Gunn Jayleen K L, Ehiri John E, Jacobs Elizabeth T, Ernst Kacey C, Pettygrove Sydney, Center Katherine E, Osuji Alice, Ogidi Amaka G, Musei Nnabundo, Obiefune Michael C, Ezeanolue Chinenye O, Ezeanolue Echezona E
Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
PLoS One. 2017 Mar 29;12(3):e0174369. doi: 10.1371/journal.pone.0174369. eCollection 2017.
In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria.
Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17-45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented.
In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38-0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04-2.28).
This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
为实现降低孕产妇死亡率的可持续发展目标，增加剖宫产等产科干预措施的可及性至关重要。由于尼日利亚妇女获得常规和急诊产科服务的机会有限，该国是全球孕产妇死亡负担的主要贡献者。在本分析中，我们旨在确定尼日利亚东南部埃努古的剖宫产率，并确定与剖宫产相关的社会经济或医学风险因素。
本研究的数据源自“健康开端倡议”研究。通过半结构化问卷在基线时从2300名妇女中获取参与者特征。本分析仅保留年龄在17 - 45岁之间、单胎分娩的妇女。产后问卷用于确定分娩方式。呈现以剖宫产为主要结局的粗逻辑回归和调整逻辑回归。
在该样本中，7.22%的妇女进行了剖宫产。与居住在城市地区的妇女相比，居住在农村地区的妇女进行剖宫产的几率显著降低（调整后比值比：0.58；0.38 - 0.89）。与外周血疟疾寄生虫血症水平低的妇女相比，外周血疟疾寄生虫血症水平高的妇女进行剖宫产的几率显著更高（调整后比值比：1.54；1.04 - 2.28）。
本研究表明，与低收入国家剖宫产使用的上升趋势相反，尼日利亚该地区的妇女获得这种干预措施的机会有限。年龄增长以及收入和获得医疗服务的社会经济指标（如拥有高等教育、全职工作和城市居住）被证明是获得剖宫产的关键决定因素。需要进一步研究以确定该地区妇女接受剖宫产的产科情况，并进一步阐明社会经济因素在获得剖宫产方面的作用。
