From Necessity to Preference: A Study of Predictors Influencing Elective Caesarean Section in Rwanda

BackgroundCaesarean section is an important obstetric intervention that saves the lives of mother and newborn babies. However, its increase is of global public health concern. Despite tremendous reduction in maternal and newborn morbidity and mortality, Rwanda has shown a very high incidence of CS among mothers in recent years. Therefore, this study investigated the predictors of patient-initiated elective CS in Rwanda. MethodsIn this cross-sectional study, we used nationally representative data from Rwanda Demographic and Health Survey 2019/20. A total of 6,167 females were included in this study. Chi-square test was used to test association between the type of caesarean section and demographic characteristics. Both binary and multivariate regression analysis were performed to assess the predictors of elective caesarean section at a p-value [≤] 0.05 and 95% confidence interval. Model fitness was rigorously conducted to ensure validity and reliability of study findings. The data was analysed using STATA version 14 SE. ResultsThe rate of CS among women who delivered (6,167) in the last five years preceding the survey was 1,015 (16.46%). Among the women who underwent CS, 36.6% opted for elective CS. Our findings showed that women aged 30 - 39 years were more likely to opt for elective CS [aOR: 3.130, 95%CI:1.969 - 4.978] compared to those aged 29 years or below. Women living in rural areas were less likely to opt for elective CS in the binary regression model [cOR: 0.587, 95%CI: 0.448 - 0.768]. Also, mothers who received ANC assistance by nurse/midwife were 40% less likely [aOR: 0.529, 95%CI: 0.349 - 0.803] to undergo elective CS, than those assisted by doctors. ConclusionThe rate of elective CS is very high among mothers in Rwanda. By using the 2019/20 RDHS data, the study found the key predictors behind the high rate of CS in Rwanda. These predictors should be deeply considered in developing comprehensive measures and policies to mitigate the unnecessary CS in Rwanda, which has detrimental impact on maternal and newborn outcome.