Comparative Study on Caesarian and Normal Vaginal Delivery, Rajshahi Division, Bangladesh

doi:10.21203/rs.3.rs-4904725/v1

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Comparative Study on Caesarian and Normal Vaginal Delivery, Rajshahi Division, Bangladesh

https://doi.org/10.21203/rs.3.rs-4904725/v1

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Background: One of the most important public health concerns is the marked rise in the number of caesarean sections (CS). The World Health Organization advises against CS rates that are more than 10% and lower than 5% since both of these ranges have the potential to negatively impact the health of expectant mothers and newborns.

Objective: The study aimed to investigate influencing factors for selective CS among pregnant mothers and to determine the association for selective CSamong mothers with selected socio-economic characteristics in Rajshahi Division, Bangladesh.

Methodology: It was a cross-sectional study was conducted. In this study, data were collected July 2024. A semi structured questionnaire was used for collecting data, a total number of 393 delivery mothers were participated in Rajshahi Division, Bangladesh. A descriptive analysis, the chi-square test, and binary logistic regression model were utilized in the present study.

Results: The prevalence of lower educated mothers with normal vigilant delivery (NVD) and CS delivery was 59% and 41%, respectively, and Naogaon district mothers delivered their child by cesarian section compared to other districts in Bangladesh. The women ≥30 years old (AOR = 74.934; 95% CI: 12.831-437.613) were more likely to have preferred CS delivery compared to younger women, and these factors were statistically significant (p<0.01). The educated subjects (AOR = 83.469; 95% CI: 2.554–2727.394) were more likely to have preferred CS delivery compared to their lower educated counterparts, and these factors were statistically significant (p<0.05).

Conclusions: The study revealed that a large number of women preferred CS deliveryespecially higher educated women were mostly. The main reasons for choosing CS were to take advantage of certain socioeconomic and demographic variables, ensure the safety of both mothers and their infants. This study strongly recommended health education. sessions, especially in electronic and print media, about the disadvantages of CS delivery.

Health sciences/Health care

Health sciences/Risk factors

Delivery Influencing factors

Chi-square test

Binary logistic regression

Despite the fact that caesarean sections (CS) are a necessary medical procedure to lower the risks of childbirth, a rising trend in CS deliveries has only served to increase concerns across the globe. A life-saving method of delivery to lower mother and neonatal mortality is CS delivery. Nevertheless, in the same sentence, Without indications CS delivery poses a risk to the health of both mother and child [1, 2]. Inspite of proper indication undue delay the CS delivery can lead to neonatal hypoxia, stillbirth, uterine rupture, or obstetric fistula, a sign of unusually lengthy and difficult labor [3]. The World Health Organization (WHO) states that CS must be carried out for the mother when it is medically necessary, without aiming for any certain rate [4]. The distribution of CS does, however, have some short- and long-term dangers, particularly in nations with inadequate healthcare infrastructure. According to studies [5, 6], there is no correlation between CS delivery rates surpassing 10% in a population and lower rates of maternal and newborn mortality. Instead, as the number of CS deliveries increases, preterm birth rates and infant mortality rates also increase [7, 8]. It has recently become apparent in Bangladesh that some mothers had complications-free CS deliveries [9]. Numerous studies conducted in Bangladesh have identified a number of socioeconomic and demographic factors linked to CS delivery, including mothers' education, place of residence, wealth index, mothers' age, age at marriage, age at first birth, parity, birth order, antenatal visit, husband's occupation, and delivery in the private sector, religion, geographical region [10, 11]. Additionally, multiple socio-economic, demographic, physical infrastructure, and community-related linked aspects were found to be strongly related to decisions to undergo institutional delivery in other research that are available in the literature for several countries [12, 13]. Now the question is: When is CS delivery acceptable? When the adoption of CS delivery is appropriate, there are a few well identified maternal indicators [17]. Robson's classification scheme is another useful method for lowering the delivery rate by CS [18–20]. WHO claims that Robson's categorization is the most suitable system for classifying CS to satisfy both global and regional demands [14–17]. The third sustainable development goal (SDG) aspires to lower global maternal death to less than 70 per 100,000 live births and to lower neonatal mortality to below 12 per 1000 live births and under-5 mortality to below 25 per 1000 live births [18]. It is difficult to accomplish the newborn mortality, under-5 mortality, and maternal death rates in Bangladesh, which were 23 per 1000 live births, 38 per 1000 live births, and 173 per 100000 live births, respectively, in 2017 [19, 20]. Therefore, the rising trend in CS delivery may make it difficult to accomplish these objectives. The aim of this study is to determine the prevalence of CS delivery based on different background characteristics and find the potential socioeconomic, demographic, institutional, and social-network-related factors associated with the high rate of CS delivery so that decision-makers can take proper steps regarding this issue.

The study aimed to investigate influencing factors for selective CS among pregnant mothers and to determine the association for selective CS among mothers with selected socio-economic variables in Rajshahi Division, Bangladesh.

Design and study population

It was a cross-sectional study was conducted in the Rajshahi Division, Bangladesh. There are many reasons why we select the mothers having at least one child aged 6–12 months from different Medical Collage and Sadar, Hospital such as Bogura, Shahid Ziaur Rahman Medical Collage and Hospital, Chapa Nawabganj Sadar Hospital, Natore Sadar Hospital, Naogaon Medical College Hospital and Rajshahi Medical Collage Hospital in Rajshahi Division. This area four district one is Rajshahi is the divisional head quarter and other at the nearest of Rajshahi divisional [22]. Most of the subjects were living at the different catchment area of Medical Collage and Hospital in Bogura, Chapa Nawabganj, Natore, Naogaon and Rajshahi division, Bangladesh.

Sample size determination

The following mathematical formula was used to determine the sample size for this study:

wheren = required sample size, N= household size (in here 4,53,754), d= marginal error (we considered, d= 0.05), 95% confidence level (CI) had been considered [21]. The formula provided that the significant sample size was 400 for this study. Finally, this study was collected 393 sample from the field, 17 respondents were disagreeing to provide their information.

Before sampling, 6–12-month children lists were got from the Charghat, Baghmara and Tanore upazila health complex, Rajshahi, Nachole Gomostapur upazila health complex, Chapainawabganj, Lalpur ans Singra. upazila health complex, Nature and Porsha and Sapahar, upazila Health Complex, Naogaon that list used for expanded programme on immunization. A multi-stage random sampling approach was adapted to choose the mothers having at least one child age 6–12 months from Rajshahi Division.

In the first stage, out of nine upazila of Rajshahi, five upazila of Chapa Nawabganj, seven of Natore and eleven upazila of Naogaon district, randomly selected three upazila from Rajshahi district, two from Chapa Nawabganj, two from Nature and Two from Naogaon District name Charghat, Baghmara and Tanore, Rajshahi, Nachole Gomostapur Chapainawabganj, Lalpur ans Singra. Nature and Porsha and Sapahar, Naogaon district. In the second stage, random sampling technique was used to select sample size. There were in four districts have 32 UHCs in Rajshahi, Chapainawabganj, Natore and Naogoan district. In four district, UHCs catchment area,4,53,754 mothers were living who were taken different types of general, maternal, child health, family planning and expended program on immunization (EPI) services from UHCs. In the two district, 400 mothers were selected out of 4,53,754 mothers who having at least one child age 6–12 months and finally 384 samples were successfully interviewed [22].

Data collection

In this study, data were collected July 2024. (i) socio-demographic characteristics and (ii) What type of delivery you done using a semi-structured questionnaire. The questionnaire was reviewed by three specialists and assistants, and initially a mini survey to validate the questionnaire. The questionnaire also modified based on mini survey results of the pre-test exercise to make it easier to realize and for response. Ten fully trained and experienced enumerators conducted the interview.

Outcomes variables

The dependent variable in this study is the mode of delivery subjects done, which was measured through one question, namely: i) What type of delivery is done?

Independent variables

In this study, considered some socio-economic and demographic factors were included as independent variables. Respondents age classified into three groups: a group ≤22 years, 22-30, and other age groups ≥31years. Subjects’ education was classified based on the formal learning system in Bangladesh: primary, secondary and higher, graduate and above. Subjects husband education was classified based on the formal learning system in Bangladesh: primary, secondary and higher , graduate and above. Respondents husband occupation categories as farmer, labour, service and Business. As per the living status categories as Urban, Rural, Slum and Char. Religiously subjects of delivery was divided into two group Muslim and Non-Muslim. Subjects body mass index categories as underweight, Normal, over weight and obese. Respondents’ monthly income was categorized as ≤15, 000, 15,001-25,000 and ≥25,001 Bangladeshi taka (BDT) currency.

Statistical analyses

Descriptive analyses were conducted to determine the socio-economic and demographic profile of the subjects. Chi-square test and binary logistic regression model was utilized through significance for all analyses was set at p<0,005. Statistical Package for Social Sciences (SPSS) version 25 IBM was used for analyzing the data.

Ethics approval

This study received ethical approval from Islamia Bank Medical College, Rajshahi, Bangladesh. Before data collection for this study, we received written informed consent from all the subjects. This study was conducted in full compliance with the ethical principles outlined in the Declaration of Helsinki, as well as the relevant national guidelines for human subject’s research. We ensured that all procedures adhered to these standards to protect the rights, safety, and well-being of the participants involved.

The prevalence of lower educated mothers with normal vaginal delivery (NVD) and CS delivery was 59% and 41%, the prevalence of caesarian delivery was 24.2%, 25.5%, 28.0%, and 22.4% in Rajshahi, Chapai Nawabganj, Nagaon, and Natore, respectively, So, Naogaon district mothers delivered their child by cesarian section compared to other districts in Bangladesh (Fig. 1,2).

In this study, we assessed the delivery in Rajshahi division, Bangladesh. Table 1 shows the socio-economic and demographic profile of women. Out of the total sample population of 393 women, more than 44.9% were less than 22 years of age. By education, 49.6% were primary, and 63.4% of subjects in husband education were secondary or higher. Out of the subjects, 50.6% were living in urban areas, and 82.4% were from Muslim communities. More than 66% of subjects BMI levels were normal, and 47.1% of subject’s monthly family income was 15001 to 25000 in BDT.

In Table 1 the association between caesarean section and subjects older age in years were associated and its these factors were statistically significant (p < 0.01). The graduate and above educated women were preferred caesarean delivery and these factors were statistically significant (p < 0.01). In this studyfound a unique finding lower educated people wives were preferred caesarean delivery and these factors were statistically significant (p < 0.01). A large number of service holder people wives were preferred caesarean delivery and these factors were statistically significant (p < 0.01). A huge number of the non Muslim women were preferred caesarean delivery and these factors were statistically significant (p < 0.01). Most of the lower income family women were preferred caesarean delivery and these factors were statistically significant (p < 0.01).

Table 1

Association between type of delivery and selected socio economic and demographic factors
Variables	Group	N, 393(100)	Type of delivery		p-value
Variables	Group	N, 393(100)	Normal 232(59)	C- section 161(41)	p-value
Age in years					0.001
	≤ 22	192(48.9)	141(73.4)	51(26.6)
	23–30	99(25.1)	89(89.9)	10(10.1)
	≥ 31	102(26.0)	02(2.0)	100(98.0)
Subjects’ education					0.001
	Primary	195(49.6)	95(48.7)	100(51.3)
	Secondary& higher	173(44.0)	121(69.9)	52(30.1)
	Graduate and above	25(6.4)	16(64.0)	09(36.0)
Husband education					0.001
	Primary	81(20.6)	02(2.5)	79(97.5)
	Secondary& higher	249(63.4)	214(85.9)	35(14.1)
	Graduate and above	63(16.1)	16(25.4)	47(74.6)
Husband Occupation					0.001
	Farmer	242(61.6)	112(46.3)	130(53.7)
	Service	13(3.3)	04(30.8)	09(69.2)
	Business	102(26.0)	96(94.1)	06(5.9)
	Labour	36(9.2)	20(55.6)	16(44.4)
Present residence					0.762
	Rural	194(49.4)	116(59.8)	78(40.2)
	Urban	199(50.6)	116(58.3)	83(41.7)
Religion					0.001
	Non Muslim	69(17.6)	28(40.6)	41(59.4)
	Islam	324(82.4)	204(63.0)	120(37.0)
BMI					0.073
	Under weight	32(8.1)	25(78.1)	07(21.9)
	Normal	262(66.7)	145(55.3)	117(44.7)
	Over weight	56(14.2)	36(64.3)	20(35.7)
	Obsess	43(10.9)	26(60.5)	17(39.5)
Monthly Husbands income in BDT					0.001
	≤ 15000	136(34.6)	61(44.9)	75(55.1)
	15001–25000	185(47.1)	131(70.8)	54(29.2)
	≥ 25001	72(18.3)	40(55.6)	32(44.4)

In Table2 found that, the women ≥ 30 years old (AOR = 74.934; 95% CI: 12.831-437.613) were more likely to have preferred CS delivery compared to younger women, and these factors were statistically significant (p < 0.01). The educated subjects (AOR = 83.469; 95% CI: 2.554–2727.394) were more likely to have preferred CS delivery compared to their lower educated counterparts, and these factors were statistically significant (p < 0.05). The husband educated subjects (AOR = 83.469; 95% CI: 2.554–2727.394) were less likely to have preferred CS delivery compared to their lower educated counterparts, and these factors were statistically significant (p < 0.05).

Table 2

Effects on type of delivery and selected socio economic and demographic factors
Variables	B	S.E.	p-value	AOR	95% C.I. for AOR
Variables	B	S.E.	p-value	AOR	Lower	Upper
Age in years
23–30 VS ≤ 22	-3.572	1.121	0.001	0.028	0.003	0.253
≥ 31 VS ≤ 22	4.317	0.900	0.001	74.934	12.831	437.613
Subjects Education
Secondary&higherVS Primary	0.375	1.328	0.778	1.454	0.108	19.647
Graduate and above& above VS Primary	4.424	1.779	0.013	83.469	2.554	2727.394
Husband education
Secondary& higher VS Primary	-1.620	0.760	0.033	0.198	0.045	0.878
Higher secondary & above VS Primary	-0.351	0.785	0.655	0.704	0.151	3.277
Husband Occupation
Service VS Farmer	-0.538	1.054	0.610	0.584	0.074	4.612
Business VS Farmer	-2.113	1.205	0.080	0.121	0.011	1.283
Labour VS Farmer	0.539	0.712	0.449	1.715	0.425	6.921
Religion
Muslim VS Non-Muslim	-0.196	0.715	0.784	0.822	0.202	3.339
Monthly Husbands income in BDT
15001–25000 VS ≤ 15000	0.818	1.074	0.446	2.267	0.276	18.612
≥ 25001 VS ≤ 15000	.168	1.289	0.896	1.183	.095	14.784

CS is a commonly performed procedure on women, and its frequency is rising annually around the world. The socioeconomic determinants for CS delivery in Rajshahi Division, Bangladesh, were determined by the current study (23).This audit, which aimed to report on caesarean rates, reasons for them, and related clinical care practices, was conducted on nine hospitals in the four South East Asian countries that are involved in the South East Asia-Optimizing Reproductive and Child Health in Developing Countries (SEA-ORCHID) project. Overall, the nine South and South-East Asian nations have a 13% CS prevalence; however, this number jumps to 19% when institutional births are taken into account (24,25). The subjects age in years more than 32 in those who had caesarean deliveries. To further understand the connection with children of mothers of normal weight, more research is required. To understand the mechanism underlying the association—which might include very long-lasting alterations in the gut microbiome—more research is also required (26). An increased rate of elective repeat Caesarean section appears to be related to higher education. Physicians should be aware of this differential and make an effort to offer all women, regardless of their educational background, fair informed consent, regardless of whether this is the result of patient differences or medical prejudice(27).The model construct scores for awareness, attitude, perceived behavior control, subjective norms, and behavioral intention rose with using low-husband teaching approaches. However, the instructional package in conjunction with group discussion more successfully influenced the decision to go with a natural delivery method (28). In Indonesia, 17.7% of births were caesarean sectioned. It is necessary to track and assess the rising frequency of caesarean sections performed without a medical requirement or concern for the service holder (29).These variations have remained throughout time, even among women who are not at high risk of developing CS. Conclusion: Even among women who are thought to be at lesser risk of CS, there are racial and ethnic differences in CS delivery, and these gaps have not decreased over time. Whether at the national, state, hospital, or provider level, differences in risk-adjusted CS ought to be taken into account as a quality indicator for obstetric treatment(30).A comprehensive review and meta-analysis of problems related to caesarean section and maternal and perinatal mortality in low- and middle-income countries (31)

The study revealed that a large number of women preferred CS delivery especially higher educated women were mostly. The main reasons for choosing CS were to take advantage of certain socioeconomic and demographic variables, ensure the safety of both mothers and their infants. This study strongly recommended health education. sessions, especially in electronic and print media, about the disadvantages of CS delivery.

Authors contributions: MMR designed the study, collected data, conducted the data analysis, and wrote the manuscript. MAK. MN, RP, and MANS made critical revisions of the manuscript. All authors read and approved the final manuscript.

Acknowledgements: This study was graciously acknowledged by various Upazila Health Complexes, the Medical College Hospital, and the Divisional Director of Health, Ministry of Health and Family Welfare, Bangladesh.

Declaration: All the authors declare that they have no conflict of interest.

Funding: All the authors declare that they have no funds for publications.

Data availability: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. When the paper is accepted, the data will be made available.

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Comparative Study on Caesarian and Normal Vaginal Delivery, Rajshahi Division, Bangladesh

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