Facility-based assessment of caesarean section indications and outcomes in Njombe Region, Tanzania, 2024

Abstract

Introduction: Caesarean section (CS) is a critical intervention for managing maternal and neonatal complications when vaginal delivery fails. While global CS rates rose from 7% in the year 1990 to 21% in the year 2021, during which excessive reliance on CS without clear medical indications was recorded, this has raised concerns, especially in developing countries like Tanzania, where the CS rate has increased from 7% in the year 1990 up to 13% in the year 2021. This study examines the indications and outcomes of CS among women who delivered in health facilities in the Njombe region, Tanzania. Methods: A facility-based cross-sectional study was conducted from March to May 2024, involving 567 post-delivery women (PDW) selected through multistage cluster sampling. Data were collected using structured questionnaires and hospital records, focusing on demographic, clinical, and delivery details. Descriptive statistics analysis was used to analyse categorical and continuous variables. Results: The study revealed that 60.1% of CS were elective, whereby a previous caesarean scar was the most common indication (19.3%). Neonatal complications were more prevalent after CS (32.6%) compared to vaginal deliveries (14.9%), with early neonatal sepsis being the leading complication in both modes of delivery. Maternal complications after CS included postpartum haemorrhage (39.4%) and infections (30.3%), compared to a lower complication rate in vaginal deliveries (3.6%). Conclusions: Elective CS remains high, posing unnecessary risks and resource burdens. Neonatal outcomes, particularly early neonatal sepsis, highlight gaps in infection prevention and neonatal care. Maternal complications such as postpartum haemorrhage underscore the need for enhanced obstetric management during the labour and delivery period. Strengthening antenatal care to improve birth preparedness, adhering to clinical guidelines for CS, and investing in neonatal and maternal care during the labour and delivery period will help reduce unnecessary CS and improve maternal and neonatal outcomes.