New ERA, Rudramati Marg, Kathmandu, Nepal.
School of Public Health, University of Alberta, Edmonton, Canada.
Biomed Res Int. 2021 May 3;2021:8888267. doi: 10.1155/2021/8888267. eCollection 2021.
Addressing inequalities in accessing emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was undertaken to examine the time trends and sociodemographic correlates of cesarean section (CS) utilization in Nepal between 2006 and 2016 Data from the Nepal Demographic and Health Surveys (NDHS) 2006, 2011, and 2016 were sourced for this study. Women who had a live birth in the last five years of the survey were the unit of analysis for this study. Absolute and relative inequalities in CS utilization were expressed in terms of rate difference and rate ratios, respectively. We used multivariable regression models to assess the CS rate by background sociodemographic characteristics of women.
Age and parity-adjusted CS rates were found to have increased almost threefold (from 3.2%, 95% CI: 2.1-4.3 in 2006 to 10.5%; 95% CI: 8.9-11.9 in 2016) over the decade. In 2016, women from mountain region (3.0%), those from the lowest wealth quintile (2.4%), and those living in Karnali province (2.4%) had CS rate below 5%. Whereas women from the highest wealth quintile (25.1%), with higher education (21.2%), and those delivering in private facilities (37.1%) had CS rate above 15%. Women from the highest wealth quintile (OR-3.3; 95% CI: 1.6-7.0) compared to women from the lowest wealth quintile and those delivered in private/NGO-run facilities (OR-3.6; 95% CI: 2.7-4.9) compared to women delivering in public facilities were more than three times more likely to deliver by CS.
To improve maternal and newborn health, strategies need to be revised to address the underuse of CS among poor, those living in mountain region and Province 2, Lumbini province, Karnali province, and Sudhurpaschim province. Simultaneously, there is a pressing need for policies, guidelines, and continuous monitoring of CS rates to reduce overuse among rich women, women with higher education, and those giving childbirth in private facilities.
解决获得紧急产科护理方面的不平等问题对于降低孕产妇死亡率至关重要。本研究旨在探讨尼泊尔在 2006 年至 2016 年期间剖宫产（CS）利用的时间趋势和社会人口学相关性。本研究使用 2006 年、2011 年和 2016 年尼泊尔人口与健康调查（NDHS）的数据。在调查的最后五年中有活产的妇女是本研究的分析单位。利用绝对和相对不平等指数分别表示 CS 利用率的差异率和比率比。我们使用多变量回归模型来评估按妇女的社会人口学背景特征计算的 CS 率。
调整年龄和生育因素后，CS 率在十年内几乎增加了两倍（从 2006 年的 3.2%（95%CI：2.1-4.3）增至 2016 年的 10.5%（95%CI：8.9-11.9））。2016 年，来自山区（3.0%）、最贫穷五分之一（2.4%）和 Karnali 省（2.4%）的妇女 CS 率低于 5%。而来自最富有五分之一（25.1%）、受过高等教育（21.2%）和在私立机构分娩（37.1%）的妇女 CS 率超过 15%。与最贫穷五分之一的妇女相比，最富有五分之一的妇女（OR-3.3；95%CI：1.6-7.0）和在私立/非政府组织经营的机构分娩的妇女（OR-3.6；95%CI：2.7-4.9）与在公立机构分娩的妇女相比，更有可能进行 CS 分娩。
为了改善母婴健康，需要修订战略，以解决贫困妇女、山区和第二省、蓝毗尼省、卡纳利省和苏德哈布尔沙姆省 CS 使用率低的问题。同时，迫切需要制定政策、准则并持续监测 CS 率，以减少富裕妇女、受过高等教育的妇女和在私立机构分娩的妇女的过度使用。
