Sociodemographic factors and incidence of caesarean sections in Mozambique

The United Nation`s fifth Millennium Goal, reduction of maternal mortality, is significantly lagging behind schedule. Worldwide, approximately 600,000 mothers die each year in complications due to pregnancy and childbirth. In emergency obstetrics, the caesarean section is a key measure used to reduce a large number of complications due to pregnancy and delivery. The concern has been the availability of surgical care in developing countries. Average caesarean section rates vary between 0.4 %­­­—40 %, unlike WHO`s recommended 5—15 %. There is socio-demographical distribution in caesarean section rates within countries. Also the overuse of caesarean sections can be seen in some areas. This Master`s thesis studies the distribution of caesarean sections according to socio-demographic factors in Mozambique. The data used was population—based data from years 1994—1997 and 1998—2003 from Demographic Health Survey (DHS). Mother`s age, parity, and educational level, partner´s educational level, wealth index and residential area were examined as socio-demographical factors. According to this study, the socio-demographic factors are related to the incidence of caesarean sections in Mozambique. The connection was found by carrying out cross tabulations, Pearson`s χ2- tests and logistic regression analyses. In 1994—1997 age group and parity were associated with incidence of caesarean sections when adjusted with all confounders. The older the mother was, the higher was the risk of a caesarean section. Women having their first child had caesarean section more often than women having at least their second or third child. People living in urban areas more likely receive a caesarean section than those in rural areas. In 1998—2003, in addition to age, parity and area of residence, the study found the wealth index to be the strongly associated socio-demographic factor for caesarean section. Caesarean sections were more common among women who—or whose partners—were highly educated. Socio-demographical factors, especially parity, have stronger association in incidence of caesarean sections in subsequent time period. Even in Maputo, the capital of Mozambique, where the caesarean section rates were the highest in 1998—2003 (12.9 %), the rate was slightly under the recommended upper limit of WHO. On the basis of this study it is not possible to draw final conclusions on overuse of caesarean sections. Key words: socio-demographic factors, caesarean section, Demographic Health Survey, Mozambiqu