ObjectiveTo examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016.DesignSecondary analysis of Ethiopian Demographic and Health Surveys.SettingAll administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016.ParticipantsWomen aged 15–49 years with a live birth during the 5 years preceding the survey.Main outcome measuresWe analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the ‘Three Delays Model’ to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia.ResultsThe adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths.ConclusionsA naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.
Outcomes associated with anaesthetic techniques for caesarean section in low- and middle-income countries: a secondary analysis of WHO surveys
