Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa

Int J Gynaecol Obstet. 2009 Dec;107(3):191-7. doi: 10.1016/j.ijgo.2009.08.013. Epub 2009 Sep 27.


Objective: To assess the association between cesarean delivery rates and pregnancy outcomes in African health facilities.

Methods: Data were obtained from all births over 2-3 months in 131 facilities. Outcomes included maternal deaths, severe maternal morbidity, fresh stillbirths, and neonatal deaths and morbidity.

Results: Median cesarean delivery rate was 8.8% among 83439 births. Cesarean deliveries were performed in only 95 (73%) facilities. Facility-specific cesarean delivery rates were influenced by previous cesarean, pre-eclampsia, induced labor, referral status, and higher health facility classification scores. Pre-eclampsia increased the risks of maternal death, fresh stillbirths, and severe neonatal morbidity. Adjusted emergency cesarean delivery rate was associated with more fresh stillbirths, neonatal deaths, and severe neonatal morbidity--probably related to prolonged labor, asphyxia, and sepsis. Adjusted elective cesarean delivery rate was associated with fewer perinatal deaths.

Conclusion: Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Africa / epidemiology
  • Breast Feeding / statistics & numerical data
  • Cesarean Section / mortality*
  • Cesarean Section / statistics & numerical data*
  • Developing Countries
  • Elective Surgical Procedures / mortality*
  • Elective Surgical Procedures / statistics & numerical data*
  • Female
  • Health Services Accessibility
  • Health Surveys
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Maternal Health Services / statistics & numerical data
  • Perinatal Care / statistics & numerical data
  • Pregnancy
  • Treatment Outcome
  • World Health Organization
  • Young Adult