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The changing temporal association between caesarean birth and neonatal death in Ethiopia: secondary analysis of nationally representative surveys
Authors: Engida Yisma, Ben W Mol, John W Lynch, and Lisa G Smithers
Source: BMJ Open, 9: e027235; DOI: 10.1136/bmjopen-2018-027235
Topic(s): Cesarean section
Delivery care
Maternal health
Neonatal mortality
Country: Africa
  Ethiopia
Published: OCT 2019
Abstract: Objective To examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016. Design Secondary analysis of Ethiopian Demographic and Health Surveys. Setting All administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016. Participants Women aged 15–49 years with a live birth during the 5?years preceding the survey. Main outcome measures We analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the ‘Three Delays Model’ to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia. Results The adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95%?CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95%?CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths. Conclusions A naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.
Web: https://bmjopen.bmj.com/content/9/10/e027235