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Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data

BACKGROUND: Inappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors...

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Autores principales: Dankwah, Emmanuel, Kirychuk, Shelley, Zeng, Wu, Feng, Cindy, Farag, Marwa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814993/
https://www.ncbi.nlm.nih.gov/pubmed/31653255
http://dx.doi.org/10.1186/s12939-019-1063-6
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author Dankwah, Emmanuel
Kirychuk, Shelley
Zeng, Wu
Feng, Cindy
Farag, Marwa
author_facet Dankwah, Emmanuel
Kirychuk, Shelley
Zeng, Wu
Feng, Cindy
Farag, Marwa
author_sort Dankwah, Emmanuel
collection PubMed
description BACKGROUND: Inappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it. METHODS: Data from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities. RESULTS: Out of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile . CONCLUSIONS: This study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.
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spelling pubmed-68149932019-10-31 Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data Dankwah, Emmanuel Kirychuk, Shelley Zeng, Wu Feng, Cindy Farag, Marwa Int J Equity Health Research BACKGROUND: Inappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it. METHODS: Data from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities. RESULTS: Out of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile . CONCLUSIONS: This study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies. BioMed Central 2019-10-25 /pmc/articles/PMC6814993/ /pubmed/31653255 http://dx.doi.org/10.1186/s12939-019-1063-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Dankwah, Emmanuel
Kirychuk, Shelley
Zeng, Wu
Feng, Cindy
Farag, Marwa
Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data
title Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data
title_full Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data
title_fullStr Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data
title_full_unstemmed Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data
title_short Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data
title_sort socioeconomic inequalities in the use of caesarean section delivery in ghana: a cross-sectional study using nationally representative data
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814993/
https://www.ncbi.nlm.nih.gov/pubmed/31653255
http://dx.doi.org/10.1186/s12939-019-1063-6
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