Cesarean section(CS) is the delivery of the fetus, placenta, and membranes through an incision made on the mothers abdominal and uterine walls after 28th weeks of gestation(1). CS is the most common surgical procedure during pregnancy and labor to save both the life of the mother and the newborn (2). Despite its advantage, CS is associated with adverse maternal and neonatal outcomes including long term sequels, with appropriate clinical indication significantly saves the life of the mother and the newborn as well. In contrast, CS performed without any medical indication increases the trend without giving any advantage for the patients(3). Increased CS rate has an important negative implication for health coverage nationally and internationally (4).
Cesarean section performed with aseptic technique, appropriate anesthesia, the applicability of lower transverse uterine segment cesarean section, safe and rapid availability of blood products collectively decreases the morbidity and mortality associated with cesarean section(5). The rate of cesarean section is twice higher in private than in public hospitals(6, 7).
The global cesarean section rate (CSR) is 18.6% ranging between 6.0% to 27.2% in developing and developed world respectively, Latin American and Caribbean accounts the highest proportion of cesarean section rate (40.5%) and the lowest rate is in Africa (7.3%), particularly in western Africa (3%)(2).
The major obstetrical indication for cesarean section is obstructed labor, previous CS scar, non-reassuring fetal heart pattern, malpresentation, malposition, antepartum hemorrhage and failed induction, cesarean section rate more than the WHO threshold (15%) cause morbidity and mortality than giving any advantage, so routine use of antibiotics for all women undergoing CS decreases the morbidities associated with CS(8, 9).
According to the WHO 2010 report, the minimum CS rate to have a good maternal outcome is 5%. However, for better neonatal health outcome the range should be between 5% -10%(4)
Studies conducted in three Asian countries the prevalence of CS in Bangladesh was 73%, 30% in Nepal and 18 % in India(7). Studies also that was done in brazil was 29.9 % and 86.2% in public and private health sectors respectively(10). Another study in Asia revealed that the proportion of cesarean section In India 21.6 %(11), in Pakistan 21.40% and China 54.5%(12, 13). The study conducted in the Arab region showed that Egypt having the highest CS rate (26.2%) but lowest in Mauritania 5.3%( 14). Another study conducted in 34 Sub-Saharan Africa (SSA) countries showed that the rate of cesarean section is ranged from 3% in Burkina Faso to 15.6% in Ghana. The highest rate showed in Rwanda, Namibia, and Ethiopia which is 64.2%, 60.3% and 30.1% respectively The lowest rate was shown in Congo which is 2.3%(15). Another study conducted in South Africa, Johannesburg CS rate was 39.4%(16).
Studies in Ethiopia that was conducted in private and government hospitals in Harar town the overall prevalence of CS was 34.3%(17). A hospital-based cross-sectional study done at Chiro Zonal Hospital, West Harergae rate of cesarean delivery was 18.2%(18). A cross-sectional retrospective study that was conducted in Attat Hospital; Gurage zone Southern Nations and Nationalities of people Republics (SNNPR), Ethiopia, showed that the rate of CS was 27.6%(9). Similarly, the study that was done in Oromia suggested that prevalence of CS was 29.4%(19). A hospital-based retrospective cross-sectional study carried at Jimma University specialized hospital the overall prevalence of C/S was 28.1%(20). According to the study conducted at Adigrat hospital, northern Ethiopia using a retrospective study design, the institutional cesarean delivery rate was 14.23%(21). The study that was done in the west Tigray zone, the rate of CS was 13.2%(22). According to the study conducted in Addis Ababa on cesarean delivery practices in teaching public and nongovernment/private maternal and child health (MCH) hospitals, the CSR 31.1% in public hospitals and 48.3% in private hospitals(23). Similar Studies conducted in northwest Ethiopia the prevalence of CS was 11% in Finoteselam hospital and 25.4% in felegehiwot hospital(24, 25).
Study finding in India showed that Previous lour segment cesarean sections (LSCS) was the leading indication to the CS rate (29.96%) followed by the arrest of labor (13.94%), cephalio public disproportions(CPD) (11.84%) and fetal distress (10.97%)(26). A study conducted in Pakistan showed that the most common indication of cesarean section was the previous cesarean section scar (22.76%) followed by failed progress of labor (18.29%)(12). Another study conducted in Iran showed that repeated cesarean section (52.9%), elective CS (on maternal request) (7.5%) was the most common indication(27).
Similar Study conducted in Nigeria the common indication for CS was CPD(40% followed by preeclampsia(18%) and previous CS(11.8%)(28). Another study that was conducted in Tanzania showed that prolonged/obstructed labor count (30%) of all indication (29). Similarly study in Zambia suggested that fetal distress (14.9%) and prolonged labor (10%) was the commonest indication for CS(30).
Even though the cesarean section is important and lifesaving intervention for mothers and babies when vaginal delivery is contraindicated, it has a negative health impact on mother and baby and also put the mother on risk for future pregnancy. Therefore in order to decrease this negative health impact, the cesarean section rate should be in recommendation range. So identifying the prevalence and associated factor of the cesarean section would help our hospital and the country, in general, to set plan and strategies’ to make cesarean section delivery rate within 5%-15% as WHO-recommended and to reduce maternal and fetal complication during delivery.