Trend And Associated Factors Of Cesarean Section Rate In Ethiopia: Evidence From 2000-2019 Demographic And Health Survey

Abstract Background: The world health organization (WHO) considers cesarean section (CS) prevalence of less than 5% suggests an unmet need. On the other hand, a prevalence of more than 15% may pose to risk to mother-and-child; however, Ethiopia was much lower than the aforementioned level. Therefore, this study aimed to determine the trend of CS, and factors that influence itMethods: Secondary analysis of the 2000-2019 Ethiopia demographic and health survey (EDHS) was used. The trend over 1995-2019 was assessed for the rural and urban areas using the Extended Mantel-Haenszel chi-square test; whereas, factors for CS were identified based on DHS 2016 data. A multi-level logistic regression analysis technique was used to identify the factors associated with CS. The analysis was adjusted for the different individual- and community-level factors affecting cesarean section delivery. Data analysis was conducted using STATA 14.1 software.Result: CS rate increased significantly from 5.1 % in 1995 to 16 % 2019 in urban area and 0.001 in 1995 to 3 % 2019 in rural area. The overall increment of CS rate was 0.7 % in 1995 to 6% in 2019. The odds of CS rate was higher among women of age 25-34 years (AOR=2.79; 95% CI: 1.92, 4.07) and women of age 34-49 years (AOR=5.23;95% CI: 2.85,9.59), women of secondary education (AOR=2.01; 95 % CI: 1.17, 3.56) and higher education (AOR=4.12; 95% CI: 2.33-7.29), multiple pregnancies (AOR=11.12; 95% CI: 5.37, 23. ), obese women (AOR=1.73; 95% CI: 1.22, 2.45), urban residence (AOR=2.28; /95% CI: 1.35-3.88), and women of antenatal care visit (ANC) >4 (AOR=3.34; 95% CI: 1.12, 4.58). Whereas, the odds of cesarean section lower among parity of 2-4 children (AOR=0.54; 95% CI: 0 .37, 0.80). Conclusion: In Ethiopia, the CS rate is below the level recommended by WHO, especially in rural residence, thus, intervention efforts need to be prioritized for women living in a rural area, empowering women's education, encouraging co-services such as ANC usage.