Rana Md Sohel, Mazumder Shrabanti, Khan Md Tareq Ferdous, Khan Md Mobarak Hossain, Rahman Md Mijanur
Department of Statistics, Comilla University, Cumilla, Bangladesh.
Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America.
PLoS One. 2024 Dec 5;19(12):e0311082. doi: 10.1371/journal.pone.0311082. eCollection 2024.
The prevalence of caesarean sections (C-sections) has remarkably increased in the past few decades worldwide, especially in the lower and middle-income countries (LMICs). To our best knowledge, no studies focused on and compared the C-section scenarios of Bangladesh, Nepal, and Pakistan based on the latest demographic and health survey (DHS) data.
To assess the trends and factors associated with C-sections in the three South Asian countries.
Mothers aged 15-49 years participated in DHS 1990 to 2017-2018 and gave birth within three years of each of the surveys in Bangladesh, Nepal, and Pakistan.
This study analyzed data from five recent DHS rounds in Bangladesh and four in Nepal and Pakistan. Multivariable logistic regression was used to assess the association between C-sections and sociodemographic characteristics.
The results show that institutional delivery and C-sections have increased throughout the period in all three countries. In Bangladesh, the hospital birth rate increased from 10.0% in 2004 to 49.9% in 2017, and the corresponding figures [S1 Appendix: Figure A1 and Figure A2] for C-sections increased from 3.5% to 32.8%. In Nepal, the hospital birth rate increased from 11.0% in 2001 to 58.6% in 2016, and the C-sections from 0.8% to 11.0%. Pakistan observed a sharp increase from 13.7% to 66.3% and 2.7% to 22.3% in the respective cases from 1990 to 2017. Results from regression reveal that the mother's age, place of residence, education, partner's education, wealth status, birth order, number of antenatal care visits, and body mass index are associated with C-section deliveries in all three countries.
Our findings regarding the association of sociodemographic factors with increased C-sections may help identify subgroups of women susceptible to C-sections and offer better support regarding C-sections plans. However, the substantial increase in C-sections across the three countries warrants further investigation to identify the reasons.
在过去几十年里，全球剖宫产率显著上升，尤其是在低收入和中等收入国家（LMICs）。据我们所知，尚无研究基于最新的人口与健康调查（DHS）数据，聚焦并比较孟加拉国、尼泊尔和巴基斯坦的剖宫产情况。
评估这三个南亚国家剖宫产的趋势及相关因素。
年龄在15 - 49岁之间、参加了1990年至2017 - 2018年DHS调查且在孟加拉国、尼泊尔和巴基斯坦每次调查的三年内分娩的母亲。
本研究分析了孟加拉国最近五轮DHS调查数据以及尼泊尔和巴基斯坦最近四轮DHS调查数据。采用多变量逻辑回归分析评估剖宫产与社会人口学特征之间的关联。
结果显示，在这三个国家，机构分娩和剖宫产率在整个时期内均有所上升。在孟加拉国，医院分娩率从2004年的10.0%增至2017年的49.9%，剖宫产相应数据（[S1附录：图A1和图A2]）从3.5%增至32.8%。在尼泊尔，医院分娩率从2001年的11.0%增至2016年的58.6%，剖宫产率从0.8%增至11.0%。在巴基斯坦，1990年至2017年期间，相应数据分别从13.7%大幅增至66.3%以及从2.7%增至22.3%。回归结果表明，母亲的年龄、居住地、教育程度、伴侣教育程度、财富状况、产次、产前检查次数以及体重指数在这三个国家均与剖宫产分娩有关。
我们关于社会人口学因素与剖宫产率上升之间关联的研究结果，可能有助于识别易接受剖宫产的女性亚群体，并为剖宫产计划提供更好的支持。然而，这三个国家剖宫产率的大幅上升值得进一步调查以查明原因。
