A Five-Year Review of the Rates and Indications for Caesarean Section at Mbale Regional Referral Hospital: A Cross Sectional Study

Introduction

Globally, there has been an increase in the caesarean section rates. Whereas, the rising caesarean section rate present a public health challenge given its implications on the individual and families amidst the limited health care resources, there is a stark paucity of data on its rate and indications in our setting. Therefore, the overarching aim of this study was to review files/charts from June 2013 to July 2018 inclusive to determine the rates and indications for caesarean section in Mbale Regional Referral Hospital hence provide evidence based recommendations to the stake holders.

Methods

This was a hospital cross-sectional study, based on a 5 years retrospective chart review. It was conducted in a public hospital setting where 46,575 patient files were included, of these 11,514 were caesarean section deliveries. Trained research assistants extracted data from the patient case files using a structured questionnaire. Descriptive statistics in form of frequency tables, alongside graphs, percentages, means and standard deviation were computed. Data were analyzed using STATA/SE Version 14.2.

Results

The rate of CS during this study was 24.7% (11,514 CS cases out of 46,575 total deliveries). Of these CS deliveries, elective CS deliveries accounted for 372/11,514 (3.2%) while 11,142/11,514 (96.8%) the emergency CS deliveries. Of the 11,514 caesarean section files, 6,466 had complete data and constituted the study sample. The commonest indications for emergency CS were Cephalo pelvic disproportion, microsomia, and fetal distress, abruptio-placenta, previous scar, and premature rupture of membranes.

Conclusion and Recommendations

Results show a progressively increasing CS rate from 2013 to 2018 and the common indications for CS can be screened for during Antenatal visits. This suggests that various stakeholders may need to; sensitize pregnant mothers to always attend antenatal visits, and health workers to always carefully examine pregnant mothers for such indications during antenatal checkups and advise accordingly, so as to scale down CS rate.

Author Summary

This study provides a detailed retrospective analysis of the Caesarean Section (CS) rates and the underlying indications at Mbale Regional Referral Hospital (MRRH) in Uganda, spanning from June 2013 to July 2018. This cross-sectional study utilizes a chart review of 46,575 patient records, with 11,514 cases of CS, to assess trends in CS rates and their associated factors. The study found a significant rise in CS rates over the five years, with an overall rate of 24.7%, exceeding the World Health Organization’s recommended threshold of 10-15%. Emergency CS deliveries were the predominant type, accounting for 96.8% of the cases, with common indications including Cephalo-pelvic disproportion, fetal distress, and previous cesarean sections.

The authors argue that while rising CS rates pose a public health challenge, the most frequent indications for CS are identifiable and manageable with early screening during antenatal visits. The study highlights the need for increased awareness and education to optimize the use of CS, suggesting that antenatal care could potentially help in reducing unnecessary CS procedures. Furthermore, it explores demographic factors, such as maternal age, parity, and educational level, and their correlations with CS rates, providing valuable insights into the socio-economic and health contexts influencing the rising CS trends in Eastern Uganda. The authors recommend targeted interventions for both healthcare providers and the community to address the root causes of high CS rates, contributing to more efficient and evidence-based obstetric care.