Prevalence, socio-demographic, obstetric, nutritional and birth factors associated with C-section among mothers attending primary health care facilities in selected councils of Njombe Region, Tanzania; Facility based cross-sectional analytical study

Abstract

INTRODUCTION: Advances in technology and reproductive health knowledge have increased the incidences of both emergency and elective C-section. In Tanzania the prevalence of C-section is lowest in Simiyu Region (1.5%) and highest in Njombe Region (33.2%). The objective of this study is to assess the prevalence and factors associated with C-section among mothers attending primary health care facilities in selected councils of Njombe Region, Tanzania. METHODOLOGY: The study was cross-sectional analytical study. Two councils in Njombe Region were selected by purposive and convenient sampling techniques. About 382 mothers with living children aged 0-2 years were interviewed from eight healthcare facilities. Questionnaire was developed by using previous studies, WHO guidelines and national surveys and installed into Kobo Toolbox software. The interview was conducted through face to face and review from Reproductive and Child Health Card No. 1 (RCH card 1) and Maternal Clinic Card (RCH card 4). SPSS software version 26 was used to analyse descriptive statistics, chi-square test and binary regression for this study. All statistical significant was considered at p < 0.05. RESULTS: About 307(80.4%) were aged between 21 and 34 years currently. Majority 297 (77.7%), attended 4-7 antenatal clinic visits and 60 (15.7%) attended 8 visits. About 177(46.3%) had inadequate GWG and 75(19.6%) had excess GWG. About 25 (6.5%) of mothers were drinking alcohol during previous pregnant. The average gestation age at birth was 38.34 ± 1.62 weeks, most of children 357 (93.5%) were born with recommended birth weight ≥ 2500 g and 326 (85.4%) birth height ≥ 45 cm. Majority 378(99.7%) of respondents delivered at the health care facility. Prevalence of C-section was 154(40.3%). Mothers with the history of previous scar were 63(16.5%). For all C-section, 85(55.2%) were emergency and 69(44.8%) elective. Factors associated with C-section were; history of non-cephalic birth presentation (AOR = 26.24), history of large baby (> 3500 g) (AOR = 3.51), adequate GWG (AOR = 2.30) and excess GWG (AOR = 2.17) and unemployment (AOR = 2.20). CONCLUSION: Findings suggest high C-section prevalence, poor GWG and alcohol consumption during pregnancy in sampled facilities. Different factors are associated with C-section including; socio-demographic characteristics, obstetrics, nutritional and child birth characteristics. Future cohort studies to establish GWG and to assess factors associated with emergency C-section are recommended to bring more evidences on the current matter. Targeted public health initiatives to educate pregnant women on weight gain and alcohol use during pregnant should be emphasized.