Caesarean Sections in Sierra Leone explored: a literature review from the last 20 years

AIM: The aim of this study is to describe the main trends and use of caesarean section (CS) over the last 20 years in Sierra Leone. Further exploration of CS rates, indications for CS, patient outcomes, the effect of the Ebola outbreak on CS and task sharing and its effect on CS are main focus areas in this study. METHODS: The design of the study is a semi-systematic literature review. The main literature for the thesis was identified by conducting a systematic search in PubMed, MEDLINE, SCOPUS and Google Scholar. Additional Demographic and Health Survey (DHS) reports and Maternal Death Surveillance and Response (MDSR) reports were included alongside the database search results. The literature retrieval resulted in 51 works of literature which were read by both authors, and sorted by main focus areas as well as sub themes. A selection of key articles for the results were based on relevancy for each focus area. RESULTS: The key findings of the selected articles were summarized in the results. The result section includes an overview on the findings of the literature for each focus area (CS rates, patient outcomes, indications for CS, Ebola and its effect on CS and task sharing and its effect on CS). 13 articles were used for the CS rate results, seven articles and six reports were used for the patient outcome results, three articles were used for the indications for CS results, three articles were used for the task sharing results and five were used for the Ebola section of results. CONCLUSION: Findings in literature suggest there has been a development in maternal health care services in Sierra Leone over the last 20 years, resulting in increased CS rates and decreased maternal and perinatal mortality and morbidity. However, CS access is still below the recommendations, and increased investment, research and governmental commitment to improve obstetric care is needed in Sierra Leon

Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration.

To investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.Individual-level, cross-sectional analyses of a national database.All hospital births occurring in the country in 2015.2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country’s births.CS rates and gestational age distribution (<37, 37-38, 39-41 and 42 or more weeks' gestation). Outcomes were analysed according to maternal education, measured in years of schooling and municipal CS rates. Analyses were also adjusted for maternal age, marital status and parity.Prevalence of CS was 55.5%, preterm prevalence (<37 weeks' gestation) was 10.1% and early-term births (37-38 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with 12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174-1.257) and 1.643 (1.616-1.671) higher in municipalities with≥80% CS compared with those <30%.Brazil faces three inter-related epidemics: a CS epidemic; an epidemic of early-term births, associated with the high CS rates; and an epidemic of preterm birth, also associated with CS but mostly linked to poverty-related risk factors. The high rates of preterm and early-term births produce an excess of newborns at higher risk of short-term morbidity and mortality, as well as long-term developmental problems. Compared with high-income countries, there is an annual excess of 354 000 preterm and early-term births in Brazil.