title: Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres.
abstract: OBJECTIVE
  The World Health Organization considers Cesarean section rates of 5-15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality.
  
  
  METHODS
  Women undergoing Cesarean section from August 1 2010 to January 31 2011 were included in this prospective study. Logistic regression was used to model determinants of maternal and early neonatal mortality.
  
  
  RESULTS
  1276 women underwent a Cesarean section, giving a frequency of 6.2% (range 4.1-16.8%). The most common indications were obstructed labor (399, 31%), poor presentation (233, 18%), previous Cesarean section (184, 14%), and fetal distress (128, 10%), uterine rupture (117, 9%) and antepartum hemorrhage (101, 8%). Parity >6 (adjusted odds ratio [aOR] = 8.6, P = 0.015), uterine rupture (aOR = 20.5; P = .010), antepartum hemorrhage (aOR = 13.1; P = .045), and pre-eclampsia/eclampsia (aOR = 42.9; P = .017) were associated with maternal death. Uterine rupture (aOR = 6.6, P<0.001), anterpartum hemorrhage (aOR = 3.6, P<0.001), and cord prolapse (aOR = 2.7, P = 0.017) were associated with early neonatal death.
  
  
  CONCLUSIONS
  This study demonstrates that target Cesarean section rates can be achieved in sub-Saharan Africa. Identifying the common indications for Cesarean section and associations with mortality can target improvements in antenatal services and emergency obstetric care.
authors.affiliation: Médecins sans Frontières, Johannesburg, South Africa. kathryn.chu@joburg.msf.org
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chu
authors.forename: Hilde
authors.initials: H
authors.lastname: Cortier
authors.forename: Fernando
authors.initials: F
authors.lastname: Maldonado
authors.forename: Tshiteng
authors.initials: T
authors.lastname: Mashant
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
mesh_terms: D000293:Adolescent; D000328:Adult; D002063:Burundi / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D011247:Pregnancy; D011446:Prospective Studies; D012807:Sierra Leone / Q000453:epidemiology; D015996:Survival Rate