Prevalence and factors associated with caesarean section among postpartum mothers at Masaka Regional Referral Hospital in Masaka city, Uganda.

Abstract

Caesarean section (CS) rates are rising globally, including in Uganda, often exceeding the 10-15% range recommended by the World Health Organization. While life-saving, non-medically indicated CS can increase maternal and neonatal risks. This study was conducted to address the gap in data regarding the prevalence and contributing factors at Masaka Regional Referral Hospital (RRH), a key healthcare facility in South-Central Uganda. The primary objectives of this study were to determine the prevalence of Caesarean section and to identify the socio-demographic, obstetric, and individual factors associated with it among postpartum mothers at Masaka RRH. Methods: An analytical cross-sectional quantitative study was conducted among 178 postpartum mothers selected through systematic sampling at Masaka RRH. Data were collected using a semi-structured questionnaire and data abstraction forms. The collected data were analyzed using SPSS version 26, employing descriptive statistics, binary and multivariate logistic regression to identify associations. Statistical significance was set at a p-value of ≤ 0.05. The prevalence of Caesarean section was found to be 43.3% (n=77). The most common obstetric indications for CS were fetal distress (19.5%), pre-eclampsia (15.6%), and obstructed labour (13.0%). Bivariate analysis revealed that a history of a previous CS (p=0.035), presence of pregnancy complications (p=0.003), and chronic illness (p=0.024) were significantly associated with undergoing a Caesarean section. In the multivariate logistic regression model, presence of pregnancy complication (p=0.008) was found to be significantly associated with CS. Furthermore, CS was associated with a higher incidence of stillbirths, postnatal maternal complications, and neonatal complications compared to vaginal delivery. The prevalence of Caesarean section at Masaka Regional Referral Hospital is alarmingly high, nearly three times the national average and the WHO recommendation, with pregnancy complications emerging as the only independent factor associated with CS. The high rate is predominantly driven by medically indicated obstetric complications. Masaka RRH should strengthen prenatal and intrapartum care particularly timely detection and management of labour complications to reduce unnecessary CS and improve maternal and neonatal outcomes.