RFI: Determinants of cesarean section in Africa and Asia (2)
Dear collegues from Ghent,
Are you conducting a hospital- or population-based study? Or a health
I think that, if you remain in the frame of the hospital-based study, you
can find easily a lot of references type "incidence and determinants of
the CS at the Universitary Hospital in ..... (a major African city)". For
French-speaking Africa, for example, "Cahiers Santé" and "Revue
d'Epidémiologie et de Santé Publique" publish frequently this type of
study. I promise to look in my notes and give you further data.
But, I think, the problem of the cesarean section prevalence in Africa an
Asia must be also studied in relation to the access to essential obstetric
care (EOC). This is a key of preventing maternal mortality and severe
morbidity. Access comprises availability of services, but also ability to
recognize the need for EOC and to reach a health facility (first referal
unit) where EOC is available. From this point of vue, the cesarean section
rates, computed as as a proportion of all estimated births in an area
(because not all births take place in a health facility) becomes an
indicator of EOC facilities utilization.
According to the mortality related to the CS, may I underline that
frequently there is the case -fatality rate (CFR) due to major obstetric
complications which is provided by different publications.
May I present you few data. For example, in Marocco (1989 - data provided
by the team of Antwerpen) a number of 7861 CS were performed. This
represent about 0.86% of all expected births in urban areas and 0.27% in
rural areas. They also make an interesting modelling of obstetric
interventions need based on spatial analysis of deficits. In India (1991 -
1992 I think) this rate was between 0.41% and 5.5 % according to different
districts (percentage of expected number of births). The case-fatality rate
for major obstetric complications vary between 2.8% and 6.9%. This study
conducted by UNICEF also proposes a whole system of M&E of availability of
EOC and progress acquired through a system of indicators of which the CS
rate is one of the components. This is also used as a progress indicator
of maternal mortality reduction programs.
I think your study is very interesting and I hope you will give a feed-back
Dr Denisa IONETE
Ob&Gyn, MSc in Public Health
UNICEF Field Office Libreville, Gabon
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