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Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review.

ABSTRACT: Cesarean section is the commonest obstetric operative procedure worldwide. When used appropriately cesarean sections can improve infant and/or maternal outcomes. However, when used inappropriately the potential harm may exceed the potential benefit of cesarean section. Appreciating the limited information in this area the current study assessed the rate and factors associated with cesarean section in Felegehiwot referral hospital, Bahir Dar, northwest Ethiopia.The study was a retrospective analysis of eligible patient records that included 2967 pregnant women who had underwent either cesarean or vaginal delivery from July 1, 2012 to June 31, 2013. The data were double entered to EPI-INFO 3.5.2 and analyzed with SPSS. Binary logistic regression model was fitted to identify independent factors associated with cesarean section.The proportion of women who underwent cesarean section in this study was 25.4%. Obstructed labor (30.7%), fetal distress (15.9%) and abnormal presentation (13.4%) were the major obstetric indications for cesarean section. The odd of undergoing cesarean section was higher among mothers in rural residence (AOR = 1.63, 95% CI: 1.21, 2.20), mothers reported to have pregnancy risk factors (AOR = 2.31, 95% CI: 1.74, 3.07) and lower among mothers in age category of 15-19 (AOR = 0.63, 95% CI: 0.43, 0.93).Obstetric factors occurring around birth, including obstructed labor and fetal distress were the main reasons leading to Cesarean Section rather than background characteristics assumed to be a risk. The results imply that there is a need for timely and accurate screening of women during obstetric care and, decision to perform cesarean section should be based on clear, compelling and well-supported justifications.

SUBMITTER: Abebe FE

PROVIDER: S-EPMC4721205 | biostudies-other | 2016 Jan

REPOSITORIES: biostudies-other

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Project description:BackgroundMothers' delivery care satisfaction is one of the indicators to monitor the quality of health care provision. However, there is only limited information in this regard in Ethiopia, particularly in the study area. Therefore, the study aimed to determine the level of maternal satisfaction and the determinants among vaginal and cesarean section delivery care in Bahir Dar city health facilities.MethodsFacility-based comparative cross-sectional study was conducted from April to May 2018. Using systematic random sampling, a total of 896 recently delivered mothers were interviewed. The collected data were entered into the Epi-Data soft and then exported to SPSS Version 20.0 for analysis. Descriptive statistics were computed and Logistic regression model was used to identify the association between explanatory and outcome variables. Adjusted Odds Ratio with 95% CI was used to measure the strength of the association between these variables. The model fitness was checked using Hosmer and Lemeshow goodness of fit (P > 0.05). A p-value < 0.2 at bivariate analysis was considered for variables to be candidates for multivariable logistic regression analysis. Variables with a p-value of < 0.05 at multivariate analysis were considered as statistically significant predictors of mothers' satisfaction.ResultsA total of 894 recently delivered mothers participated in the study yielded a response of 99.8%. 448 (50.1%) mothers delivered vaginally whereas 446 (25.8%) via cesarean section. The overall mean age of respondents was 26.60 (± 4.88) years. The total maternal delivery care service satisfaction level was 61.4%. More mothers were satisfied with vaginal delivery care, 65.6% (95% CI: 56.97, 74.22%) than cesarean section, 57.2% (95% CI: 48.19, 66.2%). Maternal education, residence, current delivery care planned, maternal HIV status, the gender of health care provider and gave birth in a private health facility were significantly associated with vaginal delivery care satisfaction. Whereas, maternal education, residence, current delivery care planned, antenatal care attended, gender of health care provider was significantly associated with cesarean section delivery care satisfaction.ConclusionsThe overall maternal delivery care service satisfaction level was low as, per the national standard, and there is a great discrepancy in maternal satisfaction level between vaginal and cesarean section delivery care services.

Project description:BACKGROUND:Asking patients/clients what they perceive about the care and treatment they have received is one of the important steps towards improving the quality of health care. In the scientific world, a number of efforts have been tried to understand about what laboring mothers perceive about the care provided. However, little is known about the birth experiences of partners in Ethiopia. Therefore, this study was aimed to assess the maternal and partner's level of satisfaction on the delivery room service in the study area. METHODS:A comparative cross-sectional study was conducted from December 2018 to January 2019 in University of Gondar referral hospital. The birth satisfaction scale is used for the mother, and it was adapted to the partners' perspective. Paired-samples t tests were used for comparing mothers and partners for the birth satisfaction scales global and thematic scores. A binary logistic regression model was fitted to identify predicting factors for mothers' and partners satisfaction. RESULTS:The overall satisfaction of mothers in this study was 47.6%. Whereas, 41.2% of partners were satisfied by delivery room services. There were mean difference between mothers and partners' birth satisfaction scale (p = 0.02). Maternal satisfaction scale was affected by age [OR = 0.36, 95%CI (0.18, 0.73)], perception [OR = 0.02, 95%CI (0.001,0.09)], waiting time [OR = 0.11, 95%CI (0.001, 0.09)],visiting mode [OR = 0.01, 95%CI (0.001,0.08)], pregnancy status [OR = 0.04, 95%CI (0.01,0.33)] and fatal outcome [OR = 0.001, 95%CI (0.001,0.018)] .whereas, partners satisfaction was associated with age [OR = 0.16,95%CI (0.05 0.49)], occupational status [OR = 0.02, 95%CI (0.001, 0.24), amount of money to pay for service [OR = 2.87, 95%CI (1.07, 7.71), visiting mode of his wife [OR = 0.08, 95%CI (0.01, 0.35)], waiting time [OR = 0.12, 95%CI (0.04, 0.33)], privacy [OR = 10.61, 95%CI (3.00, 37.52)], mode of delivery of his wife [OR = 7.69, 95%CI (3.00, 19.69)]. CONCLUSION:This finding would alert the health care system to design a client-friendly approach. It will provide insight to hospital administrators and providers in formulating a policy that would enhance the support of partners during labour and delivery process.

Project description:BackgroundAcquired Immunodeficiency Syndrome (AIDS) is one of the most fatal infectious diseases in the world, especially in Sub-Saharan Africa, including Ethiopia. Even though Antiretroviral therapy (ART) significantly decreases mortality overall, death rates are still highest especially in the first year of ART initiation.ObjectiveTo assess the incidence and predictors of mortality within the first year of ART initiation among adults on ART at Debre-Markos Referral Hospital, Northwest Ethiopia.MethodsA retrospective follow-up study was conducted among 514 newly enrolled adults to ART from 2014 to 2018 at Debre-Markos Referral Hospital. Patients' chart number was selected from the computer using a simple random sampling technique. Data were entered into EPI- INFO 7.2.2.6 and analyzed using Stata 14.0. The mortality rate within the first year was computed and described using frequency tables. Both bivariable and multivariable Cox-proportional hazard models were fitted to show predictors of early mortality.ResultsOut of 494 patient records included in the analysis, a total of 54 deaths were recorded within one year follow-up period. The overall mortality rate within 398.37 person years (PY) was 13.56 deaths/100 PY with the higher rate observed within the first three months. After adjustment, rural residence (Adjusted Hazard Ratio (AHR) = 1.97; 95% CI: 1.05-3.71), ≥ 6 months pre-ART duration (AHR = 2.17; 95% CI: 1.24-3.79), ambulatory or bedridden functional status at enrolment (AHR = 2.18; 95% CI: 1.01-4.74), and didn't take Cotrimoxazole preventive therapy (CPT) during follow-up (AHR = 1.88; 95% CI: 1.04-3.41) were associated with early mortality of adults on ART.ConclusionMortality within the first year of ART initiation was high and rural residence, longer pre-Art duration, ambulatory or bedridden functional status and didn't take CPT during follow-up were found to be independent predictors. Hence, giving special attention for patients from rural area and provision of CPT is crucial to reduce mortality.

Project description:Background:Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone Cesarean section under spinal anesthesia. Method:A prospective cohort study was conducted from 01 February to 28 May 2019 in preeclamptic and non-preeclamptic parturients. We hypothesized preeclamptic parturients are at high risk of spinal anesthesia induced hypotension than non preeclamptics. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). Parturients with cardiac disease, twin pregnancy, chronic hypertension, gestational hypertension, superimposed hypertension, renal disease, diabetes mellitus, coagulopathy (platelet count <?80?×?109/L), active labor, eclampsia, abruptio placentae, placenta praevia, any adjuvant added with local anesthetics were excluded. The data analysis was done using SPSS version 22 statistical software. Student t test, MannWhitney U test and Fisher exact test were used to compare the data. All P values <?0.05 were considered statistically significant. Result:The incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics. Conclusion:The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients.. Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia.

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Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review.

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