title: Trends in and socio-demographic factors associated with caesarean section at a Tanzanian referral hospital, 2000 to 2013.
abstract: BACKGROUND
  Caesarean section (CS) can prevent maternal or fetal complications. Sub-Saharan Africa has the lowest CS levels in the world but large variations are seen between and within countries. The tertiary hospital, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania has had a high level of CS over years. The aim of this study was to examine trends in the socio-demographic background of babies born at KCMC from year 2000 to 2013, and trends in the CS percentage, and to identify socio-demographic factors associated with CS at KCMC during this period.
  
  
  METHODS
  This is a registry-based study. The analyses were limited to singletons born by women from Moshi urban and rural districts. The Chi square test for linear trend was used to examine trends in the CS percentage and trends in the socio-demographic background of the baby. The association between different socio-demographic factors and CS was assessed using logistic regression. The analyses were stratified by the mother's residence.
  
  
  RESULTS
  The educational level of mothers and fathers and the age of the mothers of singletons born at KCMC increased significantly from year 2000 to 2013 both among urban and rural residents. Among 29,752 singletons, the overall CS percentage was 28.9%, and there was no clear trend in the overall CS percentage between 2000 and 2013. In the multivariable model, factors associated with higher odds of CS were: having been referred for delivery, maternal age above 25 and no- or primary education level of the baby's father. Among rural mothers, no- or primary education, being from the Pare tribe and para 2-3 were also associated with higher odds of CS. Being from the Chagga tribe and high parity were associated with lower odds of CS compared to other tribes and parity 1.
  
  
  CONCLUSIONS
  The CS percentage remained high but stable over time. Large variations in CS levels between different socio-demographic groups were observed. The educational level of the parents of babies born at KCMC increased over time, possibly reflecting persistent inequitable access to the services offered at the hospital.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Nilsen
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.forename: Anne Kjersti
authors.initials: AK
authors.lastname: Daltveit
authors.forename: Blandina Theophil
authors.initials: BT
authors.lastname: Mmbaga
authors.forename: Ingvild Fossgard
authors.initials: IF
authors.lastname: Sandøy
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013636:Tanzania; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult