Belizán JM, et al. - Considering the lack of establishment of the specific prevalence of obstetric and medical complications that require caesarean section, especially in low-income and middle-income countries (LMICs), researchers performed a literature review providing information to inform the approach to the provision of caesarean section in low-resource settings. The site with a high caesarean section prevalence revealed that more than half of the procedures were not performed for life-saving conditions. However, an insufficient number of caesarean procedures to cover those life-threatening causes was observed among the sites with low proportions of caesarean section (below 9%). They recommend concurrently focusing on the life-threatening causes for the mother and child while attempting to establish a minimum caesarean prevalence.

Methods

• The prevalence of obstetric and medical conditions for six potentially life-saving indications for which caesarean section could reduce mortality in LMICs was established via performing a literature review.
• A large, prospective population-based dataset from six LMICs (Argentina, Guatemala, Kenya, India, Pakistan, and Zambia) was then analysed in order to determine the prevalence of caesarean section by indication for each site.
• For this study, an acceptable number of events were considered between the 25th and 75th percentile of those found in the literature.

Results

• A total of 271,855 deliveries in six LMICs (seven research sites) were enrolled between Jan 1, 2010, and Dec 31, 2013.
• Findings revealed that prevalence of caesarean section ranged from 35% (3467 of 9813 deliveries in Argentina) to 1% (303 of 16,764 deliveries in Zambia).
• For five of six indications, Argentina's and Guatemala's sites all met the minimum 25th percentile.
• However, the minimum prevalence for caesarean section for any of the indications was not reached at sites in Zambia and Kenya.
• A minimum overall caesarean section of 9% across all sites was required to meet the prevalence of the six indications in the population studied.