Evolution of the frequency of caesareans in health zones in South Kivu in the Democratic Republic of Congo, 2007-2016
Mulinganya M.G1, Lukula A.M2, Cikomola M.A1,2,3, Nabugobe S.P5, Ngaboyeka A.G2, Bwenge M.E.1,2, Mwembo T.A3,4, Bisimwa B G1,2,3.
(1 = Department of Gynecology and Obstetrics, Faculty of Medicine, Catholic University of Bukavu, 2 = Regional School of Public Health of the Catholic University of Bukavu, 3 = Institutional Strengthening for Health Policies based on Evidence in the Democratic Republic of of Congo, RIPSEC, 4 = School of Public Health of the University of Lubumbashi, 5 = Provincial Division of Health of South Kivu).
Caesarean section is an artificial birth after surgical opening of the abdominal gravid uterus. It is a major intervention asking the obstetrician for experience and dexterity.
The optimal rate of caesarean section to achieve the best maternal-fetal outcome remains a debated issue. The World Health Organization (WHO) recommends a population rate of between 5% and 15%, but these estimates have not been validated with data from developing countries. This rate is used as an indicator of the quality of obstetric care
The objective of this study was to determine the evolution of the proportion of caesareans performed in South Kivu in the Democratic Republic of Congo between 2007-2016.
Material and methods
It is a longitudinal study carried out in 34 Health Zones (ZS) of South Kivu Province. Data were collected from the national health information system from 2007 to 2016. However, 2008 and 2015 data were excluded as incomplete and not validated. The analyzes therefore focus on the 8-year data. The usual descriptive statistics were used to summarize data. We calculated the odds ratio as well as the 95% confidence interval to assess the trend of caesarean deliveries from 2007 to 2016.
During the 8 years of this study, 119570 caesareans were performed on 1430 499 deliveries, or 8.36% for all SZs of South Kivu. The median (minimum-maximum) ranged from 6.90% (0.0-19.48)% in 2007 to 7.688% (1.81-26.15)% in 2016. Overall, 10 ZS had a proportion of caesareans varying between 10-15% (Kadutu, Ibanda, Kabare, Kalehe, Walungu, Kaziba, Mubumbano, Kanyola, Nyangezi, Kamituga), 11 ZS did not exceed 5% (Bagira, Itombwe, Shabunda, Lulingu, Mulungu, Kalole, Nundu, Fizi, Kimbi-Lulenge, Minembwe and Idjwi). The rest of the Health Zones had a proportion varying between 6 and 9%. In 2016, three rural SZs had exceeded the 15% threshold. These are Kalehe (26.15%), Mwana (20.5%) and Haut-Plateaux (22.97%). In 2016, the odds of cesarean delivery was 25% higher than in 2007 (OR = 1.25, 95% CI: 1.19-1.26, p <0.001).
The proportion of caesareans has increased slightly in South Kivu in general, with large variations in some health areas. Further studies are needed to analyze the indications for caesarean section in these HZs and to evaluate the link between cesarean section frequency and HSS functionality in the context of South Kivu.
Key words: South Kivu, health zone, Caesarean section, evolution
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