 (Multiparous (excluding previous CS), single cephalic,>37 weeks in spontaneous labour) with (13.7%). The most common indication from the casebooks was previous scar 32%, followed by obstructed labour18% and previous scar 42(97.6%) from primary data. Presences of obstetrical indication influence of the decision for CS by husband, friends, relatives and maternal request for CS were strongly associated with having a caesarean delivery. Mothers said that the occurrence of CS was as a result of the health workers to reduce the stress of monitoring labour and profit gain of the institution Conclusion Repeat CS was the highest contributor of CSR; therefore strategies to reduce frequency of the procedure should include avoidance of medically unnecessary primary CS and encouraging Vaginal Birth After CS (VBAC) where applicable.