title: Cesarean deliveries among Nepalese mothers: changes over time 2001-2011 and determinants.
abstract: OBJECTIVE
  To examine the most recent trends of cesarean delivery in Nepal and the association with socio-demographic characteristics of mothers.
  
  
  METHODS
  Nationally representative cross-sectional data was used from three Demographic and Health Surveys conducted in Nepal in 2001 (N = 4,745), 2006 (N = 4,066) and 2011 (N = 4,148). Cesarean section delivery was measured in two categories with yes and no responses for the delivery in their latest pregnancy. Data on socio-demographic variables was obtained by interviewing the participants. The data was analysed using logistic regression models.
  
  
  RESULTS
  The prevalence of cesarean section delivery was increased by more than 4 times from 2001 to 2011 both among rural and urban residents. After adjusting for mother's age, number of births in last 5 years and mother's education the prevalence of cesarean section delivery among all mothers was 1.71 times higher in 2006 (OR = 1.71, 95 % CI 1.23-2.37) and increased further in 2011 (OR = 2.42, 95 % CI 1.78-3.30) compared with year 2001. When adjusted for all the variables simultaneously, all variables except births in last 5 years remained significantly associated with cesarean section delivery of the mother. Older age, urban resident, being educated, having educated partners and being rich according to wealth index were associated with cesarean section delivery.
  
  
  CONCLUSIONS
  The prevalence of cesarean section delivery continues to rise but still lower than the World Health Organization recommended rates. More studies are needed to examine the non-medical reason of increasing rates of cesarean section deliveries and their effect in maternal and infant morbidity and mortality in Nepal.
authors.affiliation: School of Health Sciences, University of Tampere, 33014, Tampere, Finland, prakash.kc@uta.fi.
authors.forename: K C
authors.initials: KC
authors.lastname: Prakash
authors.forename: Subas
authors.initials: S
authors.lastname: Neupane
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009390:Nepal; D011247:Pregnancy; D015995:Prevalence; D012959:Socioeconomic Factors