| dc.description.abstract | Background
Caesarean section (C-section) is a major obstetric life-saving intervention for the prevention
of pregnancy and childbirth related complications. Globally C-section is increasing, as well
as in Bangladesh. This study identifies the prevalence of C-section and socio-economic and
health care seeking related determinants of C-section among women living in hard-to-reach
(HtR) areas in Bangladesh.
Methods
A cross-sectional survey was conducted using a structured questionnaire between August
and December 2017 at four distinct types of HtR areas of Bangladesh, namely coastal, hilly,
haor (wetland), and char areas (shallow land-mass rising out of a river). Total 2,768 women
of 15–49 years of age and who had delivery within one year prior to data collection were
interviewed. For the analysis of determinants of C- section, the explanatory variables were
maternal age, educational status of women and their husbands, women’s religion, employ-
ment status and access to mobile phone, wealth index of the household, distance to the
nearest health facility from the household, the number of ANC visits and presence of compli-
cations during pregnancy and the last childbirth. Logistic regression model was run among
850 women, who had facility delivery. Variables found significantly associated with the out-
come (C-section) in bivariate analysis were included in the multivariable logistic model. A p-
value <0.05 was considered as statistically significant in the analyses.
Results
Of the 2,768 women included in the study, 13% had C-sections. The mean (±SD) age of
respondents was 25.4 (± 0.1) years. The adjusted prevalence of C-section was 13.1 times higher among women who had their delivery in private facilities than women who delivered
in public facilities (Adjusted Odds Ratio, AOR: 13.1; 95% CI 8.6–19.9; p-value: <0.001).
Women from haor area and coastal area had 4.7 times (AOR: 4.7; 95% CI 2.4–9.4; p value:
<0.001) and 6.8 times (AOR: 6.8; 95% CI 3.6–12.8; p value: <0.001) more chance of having
C-section, respectively, than women living in char area. Among women who reported com-
plications during the last childbirth, the AOR of C-section was 3.6 times higher than those
who did not report any complication (AOR: 3.6; 95% CI 2.4–5.4; p value: <0.001).
Conclusions
The study identifies that the prevalence of C-sections in four HtR areas of Bangladesh in
substantially below the national average, although, the prevalence was higher in coastal
areas than three other HtR regions. Both public and private health services for C-section
should be made available and accessible in remote HtR areas for women with pregnancy
complications. Establishment of an accreditation system for regulating private hospitals are
needed to ensure rational use of the procedure. | en_US |
