Prevalence and associated factors of caesarean section in Ethiopia: systematic review and Meta-Analysis

Abstract Background Globally, maternal mortality is a serious public health concern. Caesarean section with reasonable medical indication reduces maternal mortality. In Ethiopia, a number of studies about prevalence and associated factors of C-section among mothers were conducted. The findings of these studies were inconsistently reported and more variable. Nationally, the prevalence of C-section isn’t estimated. Therefore, the aim of this systematic review and meta-analysis was to estimate pooled prevalence of C-section and its associated factors among mothers in Ethiopia. Methods International (PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, Science Direct, and Google) and national (Ethiopian medical journal, Addis Ababa University Digital Library and Haramya University Digital Library) electronic databases were systematically searched from August 1 to October 1, 2019. All observational studies noted the prevalence of C-section and its associated factors among mothers in Ethiopia were included. Two authors (AG and AM) independently extracted all essential data using a standardized data extraction format. The extracted data were analyzed using STATA Version 14.1statistical software. We assessed heterogeneity among the included studies through the Cochrane Q test statistics and I 2 test. Lastly, a random effects meta-analysis model was fitted to estimate overall prevalence of C-section and its associated factors. Results Our search identified 573 studies amongst which 25 representing 53,381 participants were included for the final analysis stage. We found that the overall prevalence of C-section among mothers in Ethiopia was 29% (95%CI: 25, 32). Furthermore the subgroup analysis revealed that the highest pooled prevalence was observed in the Addis Ababa administrative city (35%) followed by Amhara (27%) and the smallest was observed in Oromia (25.6%). Mothers having a history of previous C-section (OR: 7.63, 95% CI: 3.29, 17.68) and delivery place (OR: 4.63, 95%CI: 2.06, 10.29) were statistically significant association with C-section. Conclusion In this study, the prevalence of C-section among mothers was 29% in Ethiopia which are high. This finding is twice higher than WHO recommendation, which not beyond 15%. Mothers’ having history of previous C-section and delivery place was factors associated with C-section among mothers in Ethiopia. We recommend that the Minster of health should give intervention about C-section in a private institution.