Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Glob Health Action. 2020 Dec 31;13(1):1748403. doi: 10.1080/16549716.2020.1748403.
: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear.: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania.: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016).: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2-1.8), those insured, aOR 1.6 (95% CI 1.3-1.9), highly educated, aOR 1.6 (95% CI 1.2-2.0) and managers aOR 1.7 (95% CI 1.3-2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2-2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9-2.6).: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital.
剖宫产率的上升趋势在全球范围内得到认可。然而，在许多资源匮乏的国家，社会经济差异导致较低和较高社会经济群体的剖宫产使用率出现不足和过度使用的情况。剖宫产率上升对新生儿存活率的影响也不清楚。
检查肯尼亚和坦桑尼亚的剖宫产率及其相关的社会经济模式和新生儿生存结果。
我们采用二元逻辑回归分析了肯尼亚（2014 年）和坦桑尼亚（2016 年）医疗机构出生的新生儿的横断面人口和健康调查数据。
剖宫产率在坦桑尼亚农村未受过教育的妇女中为 5%，在肯尼亚受过教育的城市妇女中为 26%，在坦桑尼亚城市的经理中为 37.5%。总体结果表明，来自最富裕家庭的母亲剖宫产的可能性更高，调整后的优势比（aOR）为 1.4（95%可信区间为 1.2-1.8），有保险的母亲 aOR 为 1.6（95%可信区间为 1.3-1.9），受过高教育的母亲 aOR 为 1.6（95%可信区间为 1.2-2.0），经理 aOR 为 1.7（95%可信区间为 1.3-2.2），而中层阶级、无保险、小学教育和失业的母亲分别为 aOR 1.0（95%可信区间为 0.8-1.2）。总体而言，与正常分娩相比，在调整了产妇危险因素后，剖宫产与肯尼亚和坦桑尼亚的新生儿死亡率显著相关，总体 aOR 为 1.7（95%可信区间为 1.2-2.7）。然而，当进一步控制胎儿危险因素和产前检查次数时，统计显著性消失，aOR 为 1.6（95%可信区间为 0.9-2.6）。
在肯尼亚和坦桑尼亚，剖宫产的获得机会存在差异。与剖宫产相关的新生儿死亡风险更高。无论是否有医学指征，最好在医疗机构层面根据个体情况解决剖宫产的安全性和/或选择问题。然而，需要采取政策举措消除激励措施，改善公平获取机会并加强问责制，以通过明智的决策减少不必要的剖宫产。努力预防青少年意外怀孕，培训卫生工作者，并不断进行研究以改善新生儿结局，这些都是至关重要的。
