The FACTORS ASSOCIATED WITH CAESAREAN SECTION AT A RURAL HOSPITAL IN SOUTH WESTERN UGANDA:  A CROSS-SECTIONAL STUDY

Lilian Nuwabaine; Mathius amperiize; Patience Annet  Nakalega

doi:10.51168/sjhrafrica.v4i6.417

Authors

Lilian Nuwabaine Department of Nursing, AgaKhan University, Kampala, Uganda.
Mathius amperiize Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda.
Patience Annet Nakalega Department of Public Health Nutrition, Victoria University, Kampala, Uganda.

DOI:

https://doi.org/10.51168/sjhrafrica.v4i6.417

Keywords:

caesarean section, postnatal period, spontaneous vaginal delivery

Abstract

Background:

Globally, the 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. No studies have been carried out to account for the high rates of CS at Kisiizi Hospital in Uganda. This study determined the proportion and factors associated with CS delivery at a rural hospital in southwestern Uganda.

Methods:

This was a cross-sectional study of 321 immediate postnatal women in a rural hospital in southwestern Uganda. A structured questionnaire and data abstract forms were used to collect information on the 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 a mean age of 25.8 ± 6.086 years, mean parity of 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%) were 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 at Kisiizi Hospital in Uganda and this is three times higher than the WHO-recommended CS rates. The 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.

Author Biographies

Lilian Nuwabaine, Department of Nursing, AgaKhan University, Kampala, Uganda.

Lilian Nuwabaine holds a Master of Nursing (Midwifery and Women’s Health) and bachelors’ degree in Nursing, all from Makerere University. She was the Heroes in Health Award Winner - Midwife of the year 2021. She is currently working with Aga Khan University as the Continuous Professional Development (CPD) Coordinator.

In this role from September 2019 to date, Lilian has secured accreditation for Aga Khan University as a CPD Provider and center by the Uganda Nurses and Midwives Council, where she has developed and received accreditation for more than ten midwifery and nursing short courses and conducted over 80 pieces of training, both physical and virtual, which have seen more than 2,800 midwives and nurses from various health facilities across the whole of Uganda benefit. Lilian has achieved this by successfully collaborating with various stakeholders including the MoH Uganda, NGOs, district health teams, and the top management of health facilities.

Additionally, Lilian is also the innovator of projects like “Your Nurse and Midwife on Air, The Nurses and Midwives Virtual Community WhatsApp platform, and The Nutrition and Wellness Hub. Almost all these projects focus on equipping the community with evidence-based health information.

Lilian believes in the public health approach for the prevention of diseases, and she thus does community sensitization using various media platforms like writing freely for top tabloids on a wide range of health issues and publishes, conducting free health education talks on televisions, radios, webinars among others. By July 2021, during the 2^nd lockdown due to the COVID-19 pandemic in Uganda, pregnant and breastfeeding mothers were not among the priority groups to receive the COVID-19 vaccine. Lilian identified this as a very big problem since these are a vulnerable group and based on the global research and various evidence-based recommendations from developed countries, findings showed that the vaccine benefits outweighed the risks, and hence safe in this group. Lilian didn’t sit down and watch this, she thus went ahead and advocated for this special group by writing and publishing in the different media print recommending the GOU through the MoH to include this category of people among the priority groups and held different webinars and press briefs about this. In less than two months, the MoH through the UNEPI department had recognized and included them among the priority groups. Lilian conducts and publishes research in peer-reviewed journals. Her focus is mainly on reproductive maternal newborn child and adolescent health and general nursing and midwifery.

ORCID ID: 0000-0003-3255-3876

Mathius amperiize, Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda.

Mathius Amperiize holds a BSc in Environmental Health from the School of Public Health, Makerere University. He is currently pursuing his MSc in Public Health from the School of Public Health, Makerere University. He poses experience in research Monitoring and Administration, project management, and implementation. He is interested in research in areas of environmental health, emerging infectious diseases, and Non-communicable diseases. Mathius has experience in research writing where he has co-authored peer-reviewed manuscripts and is a guest writer in recognized new papers in Uganda. Mathius is currently a research monitor and research administrator at the Infectious Diseases Institute (IDI).

ORCID: 0000-0002-4104-4830

Patience Annet Nakalega, Department of Public Health Nutrition, Victoria University, Kampala, Uganda.

Patience is a lecturer in the Department of Public Health and Nutrition at Victoria University Department of Public Health and Nutrition. She holds a Bachelor’s degree in Nursing from Makerere University, MSc in Public health and Nutrition from the same University. Patience is the research coordinator in the Faculty of Health Sciences at Victoria University. Patience intends to major as an epidemiologist where she will examine the role of disease aetiology, monitor the health status of populations, deliver health care professional training, and develop, monitor, and evaluate health interventions. Patience is also a researcher with over six peer-reviewed publications online.

ORCID: 0000-0003-0114-9985