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Published in: Journal of Public Health 5/2017

01-10-2017 | Original Article

The role of demographic and socioeconomic factors, leave policy and government institutions in CS deliveries in Ghana

Authors: Nkechi S. Owoo, Monica Puoma Lambon-Quayefio, Nicole Amara Onuoha

Published in: Journal of Public Health | Issue 5/2017

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Abstract

Aim

Caesarean section deliveries in Ghana increased from 6 to 13% between 2008 and 2014. This current rate is dangerously close to the safe limit suggested by the World Health Organisation (WHO) and is particularly concerning in the absence of a negative correlation between the rising CS rates and neonatal mortality in the country. The research therefore examines the factors correlated with caesarean section delivery in Ghana, with an aim to making research-based policy suggestions to curb the observed trends.

Subjects and methods

The 2014 Ghana Demographic and Health Survey is employed for the analysis, and a probit model is used to examine the effects of demographic and socioeconomic factors, maternal leave policy and government health institutions on the likelihood of caesarean section deliveries in Ghana. The analysis uses the last births of 1284 women of childbearing age in the country.

Results

The results indicate that demographic and socioeconomic factors are important determinants of caesarean section deliveries. While antenatal care attendance at government institutions reduces the likelihood of caesarean section, deliveries in government health facilities are more likely to be done by caesarean section. Interestingly, women with previous pregnancy complications are not significantly more likely to have a caesarean section delivery. This might indicate that many caesarean sections performed in the country may be elective and not necessarily medically necessary.

Conclusions

Child and maternal survivals are often given as justifications for caesarean section deliveries. The absence of a negative relationship between increasing caesarean section rates and neonatal mortality in the country therefore creates some concern.
Literature
go back to reference Adasekh JA, Peaceman AM, Lopez-Zeno JA, Minogue JP, Socol ML (1993) Factors contributing to the increased birth rate in older parturient women. Am J Obstet Gynecol 169:936–940 Adasekh JA, Peaceman AM, Lopez-Zeno JA, Minogue JP, Socol ML (1993) Factors contributing to the increased birth rate in older parturient women. Am J Obstet Gynecol 169:936–940
go back to reference Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E (2006) Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high- income countries: an ecological study. Birth 33(4):270–277CrossRefPubMed Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E (2006) Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high- income countries: an ecological study. Birth 33(4):270–277CrossRefPubMed
go back to reference Asante F, Chikwama C, Daniels A, Armar-Klemesu M (2007) Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana. Ghana Med J 41(3):110–117PubMedPubMedCentral Asante F, Chikwama C, Daniels A, Armar-Klemesu M (2007) Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana. Ghana Med J 41(3):110–117PubMedPubMedCentral
go back to reference Bayou YT, Mashalla YJS, Thupayagale-Tshweneagae G (2016) Patterns of caesarean-section delivery in Addis Ababa, Ethiopia. Afr J Prm Health Care Fam Med 8(2):953 Bayou YT, Mashalla YJS, Thupayagale-Tshweneagae G (2016) Patterns of caesarean-section delivery in Addis Ababa, Ethiopia. Afr J Prm Health Care Fam Med 8(2):953
go back to reference Bottoms SF, Rosen MG, Sokol RJ (1980) The increase in caesarean birth rate. Med Int 302:559–565 Bottoms SF, Rosen MG, Sokol RJ (1980) The increase in caesarean birth rate. Med Int 302:559–565
go back to reference Bragg F, Cromwell DA, Edozien LC, Gurol-Unganci I, Mahmood TA, Templeton A, van der Meulen JH (2010) Variation of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. Br Med J 341:c5065CrossRef Bragg F, Cromwell DA, Edozien LC, Gurol-Unganci I, Mahmood TA, Templeton A, van der Meulen JH (2010) Variation of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. Br Med J 341:c5065CrossRef
go back to reference Danso KA, Schwandt HM, Turpin CA, Seffah JD, Samba A, Hindin MJ (2009) Preference of Ghanaian women for vaginal or caesarean delivery postpartum. Ghana Med J 43(1):29–33PubMedPubMedCentral Danso KA, Schwandt HM, Turpin CA, Seffah JD, Samba A, Hindin MJ (2009) Preference of Ghanaian women for vaginal or caesarean delivery postpartum. Ghana Med J 43(1):29–33PubMedPubMedCentral
go back to reference Gibbons, L, Belizan, J M, Lauer, J A, Betran, A P, Merialdi, M, Althabe, F (2010) The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World health report background paper No. 30 Gibbons, L, Belizan, J M, Lauer, J A, Betran, A P, Merialdi, M, Althabe, F (2010) The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World health report background paper No. 30
go back to reference Hobcraft JN, McDonald JW, Rutstein SO (1984) Socioeconomic factors in infant and child mortality: a cross-national Comparison. Popul Stud XXXVIII:193–223CrossRef Hobcraft JN, McDonald JW, Rutstein SO (1984) Socioeconomic factors in infant and child mortality: a cross-national Comparison. Popul Stud XXXVIII:193–223CrossRef
go back to reference Kahsay S, Berhe G, Gebremariam A, Betel Birhane B (2015) Determinants of caesarean deliveries and its major indications in Adigrat hospital, northern Ethiopia: a case control study. Epidemiology (sunnyvale) 5:192. doi:10.4172/2161-1165.1000192 CrossRef Kahsay S, Berhe G, Gebremariam A, Betel Birhane B (2015) Determinants of caesarean deliveries and its major indications in Adigrat hospital, northern Ethiopia: a case control study. Epidemiology (sunnyvale) 5:192. doi:10.​4172/​2161-1165.​1000192 CrossRef
go back to reference Lauer J, Betran AP, Merialdi M, Wojdyla D (2010) Determinants of CS rates in developed countries: supply, demand and opportunities for control. World Health Report Background Paper, No. 29 Lauer J, Betran AP, Merialdi M, Wojdyla D (2010) Determinants of CS rates in developed countries: supply, demand and opportunities for control. World Health Report Background Paper, No. 29
go back to reference McGovern P, Dowd B, Gjerdingen D, Dagher R, Ukestad L, McCaffrey D, Lundberg U (2007) Mothers' health and work-related factors at 11 weeks postpartum. Ann Fam Med 5:519–527 McGovern P, Dowd B, Gjerdingen D, Dagher R, Ukestad L, McCaffrey D, Lundberg U (2007) Mothers' health and work-related factors at 11 weeks postpartum. Ann Fam Med 5:519–527
go back to reference Mishra US, Ramanathan M (2002) Delivery-related complications and determinants of CS rates in India. Health Policy Plan 17(1):90–98CrossRefPubMed Mishra US, Ramanathan M (2002) Delivery-related complications and determinants of CS rates in India. Health Policy Plan 17(1):90–98CrossRefPubMed
go back to reference Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, Prost A (2014) Prevalence and determinants of caesarean section in private and public health facilities in underserved south Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ Open 4(12):e005982CrossRefPubMedPubMedCentral Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, Prost A (2014) Prevalence and determinants of caesarean section in private and public health facilities in underserved south Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ Open 4(12):e005982CrossRefPubMedPubMedCentral
go back to reference Peippert JF, Bracken MB (1993) Maternal age: an independent risk factor in the caesarean delivery. Obstet Gynaecol 81:200–205 Peippert JF, Bracken MB (1993) Maternal age: an independent risk factor in the caesarean delivery. Obstet Gynaecol 81:200–205
go back to reference Pomeroy A, Koblinksy M, Alva S (2010) Private delivery care in developing countries: trends and determinants. DHS Working document No.76 Pomeroy A, Koblinksy M, Alva S (2010) Private delivery care in developing countries: trends and determinants. DHS Working document No.76
go back to reference Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, Shah A, Campodónico L, Bataglia V, Faundes A, Langer A, Narváez A, Donner A, Romero M, Reynoso S, de Pádua KS, Giordano D, Kublickas M, Acosta A (2006) Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 367(9525):1819–1829CrossRefPubMed Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, Shah A, Campodónico L, Bataglia V, Faundes A, Langer A, Narváez A, Donner A, Romero M, Reynoso S, de Pádua KS, Giordano D, Kublickas M, Acosta A (2006) Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 367(9525):1819–1829CrossRefPubMed
go back to reference Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al (2007) Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 335(7628):1025 Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al (2007) Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 335(7628):1025
go back to reference World Health Organization (1985) Appropriate technology for birth. Lancet 2:436–437 World Health Organization (1985) Appropriate technology for birth. Lancet 2:436–437
go back to reference World Health Organization (2009) Monitoring emergency obstetric care: a Handbook. WHO Press, Geneva World Health Organization (2009) Monitoring emergency obstetric care: a Handbook. WHO Press, Geneva
Metadata
Title
The role of demographic and socioeconomic factors, leave policy and government institutions in CS deliveries in Ghana
Authors
Nkechi S. Owoo
Monica Puoma Lambon-Quayefio
Nicole Amara Onuoha
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Journal of Public Health / Issue 5/2017
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI
https://doi.org/10.1007/s10389-017-0816-1

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