Prevalence, Indications and Determinants of Caesarean Delivery in Alexandria, Egypt

Abstract

Background: Prevalence of Caesarean delivery (CD) is increasing worldwide including Egypt. Alexandria is one of the governorates recording the highest rates in Egypt. Identifying factors associated with CD is important to plan for reduction. Objective: To identify prevalence, indications and determinants of CD in Alexandria, Egypt. Methods: This cross sectional survey was carried out in Alexandria, Egypt between July and December 2017. Target population was ever-married fertile women aged 15-49 years. Only women having at least one child aged ≤ 5 years were included. Using the cluster sample survey, 900 eligible women were selected and subjected to an interview questionnaire for data collection. It included socio-demographic data, habits, reproductive history and medical profile. Results: Prevalence of CD in Alexandria (2017) was 70.4%. The reported leading causes for CD were previous CD (34.9%) and women request (12.1%). The significant socio-demographic factors associated with CD included educational level (p< 0.000) and residence (OR=2). Biomedical variables involved previous abortion (p= 0.005), previous complicated pregnancy (OR=1.6), frequent antenatal visits (OR=1.8), pre-/eclampsia (OR=1.8), previous CD (OR=2.2), assisted reproduction (OR=2.2), delivery age ≥35 (OR=2.2), preceding birth interval ≤ 2 (OR=2.2), parity ≥5 (OR=2.5), preterm labour (OR=2.6), delivery in private sector (OR=2.7), and multiple pregnancy (OR=5.7). Conclusion: The rate of CD in Alexandria is high. Predictors of CD are high parity, pre-/eclampsia, previous CD, short preceding birth interval, higher education, urban residence, frequent antenatal visits, and delivery in private sector. The study recommends women health education and developing guidelines with medical audit of CD practice.