title: Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative.
abstract: BACKGROUND
  In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria.
  
  
  METHODS
  Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17-45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented.
  
  
  RESULTS
  In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38-0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04-2.28).
  
  
  CONCLUSIONS
  This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
authors.affiliation: Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
authors.forename: Jayleen K L
authors.initials: JK
authors.lastname: Gunn
authors.affiliation: Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
authors.forename: John E
authors.initials: JE
authors.lastname: Ehiri
authors.affiliation: Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.|University of Arizona Cancer Center, Tucson, Arizona, United States of America.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Jacobs
authors.affiliation: Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
authors.forename: Kacey C
authors.initials: KC
authors.lastname: Ernst
authors.affiliation: Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
authors.forename: Sydney
authors.initials: S
authors.lastname: Pettygrove
authors.affiliation: BrightOutcome, Inc., Buffalo Grove, Illinois, United States of America.
authors.forename: Katherine E
authors.identifier: http://orcid.org/0000-0002-5635-310X
authors.initials: KE
authors.lastname: Center
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Alice
authors.initials: A
authors.lastname: Osuji
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Amaka G
authors.initials: AG
authors.lastname: Ogidi
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Nnabundo
authors.initials: N
authors.lastname: Musei
authors.affiliation: Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America.|Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Obiefune
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
authors.forename: Chinenye O
authors.initials: CO
authors.lastname: Ezeanolue
authors.affiliation: Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.|Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America.|Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada, United States of America.
authors.forename: Echezona E
authors.initials: EE
authors.lastname: Ezeanolue
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult