Waniala Isaac, Nakiseka Sandra, Nambi Winnie, Naminya Isaac, Osuban Ajeni Margret, Iramiot Jacob, Nekaka Rebecca, Nteziyaremye Julius
Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Busitema, Uganda.
Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Busitema, Uganda.
Obstet Gynecol Int. 2020 Jul 20;2020:5036260. doi: 10.1155/2020/5036260. eCollection 2020.
Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda.
It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12.
Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route.
Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5-15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.
乌干达的孕产妇死亡率较高，每10万例活产中有336例死亡。剖宫产是实现紧急产科护理服务公平性的基础。尽管它是一种挽救生命的干预措施，但也存在风险。一些地区的剖宫产率激增，而其他地区的服务仍然不足。研究表明，剖宫产率超过15%并不会改善孕产妇和新生儿的发病率及死亡率。我们的研究旨在确定乌干达东部剖宫产分娩的患病率、指征及社区认知情况。
这是一项基于乌干达东部恩戈拉区医疗机构和社区的横断面描述性研究。采用了混合数据收集方法，其中定量数据通过回顾性查阅2018年4月至2019年3月期间在两家综合紧急产科护理服务机构分娩的所有母亲的病历进行收集。定性数据通过焦点小组讨论收集，直至达到饱和点。数据录入EpiData（3.1版）并使用SPSS软件（24版）进行分析。定性数据分析通过逐字转录并翻译成英文，然后在NVIVO 12的帮助下分析为主题和子主题。
在总共2573例分娩中，14%（357/2573）为剖宫产。主要的单一指征为产程梗阻17.9%、胎儿窘迫15.3%、巨大儿11.6%以及头盆不称（CPD）11%。尽管剖宫产被认为对年轻母亲、患有疾病的母亲和反复出现宫内胎儿死亡的情况具有挽救生命的作用，但其他人认为剖宫产是一种诅咒、婚姻破坏者、不幸、赚钱手段、卫生工作者无能的标志，是给懒惰的女性和富有的公务员准备的。剖宫产率的上升还归因于肌肉注射和避孕措施的使用。总体而言，阴道分娩是首选途径。
发现了一些可能阻碍剖宫产实施的误解，这需要更多的咨询和男性参与。尽管是基于医疗机构的数据，但该比率高于期望的5 - 15%。它高于预计到2021年增长36%的水平。这凸显了在剖宫产咨询和同意过程中男性参与的必要性，以及共同努力消除社区对接受剖宫产女性的误解。这些误解可能会阻碍剖宫产的实施。
