Dusabe Jacinta, Akuze Joseph, Kisakye Angela Nakanwagi, Kwesiga Benon, Nsubuga Peter, Ekirapa Elizabeth
Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda.
Pan Afr Med J. 2018 Mar 27;29:179. doi: 10.11604/pamj.2018.29.179.14870. eCollection 2018.
World Health Organization estimates that the appropriate caesarean section rates should range from 10% to 15% at the population level. There is limited access and utilisation of caesarean section services in Uganda. This case-control study explored factors associated with caesarean section delivery, focusing on service-related and individual level factors.
we interviewed 134 cases that had a caesarean section and 134 controls that had a "normal" vaginal delivery. The study was conducted at health facilities in Kabarole district during March to May 2016. Multivariable logistic regression was used to determine individual factors associated with caesarean sections, at a significance level of p < 0.05. Key Informant (KI) data obtained from health workers was analysed using MAXQDA (version 12) software to determine health service factors affecting caesarean section service delivery.
the mean age of the overall sample was 26 years (SD ± 6.5 years). Cases had 5% more women who belonged to the eldest age group (> 35 years) compared to the controls. The factors associated with caesarean section delivery were: having a previous caesarean section delivery (adjusted odds ratio (AOR): 4.5 CI: 2.22-9.0), attendance of four or more ANC visits (AOR: 2.0 CI: 1.04-3.83). Inadequate human resource, medicines and supplies affected access to the service. Misconceptions such as negative branding of women that have caesarean section deliveries as "lazy" reduced its acceptance thus low utilisation of the service.
health system inadequacies and misconceptions about caesarean section delivery contributed to the low access and utilisation of the service.
世界卫生组织估计，在人群层面，适当的剖宫产率应在10%至15%之间。在乌干达，剖宫产服务的可及性和利用率有限。本病例对照研究探讨了与剖宫产分娩相关的因素，重点关注服务相关因素和个体层面因素。
我们采访了134例接受剖宫产的病例和134例进行“正常”阴道分娩的对照。该研究于2016年3月至5月在卡巴罗莱区的医疗机构进行。采用多变量逻辑回归确定与剖宫产相关的个体因素，显著性水平为p<0.05。使用MAXQDA（版本12）软件分析从卫生工作者处获得的关键信息提供者（KI）数据，以确定影响剖宫产服务提供的卫生服务因素。
总体样本的平均年龄为26岁（标准差±6.5岁）。与对照组相比，病例组中属于最年长年龄组（>35岁）的女性多5%。与剖宫产分娩相关的因素包括：既往有剖宫产史（调整后的优势比（AOR）：4.5，置信区间：2.22 - 9.0），产前检查就诊4次或更多次（AOR：2.0，置信区间：1.04 - 3.83）。人力资源、药品和物资不足影响了服务的可及性。诸如将接受剖宫产的女性负面标签为“懒惰”等误解降低了对该服务的接受度，因此服务利用率较低。
卫生系统的不足以及对剖宫产分娩的误解导致了该服务的低可及性和低利用率。
