Nimi Tazi, Costa Diogo, Campos Paulo, Barros Henrique
Institute of Public Health. University of Porto. Porto.; Faculdade de Medicina. Universidade Agostinho Neto. Luanda. Angola.
Institute of Public Health. University of Porto. Porto. Department of Clinical Epidemiology, Predictive Medicine and Public Health. Medical School. University of Porto. Porto. Portugal.
Acta Med Port. 2019 Jun 28;32(6):434-440. doi: 10.20344/amp.10409.
This study aimed to describe demographic, socioeconomic and pregnancy-related characteristics associated with a caesarean delivery in Luanda.
We conducted a cross-sectional study which included 995 puerperal women and who were assessed between December 2012 and February 2013 at Lucrécia Paím maternity hospital in Luanda, Angola. Data was collected using a structured questionnaire administered by trained interviewers. Logistic regression models were fitted to estimate the magnitude of associations (odds ratios-95% confidence intervals) between the type of delivery and variables showing a significant association in the bivariate analysis.
The prevalence of caesarean section was 44%. Women with caesarean delivery were less educated, resided more often in a periurban area and were more likely to disclose lower family income when compared with women who had vaginal delivery. Living in a periurban area was significantly associated with a caesarean delivery regardless of all covariates considered, for primiparous women (adjusted odds ratios, 95% confidence intervals = 2.14, 1.27 - 3.62) and for multiparous women (1.78, 1.26 - 2.51). Among multiparous women, a lower family income was also significantly associated with caesarean delivery. Hypertensive disorders during the current pregnancy were associated with a caesarean delivery in the multivariate models fitted for primiparous (3.96, 1.57 - 9.98) and for multiparous women (1.68, 1.03 - 2.74).
The associations between low socioeconomic position and high risk of caesarean delivery demonstrated in this study are consistent results in previous researches curried out in African contexts. The poorer and less educated women, who live far from health facilities, have few antenatal care visits and often arrive with complicated conditions, justifying a caesarean delivery. Lack of qualified human and material resources to manage emergencies in peripheral health centers and delaying in the reference system also leads to an increase in the number of caesareans performed in this particular maternity hospital.
Sociodemographic differences were observed according to the type of delivery. Cesarean section was more prevalent among women with lower income and residents in periurban areas.
本研究旨在描述罗安达地区与剖宫产相关的人口统计学、社会经济和妊娠相关特征。
我们开展了一项横断面研究，纳入了995名产后妇女，她们于2012年12月至2013年2月期间在安哥拉罗安达的卢克雷西亚·派姆妇产医院接受评估。数据通过由经过培训的访谈员管理的结构化问卷收集。采用逻辑回归模型来估计分娩类型与在双变量分析中显示出显著关联的变量之间的关联强度（比值比-95%置信区间）。
剖宫产的患病率为44%。与顺产妇女相比，剖宫产妇女受教育程度较低，更多居住在城郊地区，且更有可能表示家庭收入较低。无论考虑所有协变量如何，对于初产妇（调整后的比值比，95%置信区间=2.14，1.27 - 3.62）和经产妇（1.78，1.26 - 2.51）而言，居住在城郊地区与剖宫产显著相关。在经产妇中，家庭收入较低也与剖宫产显著相关。在为初产妇（3.96，1.57 - 9.98）和经产妇（1.68，1.03 - 2.74）拟合的多变量模型中，本次妊娠期间的高血压疾病与剖宫产相关。
本研究中显示的社会经济地位低下与剖宫产高风险之间的关联与先前在非洲背景下进行的研究结果一致。贫困且受教育程度较低的妇女居住在远离医疗机构的地方，产前检查次数少，且往往在病情复杂时才前来就诊，这使得剖宫产成为必要。外周卫生中心缺乏管理紧急情况的合格人力和物力资源以及转诊系统的延迟也导致了这家特定妇产医院剖宫产数量的增加。
根据分娩类型观察到了社会人口统计学差异。剖宫产在低收入妇女和城郊地区居民中更为普遍。
