Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.
BMC Pregnancy Childbirth. 2023 Nov 10;23(1):781. doi: 10.1186/s12884-023-06087-2.
Caesarean section is a clinical intervention aimed to save the lives of women and their newborns. In Ghana, studies have reported inequalities in use among women of different socioeconomic backgrounds. However, geographical differentials at the district level where health interventions are implemented, have not been systematically studied. This study examined geographical inequalities in caesarean births at the district level in Ghana. The study investigated how pregnancy complications and birth risks, access to health care and affluence correlate with geographical inequalities in caesarean section uptake.
The data for the analysis was derived from the 2017 Ghana Maternal Health Survey. The log-binomial Bayesian Geoadditive Semiparametric regression technique was used to examine the extent of geographical clustering in caesarean births at the district level and their spatial correlates.
In Ghana, 16.0% (95% CI = 15.3, 16.8) of births were via caesarean section. Geospatial analysis revealed a strong spatial dependence in caesarean births, with a clear north-south divide. Low frequencies of caesarean births were observed among districts in the northern part of the country, while those in the south had high frequencies. The predominant factor associated with the spatial differentials was affluence rather than pregnancy complications and birth risk and access to care.
Strong geographical inequalities in caesarean births exist in Ghana. Targeted and locally relevant interventions including health education and policy support are required at the district level to address the overuse and underuse of caesarean sections, to correspond to the World Health Organisation recommended optimal threshold of 10% to 15%.
剖宫产是一种旨在拯救妇女及其新生儿生命的临床干预措施。在加纳，已有研究报告称，不同社会经济背景的妇女之间剖宫产的使用存在不平等现象。然而，在实施卫生干预措施的地区层面，尚未系统研究地理差异。本研究旨在探讨加纳地区层面剖宫产的地理不平等现象。该研究调查了妊娠并发症和分娩风险、获得医疗保健的机会以及富裕程度与剖宫产率的地理差异之间的关系。
本分析使用的数据来自 2017 年加纳孕产妇健康调查。采用对数二项贝叶斯地理加性半参数回归技术，研究了地区层面剖宫产的地理集聚程度及其空间相关性。
在加纳，16.0%（95%CI=15.3，16.8）的分娩是通过剖宫产完成的。地理空间分析显示，剖宫产的地理分布存在很强的空间依赖性，存在明显的南北差异。该国北部地区的剖宫产率较低，而南部地区的剖宫产率较高。与空间差异密切相关的主要因素是富裕程度，而不是妊娠并发症和分娩风险以及获得医疗保健的机会。
在加纳，剖宫产的地理不平等现象非常明显。需要在地区层面采取有针对性和与当地相关的干预措施，包括健康教育和政策支持，以解决剖宫产过度使用和使用不足的问题，以符合世界卫生组织建议的 10%至 15%的最佳阈值。
