High proportion of caesarean section at a rural hospital in south western Uganda: A cross sectional study

Abstract Background: Globally, overall prevalence of caesarean section (CS) is estimated at 18.6%, with 27% in high-income countries and 6% in low- and middle-income countries. There is an increase in trends of CS in Uganda from 8.5% in 2012 to 11% in 2016. There have been no studies done to account for the high rates of CS in a rural hospital in Uganda. This study determined the proportion and factors associated with CS delivery at a rural hospital in south western Uganda.Methods: This was a cross sectional study of 321 immediate postnatal women in a rural hospital in south western Uganda. A structured questionnaire and data abstract forms were used to collect information on proportion and factors associated with CS. Eligible participants were enrolled consecutively. Logistic regression analysis was done to identify the factors associated with CS taking into account potential confounders.Results: This study recruited 321 women with mean age of 25.8 ±6.086 years, mean parity 2.6 ±1.673 and mean antenatal care visits of 4.27 ±1.197. The proportion of CS in this study was 38.3% (123/321). Of these, 110 (89.4%) were emergencies and 27(10.6%) electives. Only 8.4% of the respondents were referrals. The commonest indications of CS were fetal distress (28.5%), history of previous CS (18.7%) and poor progress of labour (11.4%). No factors were significantly associated with CS in this study.Conclusion: There is a high proportion of CS in a rural hospital in Uganda and this is three times higher than the WHO recommended CS rates. Majority of CS are emergencies due to fetal distress and poor progress of labour. There is a need for additional studies exploring the reasons for the much higher than expected CS rates.