Article Text
Abstract
Introduction Sierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.
Methods We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality.
Results In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed.
Conclusions The caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.
- maternal health
- obstetrics
- surgery
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Footnotes
Handling editor Sanni Yaya
Presented at Preliminary findings of this research were presented at the 9th Annual Sierra Leone Health and Biomedical Research Group (HBIOMED) conference in Freetown, Sierra Leone, on 17–19 October 2018.
Contributors HH and LH conceived the study and developed the study design together with MMK, HAB, AvD, FF, BH and HL. HH and HL sought ethical approval and oversaw data collection. BH, FF, SC and SS facilitated access to the MDSR database. HL led the collection of facility data and MMK led the logbook review for patients who died with caesarean section. HH wrote the first draft of the manuscript and analysis, and developed the final manuscript with significant input from all coauthors, in particular AvD, MMK, FF, JL, HL, SRH and LH. All authors read and approved the final version.
Funding This study was funded by Lund University and Norwegian University of Science and Technology.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Sierra Leone Ethics and Scientific Review Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.