Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
Chr. Michelsen Institute, PO Box 6033, N-5892, Bergen, Norway.
BMC Health Serv Res. 2021 Dec 29;21(1):1367. doi: 10.1186/s12913-021-07386-0.
Caesarean section (C-section) delivery is an important indicator of access to life-saving essential obstetric care. Yet, there is limited understanding of the costs of utilising C-section delivery care in sub-Saharan Africa. Thus, we estimated the direct and indirect patient cost of accessing C-section in Tanzania.
Cross-sectional survey data of 2012 was used, which covered 3000 households from 11 districts in three regions. We interviewed women who had given births in the last 12 months before the survey to capture their experience of care. We used a regression model to estimate the effect of C-section on costs, while the degree of inequality on C-section coverage was assessed with a concentration index.
C-section increased the likelihood of paying for health care by 16% compared to normal delivery. The additional cost of C-section compared to normal delivery was 20 USD, but reduced to about 11 USD when restricted to public facilities. Women with C-section delivery spent an extra 2 days at the health facility compared to normal delivery, but this was reduced slightly to 1.9 days in public facilities. The distribution of C-section coverage was significantly in favour of wealthier than poorest women (CI = 0.2052, p < 0.01), and this pro-rich pattern was consistent in rural districts but with unclear pattern in urban districts.
C-section is a life-saving intervention but is associated with significant economic burden especially among the poor families. More health resources are needed for provision of free maternal care, reduce inequality in access and improve birth outcomes in Tanzania.
剖宫产是获得救命基本产科护理的一个重要指标。然而，对于撒哈拉以南非洲地区利用剖宫产分娩护理的成本，人们了解有限。因此，我们评估了坦桑尼亚获取剖宫产的直接和间接患者成本。
使用了 2012 年的横断面调查数据，该数据覆盖了来自三个地区 11 个区的 3000 户家庭。我们采访了在调查前 12 个月内分娩的妇女，以了解她们的护理经历。我们使用回归模型来估计剖宫产对成本的影响，而剖宫产覆盖率的不平等程度则通过集中指数进行评估。
与正常分娩相比，剖宫产使支付医疗费用的可能性增加了 16%。与正常分娩相比，剖宫产的额外费用为 20 美元，但在限制在公立机构时，这一费用降至约 11 美元。与正常分娩相比，接受剖宫产的妇女在卫生机构多花费 2 天，但在公立机构中，这一数字略有减少至 1.9 天。剖宫产的覆盖率分布明显有利于比最贫困妇女更富裕的妇女（CI=0.2052，p<0.01），这种有利于富人的模式在农村地区是一致的，但在城市地区模式不明确。
剖宫产是一种救命干预措施，但会给贫困家庭带来巨大的经济负担。坦桑尼亚需要更多的卫生资源来提供免费的产妇护理，减少获取方面的不平等，改善生育结局。
