Cesarean delivery practices in teaching public and non-government/private MCH hospitals, Addis Ababa

Abstract

Background: Cesarean section is one of the skilled delivery interventions that have proven to be a life-saving procedure. It should be done under appropriate indications owing to the inherent short and long term complications and high cost. In Ethiopia, a study comparing the practice of cesarean sections in government and non-government hospitals has not been undertaken before.
Objective: To describe and compare the practices of cesarean delivery in the teaching public and non-governmental MCH hospitals in Addis Ababa, Ethiopia.
Methods: Retrospective cross-sectional study using the cesarean section data of 2011 G.C. from three teaching government and three private-MCH hospitals. The data was analyzed and the mean with standard deviation for continuous variables and proportions for categorical variables were used as descriptive statistics. Chi-square test was used to measure the strength of associations where appropriate, with level of significance set at p-value <0.05.
Results: The difference in the proportion of cesarean delivery between the two groups was statistically significant, 31.1% and 48.3% (P<0.05) in the teaching government hospitals and the non-governmental hospitals, respectively. Non-government MCH hospitals contributed to one-third of the total deliveries and 40% of the cesarean sections. Non-reassuring fetal heart rate pattern, previous cesarean section scar, and cephalo-pelvic disproportion account for 51.3% and 59.6% of the indications in the teaching hospitals and non-governmental hospitals, respectively. When individual indications were analyzed between the two groups, previous cesarean section was higher in the non-governmental hospitals, 29.3% vs. 14.6%, (P<0.05), and non-reassuring fetal heart rate pattern frequented more in the teaching hospitals 26.3% vs. 17.8%,(P<0.05), contributed significantly. Maternal request per se contributed to 7.5% of the indication in the non-governmental hospitals compared to none in the teaching hospitals. Of the repeat cesarean sections, 70.3% were done merely for reasons of first cesarean section in non-governmental hospitals compared to 16.8% in the teaching (P<0.05). The proportion of low birth weight, post-term pregnancy and unknown date were seen more in the teaching hospitals compared to non-governmental hospital, (P<0.05). Though three dosing was the most frequently practiced prophylaxis in both study groups, there is a great deal of variability in the choice of antibiotics.
Conclusion: The higher proportion of maternal morbidities/mortalities and poor peri-natal outcomes in the setting of higher proportion of emergency cesarean delivery in teaching government hospitals need further study to explore for factors that have contributed so as to improve the quality of care. The high rate of repeat cesarean delivery for one previous cesarean section scar and other non medical indications like maternal request in the non-government MCH hospitals elucidates the need to monitor the appropriateness of these indications. We also recommend standardization of prophylactic antibiotic use and expand use of regional anesthesia for cesarean section.