Demographic and Health Surveys: caesarean section rates in sub-Saharan Africa
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7381.136 (Published 18 January 2003) Cite this as: BMJ 2003;326:136
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Sir,
Beukens and colleagues make the need for increased access to caesarean
sections in sub-Saharan Africa evident. The data were obtained from the
Demographic and Health Surveys, that generally incorporate a question on
caesarean section for the two or three last institutional births. We
estimate that the national health information systems could also have been
a source of information, but therefore there is an urgent need for program
planners to promote the integration of process indicators for obstetric
service delivery in standard information systems.
Population based caesarean section rate is recognized as a valid indicator
to monitor progress of the Safe Motherhood initiative 1 and other process
indicators related to obstetric service delivery, have been suggested2.The
availability of basic and comprehensive emergency obstetric care, the met
need for emergency obstetric care, the facility based case fatality rate
for obstetric complications, the skilled attendance at delivery and the
unmet need for major obstetric interventions3 are indicators that can
easily be calculated at national level from routine data collected at the
health facility level.
If there really is a decline in the proportion of caesarean sections, we
urge program planners and policy makers to promote systematically the
integration of population based C-section rate and other process
indicators for obstetric care delivery in the national health information
systems. The Safe Motherhood initiative can only become a reality if there
is a real commitment to monitor the progress we made.
Reference List
1. Interagency Group for Safe Motherhood. The Safe Motherhood Action
Agenda: Priorities for the Next Decade. Report on the Safe Motherhood
technical Consultation 18 – 23 October 1997.
2. UNICEF, World Health Organization, UNFPA. Guidelines for monitoring
the availability and use of obstetric services. New York: 1997.
3. De Brouwere V, Van Lerberghe W. Les besoins obstétricaux non couverts.
Paris: L'Harmattan, 1998.
Authors
Derveeuw M.G.L.
Biaye M.
Competing interests:
None declared
Competing interests: No competing interests
Caesarean section rates: a useful process indicator provided by national health information system
Sir,
Buekens and colleagues suggest that a decrease in caesarean sections
rates in sub-Saharan Africa is partly linked to a decline in the access to
health services (1). The presented data were retrieved from the
Demographic and Health Surveys (DHS), based on periodic and nationally
representative household surveys.
Using data issued from an other useful source, the national health
information system (NHIS), a complementary approach could be considered.
The available data in the national NHIS in the Ivory Coast were analysed.
Since 1995, the NHIS in Ivory Coast is based on routine data management in
public health care facilities (dispensaries, health centres and
hospitals), collecting data regarding surgery units coverage and health
facility activities (number of deliveries, caesarean sections and prenatal
consultations) and monitored indicators. The Ivory Coast was
administratively divided into 10 health regions and the indicators were
analysed by region.
In 1997, the national caesarean section rate was 1.7% and ranged
between 0.8% and 2.4% in the 10 regions. The ratio of surgery units to
women of reproductive age population was 4.7 per 100,000 (regional range:
14.2-1.1). A positive, but insignificant relation (p=0.85), was observed
between rates of caesarean sections and the ratio of surgery units to
women of reproductive age population. Prenatal coverage was 36.6%
(regional range: 26.8%-45.2%), an insignificant positive association was
observed between the rates of caesarean sections and the prenatal coverage
(p=0.34).
In West Africa, the poor access of pregnant women to obstetrical
surgery units is commonly due to several factors, particularly the lack of
accessibility and availability to comprehensive obstetric care units and
the low antenatal coverage often associated to an insufficient screening
of pregnancy risk factors in prenatal care (2). Complementary to the DHS
surveys, NHIS is a useful source of information, which provides relevant
indicators of maternal health care and may be used for advocating
improvements for safe-motherhood policy (3, 4).
References
1 - Buekens P, Curtis S, Alayon S. Demographic and Health Surveys:
caesarean sections rates in sub-Saharan Africa. BMJ 2002; 326:136.
2 - Okonofua F. Optimising caesarean-section rates in West Africa.
Lancet 2001; 358:1289.
3 - Gichangi P, Apers L, Temmerman M. Rate of caesarean section as a
process indicator of Safe-motherhood Programmes: the case of Kenya. J
Health Popul Nutr 2001; 19:52-58.
4 - Belghiti A, De Brouwere V, Kegels G, Van Lerberghe W. Monitoring
unmet obstetric need at the district level in Morocco. Trop Med Int Health
1998; 3:584-91.
Competing interests:
None declared
Competing interests: No competing interests