Khan Md Nuruzzaman, Kabir Md Awal, Shariff Asma Ahmad, Rahman Md Mostafizur
Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh.
PLOS Glob Public Health. 2022 Feb 2;2(2):e0000091. doi: 10.1371/journal.pgph.0000091. eCollection 2022.
Caesarean section (CS) use is rising rapidly in Bangladesh, though lack of CS use remains common among disadvantage women. This increases risks of long-term obstetric complications as well as maternal and child deaths among disadvantage women. We aimed to determine the interaction effects of women's disadvantage characteristics on CS use in Bangladesh. For this we have analysed a total of 27,093 women's data extracted from five rounds of Bangladesh Demographic and Health Survey conducted during 2004 and 2017/18. The outcome variable was CS use, coded as use (1) and non-use (0). The major exposure variables were individual level, household level, and community level characteristics. Multilevel logistic regression model was used to determine association of CS use with socio-demographic characteristics and the interactions of three variables: working status, wealth quintile, and place of residence. We found a 751% increase of CS use over the last 13 years-from 3.88% in 2004 to 33% in 2017/18. Nearly, 80% of the total CS operation occurred in the private health facilities followed by the government health facilities (15%). Women living in rural areas with no engagement in formal income generating activities showed a 11% (OR, 0.89, 95% CI, 0.71-0.99) lower use of CS in 2004. This association was further strengthened over time, and a 51% (OR, 0.49, 0.03-0.65) lower in CS use was reported in 2017/18. Similarly, around 12%-83% lower likelihoods of CS use were found among rural poor and poorer women. These indicate Bangladesh is facing a double burden of CS use, that is a group of women with improved socio-economic condition are using this life saving procedure without medical necessity while their counterpart of disadvantage characteristics could not access the service. Improved monitoring from the government along with support to use CS services for the disadvantage groups on necessity are important.
在孟加拉国，剖宫产的使用率正在迅速上升，不过在处境不利的妇女中，不进行剖宫产的情况仍然很常见。这增加了长期产科并发症以及处境不利妇女母婴死亡的风险。我们旨在确定孟加拉国妇女的不利特征对剖宫产使用的交互作用。为此，我们分析了从2004年至2017/18年期间进行的五轮孟加拉国人口与健康调查中提取的总共27,093名妇女的数据。结果变量是剖宫产的使用情况，编码为使用（1）和未使用（0）。主要的暴露变量是个人层面、家庭层面和社区层面的特征。采用多水平逻辑回归模型来确定剖宫产使用与社会人口特征之间的关联以及工作状态、财富五分位数和居住地点这三个变量的交互作用。我们发现，在过去13年中，剖宫产的使用率增长了751%，从2004年的3.88%升至2017/18年的33%。几乎所有剖宫产手术的80%发生在私立医疗机构，其次是政府医疗机构（15%）。2004年，生活在农村地区且未从事正规创收活动的妇女剖宫产使用率低11%（比值比，0.89，95%置信区间，0.71 - 0.99）。随着时间的推移，这种关联进一步增强，2017/18年报告的剖宫产使用率低51%（比值比，0.49，0.03 - 0.65）。同样，农村贫困和较贫困妇女进行剖宫产的可能性低约12% - 83%。这些表明孟加拉国面临剖宫产使用的双重负担，即一群社会经济状况改善的妇女在没有医疗必要的情况下使用这种救命程序，而其具有不利特征的对应人群却无法获得该服务。政府加强监测并在必要时为弱势群体提供使用剖宫产服务的支持很重要。
