Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5-15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.
This was a both a community and health facility based cross-sectional study design with mixed methods (qualitative and quantitative methods). For quantitative data, we did a retrospective review of all the maternity charts of mothers that had delivered between April 2018 and March 2019. This was done at the two major health centers, Ngora health Centre IV and Ngora district Maternity Unit—the two are the only ones that provide comprehensive emergency obstetric care services (CEmOC) in the district. From these charts, we were able to review the demographics, obstetric factors, and the indications for the CS. Quantitative data collected from the charts were double-checked for completeness and later entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Tables and frequencies were used for data summarization. The study design for the qualitative part was phenomenological. We held focus group discussions (FGDs) with men and women at different times using the interview guides that were developed with the aid of the Busitema University Community Based Education and Research Services (COBERS) department that is experienced in phenomenological studies (Supplementary Materials (available here)). The research assistants were trained in guiding interviews prior to this exercise. We selected community participants with the aid of the village health team members. The participants in these FGDs were purposively selected targeting those mothers who had undergone caesarean section and men whose wives had undergone caesarean section in a period not exceeding one year prior to the study period. One year was considered not too long for a person to remember the events surrounding the event. Each FGD had 6–12 participants and lasted about 1-2 hours. We held two FDGs for men and three for women. We stopped after reaching the point of saturation. Each focus group discussion had a research assistant who also did the recording of the proceedings. The FGDs led by research assistants were held in the major local language Ateso and recorded, transcribed, and translated into English verbatim. Each transcript was analyzed by two researchers working independently to reduce bias using NVIVO software version 12. Coding was done manually based on the key words and phrases developed from the data. The codes were then grouped together into higher-order headings. Accordingly, on a higher logical level of abstractions codes, subcategories, categories, and themes were formed. The themes were categorized according to the perceptions, indications, risk factors, and advantages relating to the caesarean section. The data were sorted out thematically by clustering material with similar content. At this stage, we used creative and analytical reasoning to determine categories of the meaning.
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