Factors Associated with Caesarean and Peripartum Complications at Southern Mozambique's Rural Hospitals: A Cross-Sectional Analytical Study.

Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients' files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had "high obstetric-risk" and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8; 95% Confidence Interval (95%CI) = 1.3-2.6], preeclampsia [aOR (95%CI) = 2.0 (1.2-3.3)], age [aOR (95%CI) = 0.96 (0.93-0.99)] and "high obstetric-risk" [aOR (95%CI) = 0.54 (0.37-0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8-2.6)], "high obstetric-risk" [aOR (95%CI) = 1.6 (1.3-1.96)], preeclampsia [aOR (95%CI) = 1.5 (1.2-1.8), mother's age [aOR (95%CI) = -2% (-3%, -0.1%)] and gestational age [aOR (95%CI) = -8% (-13%, -6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals' performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads.