Department of Statistics, Shahjalal University of Science & Technology, Sylhet, Bangladesh.
Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL, United States of America.
PLoS One. 2020 Dec 3;15(12):e0242864. doi: 10.1371/journal.pone.0242864. eCollection 2020.
The rate of cesarean delivery (C-section) has been increasing worldwide, including Bangladesh, and it has a negative impact on the mother and child's health. Our aim was to examine the association between C-section and childhood diseases and to identify the key factors associated with childhood diseases.
We used four nationally representative data sets from multiple indicator cluster survey (MICS, 2012 and 2019) and Bangladesh Demographic and Health Survey (BDHS, 2011and 2014) and analyzed 25,270 mother-child pairs. We used the frequency of common childhood diseases (fever, short or rapid breaths, cough, blood in stools, and diarrhea) as our outcome variable and C-section as exposure variable. We included mother's age, place of residence, division, mother's education, wealth index, child age, child sex, and child size at birth as confounding variables. Negative binomial regression model was used to analyze the data.
In the BDHS data, the prevalence of C-section increased from 17.95% in 2011 to 23.33% in 2014. Also, in MICS, the prevalence almost doubled over an eight-year period (17.74% in 2012 to 35.41% in 2019). We did not observe any significant effect of C-section on childhood diseases in both surveys. Only in 2014 BDHS, we found that C-section increases the risk of childhood disease by 5% [Risk Ratio (RR): 1.05, 95% CI: 0.95, 1.17, p = 0.33]. However, the risk of childhood disease differed significantly in all survey years by division, child's age, and child's size at birth after adjusting for important confounding variables. For example, children living in Chittagong division had a higher risk [(2011 BDHS RR: 1.22, 95% CI: 1.08, 1.38) and (2019 MICS RR: 1.21, 95% CI: 1.08, 1.35)] of having disease compared to Dhaka division. Maternal age, education, and wealth status showed significant differences with the outcome in some survey years.
Our study shows that C-section in Bangladesh continued to increase over time, and we did not find significant association between C-section and early childhood diseases. High C-section rate has a greater impact on maternal and child health as well as the burden on the health care system. We recommend raising public awareness of the negative impact of unnecessary C-section in Bangladesh.
在全球范围内，包括孟加拉国在内，剖宫产率（C -section）一直在上升，这对母婴健康产生了负面影响。我们的目的是研究 C 剖与儿童疾病之间的关联，并确定与儿童疾病相关的关键因素。
我们使用了来自多个指标群集调查（MICS，2012 年和 2019 年）和孟加拉国人口与健康调查（BDHS，2011 年和 2014 年）的四个全国代表性数据集，分析了 25270 对母婴对。我们将常见儿童疾病（发热、呼吸急促、咳嗽、粪便带血和腹泻）的频率作为我们的结果变量，将 C 剖作为暴露变量。我们将母亲的年龄、居住地、行政区、母亲的教育程度、财富指数、儿童年龄、儿童性别和出生时的儿童大小作为混杂变量。使用负二项回归模型分析数据。
在 BDHS 数据中，C 剖的比例从 2011 年的 17.95%上升到 2014 年的 23.33%。同样，在 MICS 中，这一比例在八年期间几乎翻了一番（2012 年为 17.74%，2019 年为 35.41%）。我们在两项调查中均未观察到 C 剖对儿童疾病有任何显著影响。只有在 2014 年的 BDHS 中，我们发现 C 剖使儿童疾病的风险增加了 5%[风险比（RR）：1.05，95%CI：0.95，1.17，p=0.33]。然而，在调整了重要混杂变量后，按行政区、儿童年龄和儿童出生时的大小划分，所有调查年份的儿童疾病风险差异均有显著意义。例如，与达卡行政区相比，生活在吉大港行政区的儿童患病风险更高[2011 年 BDHS RR：1.22，95%CI：1.08，1.38]和[2019 年 MICS RR：1.21，95%CI：1.08，1.35)]。母亲的年龄、教育程度和财富状况在某些调查年份与结果有显著差异。
我们的研究表明，孟加拉国的 C 剖率随着时间的推移持续上升，我们没有发现 C 剖与幼儿疾病之间有显著关联。高 C 剖率对母婴健康以及医疗保健系统的负担产生了更大的影响。我们建议提高公众对孟加拉国不必要的 C 剖的负面影响的认识。
