Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study

Abebaw Gedef Azene; Gizachew Tadesse Wassie; Desale Bihonegn Asmamaw; Wubshet D Negash; Tadele Biresaw Belachew; Bewketu Terefe; Kindie Fentahun Muchie; Getasew Mulat Bantie; Habitu Birhan Eshetu; Kassawmar Angaw Bogale

doi:10.1038/s41598-024-71293-7

Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study

Sci Rep. 2024 Sep 16;14(1):21637. doi: 10.1038/s41598-024-71293-7.

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. abebaw2516@gmail.com.
² Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
³ Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. desalebihonegn1988@gmail.com.
⁴ Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁵ Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁶ Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia.
⁷ Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Abstract

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran's I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff's SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers' age (AOR = 1.07, 95% CI 1.02-1.12), mother's had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother's higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.

Keywords: Cesarean section; Ethiopia; Multilevel modeling; Spatial variations.

MeSH terms

Adolescent
Adult
Cesarean Section* / statistics & numerical data
Cross-Sectional Studies
Ethiopia
Female
Humans
Middle Aged
Pregnancy
Spatial Analysis
Young Adult