Determinants of caesarean section rates in private-not-for-profit healthcare facilities: St. Joseph’s Hospital_ Kitovu

Figures & data

Figure 1. Out-patient Department of St. Joseph Hospital _ Kitovu

Figure 2. Conceptual Framework for Determinants of C-Section

Table 1. Proportionate Selection of Mothers

Admission = 1534	Other mothers = 612	Total SVD = 476	Total C-section = 439	Total Vacuum extraction = 7
	n1 = 318-(193) = 125Mothers	${n_2}_{\hspace{0.17em}}=\frac{476}{1534}x318=99Mothers$	$n_3=\frac{439}{1534}x318=92Mothers$	$n_4=\frac{7}{1534}x318=2Mothers$

Sample Size, n = n₁ + n₂ + n₃ + n₄ = 318 mothers

SVD = Spontaneous Vaginal Delivery, C-Section = Caesarean Section Delivery

Table 2. Study variables used

Variable sub-categories	Specific variables
Dependent (Outcome) variables	Mother’s delivery mode; Caesarean Section No C-section (Vaginal birth) Number of monthly Caesarean Section conducted Number of total deliveries conducted Number of monthly total in-patient admissions made
Independent(Explanatory) variables	Socio-demographic factors: Age Marital status Educational level Living environment (rural vs urban) Socio-economic factors: Regular Household income Occupation Pre-natal factors: Parity Gravidity Gestational age Doctor’s suggestion Counseling directed toward preferred choice Family factors: Husband’s preference Self-evaluated difficulty in getting pregnant Attitudes of health managers toward monitoring & evaluating Caesarean Section [Thoughts about CSR, Presence of M & E in the facility, Management ever involved in M & E of C-Section, Views about regularizing M & E of C-Section]

Table 3. Socio-demographic Characteristics of Respondents

S. No	Variable category	Frequency (n = 318)	Percentage
01	Caesarean Delivery Yes No	92 226	28.9% 71.1%
02	Age of respondents Less than 20 years 20–40 years More than 40 years	63 192 63	19.8% 60.4% 19.8%
03	Marital status Married Not married	261 57	82.1% 17.9%
04	Occupation of Respondents Peasant Formally employed House wife	76 82 180	23.9% 19.5% 56.6%
05	Educational level of Respondents No education Primary education Post primary education Tertiary education	74 68 73 103	23.3% 21.4% 23.0% 32.4%
06	Regular Monthly Household Income Less than UGX 100.000/ =  UGX100.000–300.000/ =  More than UGX300.000/ =	124 102 92	39.0% 32.1% 28.9%
07	Living Environment Rural Urban	162 156	50.9% 49.1%
08	Parity of mothers Para 0 Para 1 Multiparous	53 69 196	16.7% 21.7% 61.6%
09	Gravidity of mothers Prime-gravida Multigavida	68 250	21.4% 78.6%
10	Gestational Age Less than 28 weeks 28 weeks or more	30 288	9.4% 90.6%
11	Preferred Choice of Mode of Delivery Caesarean Section No C-Section	87 231	27.4% 72.6%

UGX = Uganda Shillings

Table 4. Data Used For Computation of Average CSR

Table 5. Bivariate Analysis of Caesarean Delivery versus the Independent Variables

S. No	Variable categories	Caesarean Delivery (n = 318) Yes No		X^2	df	COR	95% CI L—U	p-value
Socio-demographic Determinants
01	Age Less than 20 years 20–40 years More than 40 years	25(27.2%) 49(53.3%) 18(19.6%)	38(16.8%) 143(63.3%) 45(19.9%)	6.375 2.522 0.240	2 1 1	0.378 1.286	0.114–1.256 0.471–3.514	.041* 0.112 0.624
02	Marital status Married Not married	68(73.9%) 24(26.1%)	193(85.4%) 33(14.6%)	5.863	1	2.064	1.140–3.739	.015*
03	Educational level No education Primary education Post primary education Tertiary education	6 (6.5%) 13 (14.1%) 29 (31.5%) 44 (47.8%)	68 (30.1%) 55 (24.3%) 44 (19.5%) 59 (26.1%)	32.450 20.338 4.051 5.370	3 1 1 1	4.843 2.328 1.057	1.821– 12.878 1.100–4.926 0.565–1.976	.000* .000 .044 .020
04	Living environment Rural Urban	24 (26.1%) 68 (73.9%)	138(61.1%) 88 (38.9%)	32.004	1	2.764	1.542–4.953	.001*
Socio-economic Determinants
05	Regular House Hold income Less than UGX 100.000/ =  UGX100.000 −300.000/ =  More than UGX300.000/ =	10(10.9%) 31(33.7%) 51(55.4%)	114(50.4%) 71(31.4%) 41(18.1%)	57.796 43.042 0.156	2 1 1	11.106 2.238	5.047–24.436 1.207–4.149	.000 .000 0.011
06	Occupation Peasant Formally employed House wife	31(33.7%) 30 (32.6%) 31(33.7%)	45(19.9%) 32 (14.2%) 149(65.9%)	28.615 6.831 14.179	2 1 1	0.359 0.369	0.186–0.964 0.185–0.737	.000 .009 .000
Pre-natal Determinants
07	Parity of mothers Para 0 Para 1 Multiparous	0(0.0%) 27(29.3%) 65(70.7%)	53(23.5%) 42(18.6%) 131(58.0%)	26.774 25.890 4.459	2 1 1	2.525E 3.879	.000–0.704 1.214 −12.397	.000 .000 .035
08	Gravidity of mothers Prime-gravida Multigavida	23(25.0%) 69(75.0%)	45 (19.9%) 181(80.1%)	1.007	1	0.020	0.004–0.098	.316
09	Gestational age Less than 28 weeks 28 weeks or more	9(9.8%) 83(90.2%)	21(9.3%) 205(90.7%)	0.018	1	1.192	0.388–3.657	.892
10	Preferred Choice of Mode of Delivery Caesarean section No C-section	36(39.1%) 56(60.9%)	51(22.6%) 175(77.4%)	9.027	1	0.443	0.225–0.873	.003*
11	Reasons for preferred choice Doctor’s suggestion Counseling directed toward preferred choice	61(66.3%) 21(22.8%)	50(22.1%) 106(46.9%)	17.784 56.168	1 1	2.396 0.177	0.827–6.948 0.089–0.353	.000* .000*
Family Determinants
12	Reasons for preferred choice Husband’s preference Self-evaluated difficulty in getting pregnant	7(7.6%) 3(3.3%)	67(29.6%) 3(1.3%)	1.320 60.993	1 3	0.135	.021–0.855	.251 .000*

X² = Chi-Square, df = Degree of freedom, COR = Crude Odd Ration, CI = Confidence Interval, p-value = Probability value, L = Lower limit, U = Upper limit, UGX = Uganda Shillings

Table 6. Characteristics of respondents health managers Interviewed

Manager	Gender	Age	Marital status	Duration of service	Department
W	Male	44	Married	Less than 2 years	Administration
X	Male	40	Married	At least 2–5 years	Administration
Y	Female	47	Married	At least 2–5 years	Maternity
Z	Female	40	Married	At least 2–5 years	Operating Theatre

Table 7. Themes and Sub-themes That Emerged

01	Attitudes of managers toward monitoring & evaluating Caesarean Section Rates	Theme 1: Thoughts about CSR
		Theme 2: Presence of M & E system in the facility Sub-theme (a): M & E for some departments Sub-theme (b): No M & E for Caesarean Section
		Theme 3: Management ever involved in M & E of C-Section
		Theme 4: Views about regularizing M & E of C-Section Sub-theme (a): Negative views Sub-theme (b): Positive views