Background Caesarean section (CS) rates have risen significantly worldwide, including Tanzania, reflecting improved but uneven access to this life-saving intervention. These increasing rates in Sub-Saharan Africa call for studies to examine trends with the presence of increased maternal morbidity and mortality. We aimed to investigate the trends and determinants of CS among reproductive-age women using Tanzania Demographic and Health Survey (TDHS) data.
Methods An analytical cross-sectional study using pooled data from multiple TDHS spanning from 2004/05 to 2022 was conducted. The study included 24,213 women of reproductive age, selected through a two-stage sampling method. Multilevel logistic regression, accounting for the complex survey design, was used to identify individual and community-level determinants of CS. Analyses were conducted using Stata 18.5. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) were reported, and statistical significance was set at p < 0.05.
Results The overall prevalence of CS was 6.8% (95% CI: 6.3-7.3), showing a significant increasing trend from 4.0% in 2004/05 to 10.7% in 2022 (p<0.001). At the individual level, older age, primary and secondary education, attending more than four antenatal care (ANC) visits, and belonging to higher wealth quintiles were associated with a higher likelihood of CS delivery. Conversely, ever being married or cohabiting was associated with lower odds of CS delivery. At the community level, women in poor communities had a lower likelihood of CS delivery, while geographical zones also showed significant variations in CS delivery likelihood.
Conclusion The rising trend of CS in Tanzania, coupled with the identified individual and community-level determinants, underscores the importance of addressing disparities in access and utilization. Policies and interventions should focus on ensuring equitable access to CS based on need, considering both individual vulnerabilities and community contexts across different geographical zones.
Competing Interest StatementThe authors have declared no competing interest.
Funding StatementNo funding
Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The study is based on the publicly available 2004/05-2022 TDHS datasets, which are accessible online and have been de-identified. The initial survey was approved by the National Institute of Medical Research Ethics Committee in Tanzania and the ICF Macro Ethics Committee in Calverton, New York. We obtained permission to use the DHS data from MEASURE Tanzania Demographic and Health Surveys after submitting a request outlining our data analysis plan. We downloaded the dataset from the DHS Program’s website upon receiving approval. Informed consent was obtained from participants before the interviews. All methods were conducted following the relevant guidelines and regulations. The consent for publication was not applicable.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data AvailabilityThe raw data supporting the conclusions of this article will be made available by the authors without undue reservation. The complete dataset is available at https://dhsprogram.com.
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