The observed rate of cesarean section in west African women is 1-3%, conclude authors of a systematic review in this week’s of The Lancet.
Caesarean sections are considered to be necessary in about 5-15% of women in more-developed countries. In sub-Saharan Africa the rate of caesarean section operations is thought to be about 1%, mainly due to lack of facilities. Death rates in mothers and in babies are high.
To find out the need for caesarean section operations for maternal reasons in sub-Saharan Africa, Alexandre Dumont and colleagues from Dakar, Senegal, analysed 11 studies of caesarean section operations in this part of Africa done between 1970 and 2000. About 75% of women had a caesarean section for maternal reasons. The six main reasons were prolonged labour, placental abruption, previous caesarean section, eclampsia, placenta praevia, and malpresentaion. They estimated that their results combined with those of other published work suggest a rate of caesarean section of 3-6% in women from west Africa.
The authors state that, "Future studies should compare caesarean section rates…and assess the effect of obstetric guidelines on caesarean section rates. This information can be used for improvement of caesarean sections by hospitals in less-developed countries".
In an accompanying Commentary (page 1289), Friday Okonofua from the University of benin, Nigeria, states that "Alexandre Dumont and his colleagues have now quantified the level of caesarian sections necessary for dealing with obstetric complications in west Africa…Their findings support the notion that poor access to emergency obstetrics is a huge problem.."
Contact : Dr Alexandre Dumont, Service National de la santé de la reproduction, Ministere de la Sante, BP 11 574, Senegal. E) adumont@sentoo.sn
Dr Friday Okonofua, Department of Obstetrics and Gynecology, College of Medical Sciences, University of Benin, Benin City. E) wharc@hyperia.com
The Lancet