Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

Ayele Geleto, Catherine Chojenta, Tefera Taddele, Deborah Loxton, Ayele Geleto, Catherine Chojenta, Tefera Taddele, Deborah Loxton

Abstract

Background: Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia.

Methods: Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson's correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05.

Results: The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136-162) per 100,000 livebirths. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51-104) per 100,000 livebirths in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2-20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1-38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2-6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant.

Conclusions: At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

Keywords: Ehiopia; Maternal mortality ratio; association; caesarean section rate.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Causes of death among women who had CS in hospitals in Ethiopia in 2015. *Other direct causes: these includes maternal complications such as organ failure, complications of anaesthetic, thromboembolism, and other problems including premature rupture of membrane and breech presentation, which might finally end in direct obstetric complications such as sepsis and obstructed labour. **Other indirect: this incudes other nonspecific potentially life threatening indirect obstetric conditions including heart disease, tuberculosis and incidental causes such as accidents
Fig. 2
Fig. 2
The correlation of maternal mortality ratio and caesarean section rate in Ethiopia, 2015

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