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    Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh

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    Author
    Begum, T; Rahman, A; Nababan, H; Hoque, DME; Khan, AF; Ali, T; Anwar, I
    Date
    2017-11-20
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Nababan, Herfina
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Begum, T., Rahman, A., Nababan, H., Hoque, D. M. E., Khan, A. F., Ali, T. & Anwar, I. (2017). Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh. PLOS ONE, 12 (11), https://doi.org/10.1371/journal.pone.0188074.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257602
    DOI
    10.1371/journal.pone.0188074
    Abstract
    BACKGROUND AND METHODS: Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. FINDINGS: During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. CONCLUSIONS: C-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.

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