Jean Simon David, Jean-Baptiste Stanley, Nazaire Roodjmie, Joseph Ghislaine, Carmil Joseph Arcelin, Joseph Fanor, Kondo Tokpovi Vénunyé Claude
Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti.
Universidad de Santiago de Chile, Santiago, Chile.
Trop Med Health. 2023 Apr 17;51(1):21. doi: 10.1186/s41182-023-00513-z.
For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti.
Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05.
The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight.
While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.
几十年来，全球剖宫产率一直在上升。在一些国家，剖宫产率低于世界卫生组织建议的范围（10%-15%），而在其他国家，该比率则显著更高。本文旨在确定海地与剖宫产相关的个人和社区层面因素。
对2016-2017年海地人口与健康调查（HDHS）具有全国代表性的横断面调查数据进行二次数据分析。分析仅限于调查前5年出生的6303名儿童（受访女性的子女）。使用描述性分析（单变量/双变量）分析研究人群的特征以及剖宫产的患病率。此外，进行多水平二元逻辑回归分析以确定与剖宫产相关的因素。描述性分析和多变量分析均使用STATA 16.0软件（美国德克萨斯州Stata公司）进行。p<0.05时具有统计学意义。
海地剖宫产分娩的总体患病率估计为5.4%（95%置信区间4.8-6.0）。结果还显示，35岁及以上的母亲（调整后比值比[aOR]=1.38；95%置信区间1.00-1.96）；接受过中等教育（aOR=1.95；95%置信区间1.39-2.76）和高等教育水平（aOR=3.25；95%置信区间1.92-5.49）；参加了医疗保险（aOR=2.57；95%置信区间1.57-4.19）；子女少于3个（aOR=4.13；95%置信区间2.18-7.85）或3-4个（aOR=2.07；95%置信区间1.09-3.94）；接受过9次或更多次产前检查（aOR=2.21；95%置信区间1.40-3.50）的母亲剖宫产分娩的可能性显著更高。私立卫生设施占比高的社区中的儿童通过剖宫产分娩的几率更大（aOR=1.90；95%置信区间1.25-2.85）。此外，平均出生体重的儿童（aOR=0.66；95%置信区间0.48-0.91）比出生体重高的儿童通过剖宫产分娩的可能性更小。
虽然海地的剖宫产患病率较低，但掩盖了显著的地理、社会和经济差异。为了更好地制定和实施针对剖宫产分娩的母婴健康计划，海地政府当局和从事妇女健康领域工作的非政府组织应考虑这些差异。
