Caesareansection (C-section) considered as a public health problem, is one of the mostcommon surgeries in the world 1. The procedure is often performed without medicalneed, hence putting women and their neonates at risk of short- and long-termhealth problems. Recently, it has been reported that the rates of C-section continueto skyrocket, particularly in high- and middle-income countries 12. The international healthcare community consideredthe ideal rate for cesarean sections tobe between 10% and 15% 12 3.
On one hand, Malawifollows the United Nations (UN) process indicators, which recommend that aminimum of 5% and a maximum of 15% of all births should be delivered byC-section 4. On the hand, the World Health Organization (WHO)underscores the importance of focusing on the needs of the patient and discouragesthe practice of aiming for target rates 2. C-section may be necessary when vaginal deliverymight pose a risk to the mother or neonate particularly due to fetal distress, prolongedlabor, or because the baby is presenting in an abnormal position 13. Unfortunately, the procedure can lead to significantproblems, disability or death, predominantly in settings that lack thefacilities to conduct safe surgeries or treat potential complications 23.Previousstudies in many settings have reported that the causes of an increase in C-sections are multifactorial and poorlyunderstood 5. Notably, changes in maternal characteristics (i.e.
higher educational education, rise in maternal age, prior cesarean section, prolongedlabor, and increasing maternal Body Mass Index) 56, infant characteristics (i.e. baby weight – suspectedlow infant birthweight or macrosomia, length of the baby) 67 and professional practice styles, increasingmalpractice pressure – private hospital status, as well as economic,organizational, social and cultural factors have all been implicated in an increase in C-sections 5. Cesareansection is one of the most important riskfactors for postpartum maternal infectionwhich account for approximately 10% of pregnancy-related mortality and it carries a risk of infection 5to 20 times that of vaginal delivery 8910. It.
In Malawi, since 1992, the rates of C-sectionshave been on the rise as it was reportedthat only 3% of births occurred with C-section in 1992-2000 compared with 5% in2010 and 6% in 2015-16 11. To the best of our knowledge, few studies have untilnow been conducted to address the factors that affect C-section in Malawi. Forbetter results on C-sections, it is necessary to contextualize thesociocultural determinants in addition to the current healthcare model. Thus, thepresent study aimed to investigate the associated factors of C-sections from 2004 to 2015 using the population-based data.