Socio-demographic characteristics
Table
1 presents the socio-demographic characteristics of 4948 study participants. The mean age of the study participants was 28 years (SD = 7.06).
Table 1
Socio-Demographic Characteristics of the study participants
< 20 | 552 | 11.16 |
20–24 | 1151 | 23.26 |
25–29 | 1288 | 26.03 |
30–34 | 1061 | 21.44 |
34 + | 896 | 18.11 |
Mean = 28.01 (SD = 7.06) |
Occupation |
Unemployed | 1125 | 22.74 |
Farmer | 855 | 17.28 |
Artisan | 608 | 12.29 |
Trader | 1508 | 30.48 |
Civil Servant | 84 | 1.7 |
Student | 669 | 13.52 |
Others | 99 | 2 |
Level of education |
No Education | 1333 | 26.94 |
Primary | 1502 | 30.36 |
JHS /Middle school | 1691 | 34.18 |
SHS and above | 422 | 8.53 |
Marital status |
Single | 1325 | 27.2 |
Married | 1010 | 20.73 |
Separated/Divorced | 99 | 2.03 |
Cohabiting | 2437 | 50.03 |
Parity |
Parity 1 | 1315 | 26.58 |
Parity 2 | 1183 | 23.91 |
Parity 3 | 940 | 19 |
Parity 3+ | 1510 | 30.52 |
Timing of ANC visit |
First trimester | 2732 | 55.21 |
Second trimester | 1980 | 40.02 |
Third trimester | 236 | 4.77 |
Type of delivery |
Normal delivery | 4621 | 93.41 |
C-Section delivery | 326 | 6.59 |
Child weight at birth |
Low birth weight | 232 | 4.69 |
Normal birth weight | 2760 | 55.78 |
Not Weighed | 1956 | 39.53 |
Delivery place |
Health Facility | 3359 | 67.98 |
Outside Health Facility | 1582 | 32.02 |
Child gender |
Female | 2332 | 47.13 |
Male | 2616 | 52.87 |
Household heads education |
No education/Primary | 2614 | 52.83 |
JHS and above | 2334 | 47.17 |
Household heads gender |
Female | 1893 | 38.26 |
Male | 3055 | 61.74 |
District of residence |
Shai-Osudoku | 2165 | 43.76 |
Ningo-Prampram | 2783 | 56.24 |
While teenagers (< 20 years) contributed the least proportion of the study participants (11.16%), the 25–29 age group formed the highest proportion (26.03%) followed by the 20–24 and the 30–34 years’ groups which accounted for 23.26 and 21.44% respectively.
While 30.48% of the study participants were petty traders, 22.74 and 17.28% were unemployed and farmers respectively. Students formed 13.52% of the study participants. Mothers with Junior high school and primary school level contributed 34.18 and 30.36% respectively.
Participants without formal education accounted for 26.94% of the study’s participants. A large proportion of the study participants had their marital status as cohabiting (50.03%) while those married, single, and separated /widowed were 20.73, 27.20, and 2.03% respectively.
Participants with parity 3 or more formed 30.52% of participants while those with parity 1 and 2 were 26.56, and 23.91% respectively.
More than half (55.21%) of the study respondents started ANC visit in the first trimester of gestation. Respondents who initiated ANC attendance in the second and third trimesters formed 40.02 and 4.77% of the sample respectively.
The overall C-section delivery rate for the study period was 6.59%. The C-section rate for Shai-Osudoku District was 7.81% and that of Ningo-Prampram was 5.64%%.
The result of this study shows that 55.78% of the babies were of normal weight. Majority (67.98%) of the study participants delivered in a health facility.
Greater proportion of the babies born (52.87%) were males. More than half (52.83%) of the household heads have no education or primary level of education. As much as 56.24% of the participants were from the Ningo-Prampram district while 43.76% were from Shai-Osudoku district.
Crude and adjusted odds ratio of determinants of C-section delivery
Table
2 presents the crude and adjusted Odds Ratio (OR) at 95% Confidence Interval (CI) of socioeconomic and demographic factors associated with C-section delivery in Dodowa Health and Demographic Surveillance site.
Table 2
Crude and adjusted odd ratios of determinates of C-section delivery
Age group |
< 20 | 1.00 | | 1.00 | |
20–24 | 1.06 (0.66–1.70) | 0.825 | 1.05 (0.64–1.74) | 0.839 |
25–29 | 1.43 (0.91–2.24) | 0.121 | 1.42 (0.83–2.43) | 0.202 |
30–34 | 1.81 (1.15–2.84)a | 0.010 | 2.16 (1.20–3.90)a | 0.010 |
34 + | 1.74 (1.10–2.77)a | 0.019 | 3.73 (1.45–5.17)a | 0.002 |
Level of Education |
No Education | 1.00 | | 1.00 | |
Primary | 1.75 (1.18–2.59)a | 0.006 | 1.65 (1.08–2.51)a | 0.019 |
Junior High school | 2.79 (1.93–4.01)a | < 0.001 | 1.79 (1.19–2.70)a | 0.005 |
Senior High School and above | 7.88 (5.28–11.76)a | < 0.001 | 3.53 (2.17–5.73)a | < 0.001 |
Occupation |
Unemployed | 1.00 | | 1.00 | |
Farmer | 1.08 (0.72–1.62) | 0.706 | 1.01 (0.71–1.71) | 0.678 |
Artisan | 2.37 (1.63–3.44)a | < 0.001 | 1.48 (0.99–2.20) | 0.055 |
Trader | 1.28 (0.91–1.80) | 0.159 | 1.36 (0.95–1.95) | 0.095 |
Civil Servant | 3.56 (1.86–6.83)a | < 0.001 | 0.78 (0.38–1.59) | 0.496 |
Student | 1.34 (0.89–2.02) | 0.159 | 1.26 (0.77–2.05) | 0.363 |
Others | 2.43 (1.23–4.81)a | 0.011 | 2.31 (1.10–4.85)a | 0.026 |
Marital Status |
Single | 1.00 | | 1.00 | |
Married | 1.64 (1.21–2.22)a | 0.001 | 1.26 (0.851–1.85) | 0.247 |
Separated/Divorced | 0.96 (0.41–2.27) | 0.932 | 1.00 (0.37–2.27) | 0.856 |
Cohabiting | 0.84 (0.63–1.11) | 0.224 | 0.94 (0.66–1.32) | 0.705 |
Parity |
Parity 1 | 1.00 | | 1.00 | |
Parity 2 | 0.74 (0.55–0.99)a | 0.045 | 0.60 (0.43–0.83)a | 0.002 |
Parity 3 | 0.57 (0.41–0.80)a | 0.001 | 0.37 (0.25–0.56)a | < 0.001 |
Parity 3+ | 0.51 (0.37–0.68)a | < 0.001 | 0.35 (0.23–0.54)a | < 0.001 |
Timing of ANC visit |
First trimester | 1.00 | | 1.00 | |
Second trimester | 0.67 (0.52–0.85)a | < 0.001 | 0.81 (0.63–1.05) | 0.106 |
Third trimester | 0.15 (0.05–0.47)a | < 0.001 | 0.24 (0.07–0.76)a | 0.015 |
Socio Economic Status |
Poorest | 1.00 | | 1.00 | |
Poorer | 1.12 (0.71–1.77) | 0.627 | 1.36 (0.85–2.18) | 0.205 |
Middle | 1.44 (0.93–2.23) | 0.099 | 1.52 (0.97–2.37) | 0.069 |
Richer | 2.15 (1.43–3.23)a | < 0.001 | 1.83 (1.20–2.80)a | 0.005 |
Richest | 3.84 (2.62–5.63)a | < 0.001 | 2.14 (1.43–3.20)a | < 0.001 |
District of residence |
Shai-Osudoku | 1.00 | | 1.00 | |
Ningo-Prampram | 0.71 (0.56–0.88)a | 0.002 | 0.76 (0.59–0.96)a | 0.024 |
Household heads education |
No education/Primary | 1.00 | | 1.00 | |
Junior High School and above | 2.65 (2.08–3.38)a | < 0.001 | 1.45 (1.09–1.93)a | 0.010 |
Household heads gender |
Female | 1.00 | | 1.00 | |
Male | 1.29 (1.01–1.64) | 0.038 | | |
Child weight at birth |
Low birth weight | 1.00 | | | |
Normal birth weight | 0.80 (0.48–1.34) | 0.404 | | |
Child Gender |
Female | 1.00 | | | |
Male | 1.12 (0.89–1.41) | 0.32 | | |
In the crude model, there was a statistically significant association between maternal age and C-section delivery.
The odds of having C-section delivery by women aged 20–24 and 25–29 years is 6 and 43% respectively more likely compared to those aged < 20 years (OR: 1.06, 95% CI: 0.66–1.70, OR: 1.43, 95% CI: 0.91–2.24). Women aged 30–34 and 34+ years were 81 and 74% respectively more likely to have C-section delivery compared to those aged < 20 years (OR; 1.80, 95% CI: 1.15–2.84, OR:1.74, 95% CI: 1.10–2.77). This is statistically significant.
A similar relationship is observed after adjusting other explanatory variables such that, the odds of having C-section went up with increasing maternal age. Women aged 30–34 and 34+ years were more than twice and thrice more likely respectively to have C-section compared to those aged < 20 years (OR:2.16, 95% CI: 1.20–3.90, OR: 3.73, 95% CI: 1.45–5.17). This was statistically significant.
The results further revealed that, the odds of women having C-section delivery went up with increasing level of education in both the crude and adjusted models. In the crude model, odds of women with primary level of formal education having C-section delivery was 75% higher compared to those with no education (OR:1.75, 95% CI: 1.18–2.59). The odds of women with Junior High School (JHS) level of education having C-section delivery as compared to those with no education is almost three times more likely (OR: 2.79, 95% CI: 1.93–4.01). Again, the odds of participants with Senior High level of schooling having C-section delivery was eight times more likely compared to those with no formal education (OR: 7.88, 95% CI: 5.28–11.76).
Holding other variables constant, the odds of having C-section was 65 and 79% higher for participants with Primary and JHS level of schooling respectively compared to those with no education (OR: 1.65, 95%CI: 1.08–2.51, OR:1.79, 95% CI: 1.19–2.70).
In the crude logistics regression model, maternal occupation was statistically significantly associated with C-section. Women who are artisans were more than twice more likely to have C-section compared to those unemployed (OR: 2.37, 95% CI: 1.63–3.44). This was also statistically significant. Women who were civil servants and women who were engaged in other forms of occupation were more than three and two times more likely to undergo C-sections compared with those who were unemployed (OR: 3.56, 95% CI: 1.86–6.83, OR:2.43, 95% CI:1.23–4.81). This is also statistically significant.
Women who were married were 64% more likely to have C-section delivery (OR: 1.64, 95% CI: 1.21–2.22) compared to those who are single. This again was statistically significant. For participants with marital status as separated/divorced and cohabiting, the odds of having a C-section reduced to 96 and 84% respectively compared to those who were single (OR: 0.96, 95% CI: 0.41–2.27, OR:0.84, 95% CI: 0.63–1.11). In the adjusted model, participants who were married had increased odds of 26% of having C-section delivery compared to those who were single (OR: 1.26, 95% CI: 0.85–1.85).
In the crude model, study participants who started ANC visit in the second and third trimesters were 67 and 15% respectively less likely to have a C-section compared with those who started their ANC visit in the first trimester (OR: 0.67, 95% CI: 0.52–0.85, OR: 0.15, 95% CI: 0.05–0.68). After adjusting other explanatory variables, women who started ANC visit in the third trimester were 24% less likely to have C-section compared to those who initiated their ANC visit in the first trimester of pregnancy. This was statistically significant (OR: 0.24, 95% CI: 0.07–0.76).
The odds of having C-section delivery reduced significantly with increasing parity. There was reduced odds of 74, 57 and 51% of women with parities 2, 3 and 3+ respectively having C-section delivery compared to those with parity 1 (OR: 0.74, 95% CI: 0.55–0.99, OR: 0.57, 95% CI: 0.41–0.80, OR:0.51, 95% CI: 0.37–0.68). In the adjusted model, a similar relationship was observed such that the odds of having C-section delivery reduced with increasing parity. Thus, there was reduced odds of 60, 37, and 35% for women with parities 2, 3 and 3+ respectively compared with those with parity 1(OR:0.60, 95% CI: 0.43–0.83, OR: 0.37, 95% CI: 0.25–0.56, OR:0.35, 95% CI: 0.25–0.54).
The odds of having C-section went up with increasing socioeconomic status. In the crude analysis, participants with middle wealth quintile were 44% more likely to have C-section (OR: 1.44, 95%CI:0.93–2.23) compared to those in the poorest group. Participants who belong to the richer and richest quintiles were more than two times and three times more likely to have C-section delivery compared to those who belong to the poorest group (OR: 2.15, 95% CI: 1.43–3.23, OR: 3.84, 955 CI: 2.62–5.63). Participants’ socioeconomic status continued to be increasingly significantly associated with C-section delivery after adjusting other confounding variables in the adjusted model. There were increased odds of 36, 52, 83% for women who belong to poorer, middle, and richer wealth quintiles respectively (OR: 1.36, 95% CI: 0.85–2.18, OR: 1.52, 95% CI: 0.97–2.37, OR: 1.83, 95% CI: 1.20–2.80). Participants who belong to the richest wealth quintile were more than two times more likely to have C-section delivery compared to those who were in the poorest category (OR: 2.14, 95% CI: 1.43–3.20).
The district where participant resides was significantly associated with C-section delivery such that, there was reduced odds of 71 and 76% in the crude and adjusted models respectively for women from Ningo-Prampram district compared to those from Shai-Osudoku district (OR:0.71, 95% CI: 0.56–0.88, OR:0.76, 95% CI: 0.59.0.96).
While there were increased odds of participants giving birth to male babies having C-section delivery (OR: 1.12, 95%CI: 0.89–1.41) compared to those with female babies, there was reduced odds of 80% of having C-section for participants who gave birth to normal weight babies in the crude model (OR: 0.80, 95% CI: 0.48–1.34) compared to those with low birth weight.
There was a statistically significant association between the level of education of household head and C-section such that participants whose household heads have JHS or more education were more than two times more likely to have C-section in the crude model (OR: 2.65, 95% CI: 2.08–3.38) compared to those whose heads had primary/no formal education. In the adjusted model, women whose household heads had JHS and above level of formal education were 45% more likely to have C-section delivery compared to those with primary / no formal education (OR: 1.45, 95% CI: 1.09–1.93).