Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017

IntroductionCaesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period.MethodsSeven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference.ResultsThe proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales.ConclusionThis study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women’s and providers’ perspectives and preferences for childbirth, should be prioritised to optimise the use of CS.

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Prevalence and indications for caesarean section in Enugu state, Nigeria

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214311 ◽

2021 ◽

Vol 10 (11) ◽

pp. 4059

Author(s):

Hope O. Nwoga ◽

Miriam O. Ajuba ◽

Chukwuma P. Igweagu

Keyword(s):

Caesarean Section ◽

Health Facility ◽

Educational Level ◽

Binary Logistic Regression ◽

Health Concern ◽

Chi Square ◽

The Past ◽

Chi Square Test ◽

Higher Educational ◽

Level Of Significance

Background: Caesarean section (C/S) is one of the commonly performed surgical procedures in obstetrics. This procedure has been on the increase in the past decade, creating a public health concern. The objective of this study was to determine the prevalence and predictors of C/S delivery in a tertiary health facility in Nigeria.Methods: A prospective cohort study conducted at a tertiary health facility in Nigeria. Data was retrieved from the delivery cards of the mothers. Data was analysed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Chi-square test was performed with the level of significance set at p≤0.05. Binary logistic regression was used to determine factors that predicted C/S delivery.Results: The prevalence of C/S was 48.3%. Commonest indication for C/S was 2 or more previous C/S. Mothers aged >30 years, employed, higher educational level, higher parity and delivered preterm predicted C/S delivery on logistic regression.Conclusions: The prevalence of C/S was high. Higher maternal age, employment, higher educational level, higher parity and preterm delivery were positively associated with C/S delivery.

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Levels, trends and socio-economic correlates of caesarean section deliveries

Journal of Health Research ◽

10.1108/jhr-10-2018-0131 ◽

2019 ◽

Vol 33 (4) ◽

pp. 323-335

Author(s):

Javeed A. Golandaj ◽

Jyoti S. Hallad

Keyword(s):

Caesarean Section ◽

Maternal Education ◽

State Level ◽

Household Survey ◽

Poverty Line ◽

Health Facilities ◽

Content Type ◽

Logistic Regression Models ◽

Surgical Tool ◽

Life Saving

Purpose Caesarean section (CS) is being used as a life-saving surgical tool when complications arise in the process of childbirth. CS rates have dramatically increased across the world, especially in recent decades. In this background, the purpose of this paper is to explore the CS rates and its determinants in Karnataka, India. Design/methodology/approach The study uses multiple rounds of the District Level Household Survey (DLHS) data to show the trends, differentials and determinants in CS deliveries. Both bivariate and multivariate analyses have been carried out, and the χ2 test and logistic regression models were applied. Findings Result shows a sharp increase in CS rates across Karnataka; further, this is high and reaches an alarming level in southern parts of the state. Along with a huge rural–urban difference, significant biological and socio-economic differences were observed. Further, a very dramatic increase in the CS rate was observed in private health facilities, whereas it was stagnant or even decreased in public health facilities during recent years. Mothers age at birth, birth weight, birth order, multiple births, birth institution and place of residence were significantly associated with CS delivery. Unlike these biological factors, the social-economic factors like maternal education, caste, religion and below poverty line household were not found to be significant in determining CS deliveries. Originality/value A strong policy to address the dramatic increase in CS deliveries is the need of the hour. Further, there should be a proper mechanism at national, state and sub-state level to provide appropriate checks and monitoring for CS deliveries which are unnecessary.

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The Role of Histones and Heparin in Sepsis: A Review

Journal of Intensive Care Medicine ◽

10.1177/0885066621992320 ◽

2021 ◽

pp. 088506662199232

Author(s):

Xiaojuan Zhang ◽

Xin Li

Keyword(s):

Septic Shock ◽

Multiple Organ ◽

Clinical Settings ◽

The Past ◽

Life Saving ◽

Extracellular Histones ◽

Sepsis And Septic Shock ◽

Development And Management ◽

Made In

Septic shock with multiple organ failure is a devastating situation in clinical settings. Through the past decades, much progress has been made in the management of sepsis and its underlying pathogenesis, but a highly effective therapeutic has not been developed. Recently, macromolecules such as histones have been targeted in the treatment of sepsis. Histones primarily function as chromosomal organizers to pack DNA and regulate its transcription through epigenetic mechanisms. However, a growing body of research has shown that histone family members can also exert cellular toxicity once they relocate from the nucleus into the extracellular space. Heparin, a commonly used anti-coagulant, has been shown to possess life-saving capabilities for septic patients, but the potential interplay between heparin and extracellular histones has not been investigated. In this review, we summarize the pathogenic roles of extracellular histones and the therapeutic roles of heparin in the development and management of sepsis and septic shock.

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Change in mean and extreme temperature at Yingkou station in Northeast China from 1904 to 2017

Climatic Change ◽

10.1007/s10584-021-02981-w ◽

2021 ◽

Vol 164 (3-4) ◽

Author(s):

Xiaoying Xue ◽

Guoyu Ren ◽

Xiubao Sun ◽

Panfeng Zhang ◽

Yuyu Ren ◽

...

Keyword(s):

Northeast China ◽

Extreme Temperature ◽

Maximum Temperature ◽

Data Set ◽

The Past ◽

Significant Downward Trend ◽

Cold Events ◽

Temperature Indices ◽

Increasing Trends ◽

Change In Mean

AbstractThe understanding of centennial trends of extreme temperature has been impeded due to the lack of early-year observations. In this paper, we collect and digitize the daily temperature data set of Northeast China Yingkou meteorological station since 1904. After quality control and homogenization, we analyze the changes of mean and extreme temperature in the past 114 years. The results show that mean temperature (Tmean), maximum temperature (Tmax), and minimum temperature (Tmin) all have increasing trends during 1904–2017. The increase of Tmin is the most obvious with the rate of 0.34 °C/decade. The most significant warming occurs in spring and winter with the rate of Tmean reaching 0.32 °C/decade and 0.31 °C/decade, respectively. Most of the extreme temperature indices as defined using absolute and relative thresholds of Tmax and Tmin also show significant changes, with cold events witnessing a more significant downward trend. The change is similar to that reported for global land and China for the past six decades. It is also found that the extreme highest temperature (1958) and lowest temperature (1920) records all occurred in the first half of the whole period, and the change of extreme temperature indices before 1950 is different from that of the recent decades, in particular for diurnal temperature range (DTR), which shows an opposite trend in the two time periods.

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Household Chores or Play Outdoors? The Intersecting Influence of Gender and School Type on Physical Activity Among Indian Adolescents

Health Education & Behavior ◽

10.1177/1090198120931040 ◽

2020 ◽

Vol 47 (5) ◽

pp. 682-691

Author(s):

Ilana G. Raskind ◽

Shailaja S. Patil ◽

Nikhil Tandon ◽

Sharanya Thummalapally ◽

Michael R. Kramer ◽

...

Keyword(s):

Physical Activity ◽

Confidence Interval ◽

Private School ◽

Rate Ratio ◽

School Type ◽

School Students ◽

Public And Private ◽

Active Time ◽

Public School Students ◽

Indian Adolescents

Most Indian adolescents, particularly girls and private school students, do not engage in sufficient physical activity (PA). Current understanding of these sociodemographic differences is limited by a focus on exercise, which may not fully capture PA in developing countries. We examined how gender and school type are associated with multiple PA domains and whether associations with gender differ by school type. We randomly selected an equal number of girls and boys (ages 13-16 years) from public and private schools in Southern India ( n = 395). Cross-sectional 24-hour time-use surveys measured PA, which was categorized into three domains: chores, errands, and work; play; and transportation. Negative binomial and logistic regression modeled relative differences in domain-specific PA minutes and the probability of engaging in ≥60 minutes of moderate-to-vigorous PA (MVPA), respectively, in the prior 24 hours. Girls and boys were equally likely to meet MVPA recommendations. However, girls spent twice as much active time completing chores, errands, and work (rate ratio = 1.98, 95% confidence interval = [1.32, 2.98]), while boys spent twice as much active time playing (rate ratio = 2.11, 95% confidence interval = [1.23, 3.62]). Public and private school girls spent more active time in chores, errands, and work than boys; however, gender differences were greater among public school students ( p value for interaction <.05). Although comparable MVPA levels for girls and boys are beneficial for physical health, girls may gain fewer cognitive, social, and emotional benefits associated with play. Additional research may clarify why the gendered burden of household responsibilities was greater among public school students. School-based programs to engage girls in active play may help reduce inequities.

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Gender, Memory, and Identity in the Roman World

10.5117/9789462988057 ◽

2019 ◽

Keyword(s):

Roman Empire ◽

Late Antiquity ◽

Roman History ◽

Public And Private ◽

Imperial Rome ◽

The Past ◽

Roman World ◽

Material Sources ◽

Close Relationship

This volume approaches three key concepts in Roman history — gender, memory and identity — and demonstrates the significance of their interaction in all social levels and during all periods of Imperial Rome. When societies, as well as individuals, form their identities, remembrance and references to the past play a significant role. The aim of Gender, Memory, and Identity in the Roman World is to cast light on the constructing and the maintaining of both public and private identities in the Roman Empire through memory, and to highlight, in particular, the role of gender in that process. While approaching this subject, the contributors to this volume scrutinise both the literature and material sources, pointing out how widespread the close relationship between gender, memory and identity was. A major aim of Gender, Memory, and Identity in the Roman World as a whole is to point out the significance of the interaction between these three concepts in both the upper and lower levels of Roman society, and how it remained an important question through the period from Augustus right into Late Antiquity.

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Autism, Equity, and How the Journal Came to Be

Canadian Journal of Autism Equity ◽

10.15173/cjae.v1i1.4986 ◽

2021 ◽

Vol 1 (1) ◽

pp. 9-11

Author(s):

Megan Krasnodembski ◽

Stephanie Côté ◽

Jonathan Lai

Keyword(s):

At Risk ◽

Media Coverage ◽

Real Problem ◽

Canadian Society ◽

Residential Settings ◽

The Past ◽

Life Saving ◽

The World ◽

Culture Of Fear ◽

The One

Over the past year a pandemic has swept across the world and, unsurprisingly, revealed gross inequalities across all aspects of life. We saw this in the constant pandemic media coverage that overlooked the experiences of the disability community and, more specifically, the autism community, at least at first. Furthermore, let us not forget in the early days of the pandemic that in countries such as Italy, people without disabilities were prioritized for life-saving machines (Andrews et al., 2020; Lund & Ayers, 2020), contributing to a culture of fear for the one in five Canadians with a disability (Morris et al., 2018) about what would happen to them here. As COVID-19 reached Canadian shores we saw this pattern of inequity quickly replicated within our society. For instance, Canadians with developmental disabilities, such as autism, living in residential settings did not receive the same level of support as those living in different kinds of residences such as retirement residences (Abel & Lai, 2020). Likewise, the initial claims that only people with ‘preexisting conditions’ were at risk implied that those at risk were somehow less valuable to society. Nothing has highlighted the very real problem and extent of ableism within Canadian society as a whole more than these injustices arising from the COVID-19 pandemic, and this is what planted the seed for the Canadian Journal of Autism Equity (CJAE).

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Rethinking Foster Care: Why Our Current Approach to Child Welfare Has Failed

SMU Law Review Forum ◽

10.25172/slrf.73.1.12 ◽

2020 ◽

Vol 73 (1) ◽

pp. 123-139

Author(s):

Vivek Sankaran ◽

Christopher Church

Keyword(s):

Public Health ◽

Child Abuse ◽

Child Welfare ◽

Return On Investment ◽

Child Welfare System ◽

Current Approach ◽

Public And Private ◽

The Public ◽

The Past ◽

Abuse And Neglect

Over the past decade, the child welfare system has expanded, with vast public and private resources being spent on the system. Despite this investment, there is scant evidence suggesting a meaningful return on investment. This Article argues that without a change in the values held by the system, increased funding will not address the public health problems of child abuse and neglect.

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Obstetric Anal Sphincter Injuries – Maternal, Foetal and Sociodemographic Risk Factors: A Retrospective Register-Based Study

10.22541/au.163460613.32885708/v1 ◽

2021 ◽

Author(s):

Kristin André ◽

Andrea Stuart ◽

Kärin Kallén

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Caesarean Section ◽

Anal Sphincter ◽

Maternal Education ◽

Vacuum Extraction ◽

High Birth Weight ◽

Previous Caesarean Section ◽

Obstetric Anal Sphincter Injuries ◽

Increased Risk

Objective. To determine risk and protective factors of obstetric anal sphincter injuries (OASIS). Design. A retrospective register-based observational study. Setting. Sweden. Population. A cohort of 988, 988 singleton term deliveries 2005-2016 were included. Methods. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and foetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. Main outcome measures. Risk ratios for OASIS with 95% confidence interval associated with maternal and foetal risk factors were calculated. Results. The rate of OASIS was 3.5% (n=34, 583). Primiparity (aRR 3.13 95% CI 3.05–3.21), vacuum extraction (aRR 2.79 95% CI 2.73–2.86), forceps (aRR 4.27 95% CI 3.86–4.72) and high birth weight (aRR 2.61 95% CI 2.50–2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height increased the risk of OASIS. Smoking (aRR 0.74 95% CI 0.70–0.79) and low maternal education (aRR 0.87 95% CI 0.83–0.92) were associated with a decreased frequency of reported OASIS. Obesity decreased the risk of OASIS (aRR 0.90 95% CI 0.87–0.94), but only after adjusting for foetal birth weight. Previous caesarean section increased the risk of OASIS (aRR 1.41; 95% CI 1.36–1.47). Conclusion. Primiparity, instrumental delivery and high birth weight increased the risk of OASIS. Risk factors including BMI, height, age, smoking, maternal education, ethnicity and previous caesarean section also contribute to the overall risk of OASIS. Keywords. Obstetric sphincter injuries, risk factors, pregnancy.

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Born Too Soon; Implications in a Tertiary Health Facility in Enugu State Nigeria

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210630 ◽

2021 ◽

Vol 11 (6) ◽

pp. 190-196

Author(s):

Nwoga Hope Obiageli ◽

Ajuba Miriam Obinwanne ◽

Igweagu Chukwuma Paulinus

Keyword(s):

Caesarean Section ◽

Health Facility ◽

Preterm Delivery ◽

Tertiary Education ◽

Binary Logistic Regression ◽

Bivariate Analysis ◽

P Value ◽

Chi Square ◽

Chi Square Test ◽

Enugu State

Background: Preterm birth (PTB) is a complex complication of pregnancy with multiple etiologies. This results in long term medical burdens to the families and health care system at large. The objective of the study was to determine the socio-demographic and obstetric characteristics that affect preterm delivery. Methods: The study was a prospective cohort study conducted at the Obstetrics and Gynecology Department of a tertiary health facility in Nigeria. Data for the study were retrieved from the ante-natal and delivery card of the women that delivered at the unit within the time of data collection. Data was analyzed using SPSS version 25 and variables were presented as frequencies, percentages, means, and standard deviation. Bivariate analysis was done using chi-square test. The level of significance was set at p value ≤ 0.05. Binary logistic regression was used to determine factors that predicted preterm delivery. Results: Majority of them were married 746(96.9%), Igbos 763(99.1) and Christians 766(99.5%). Most of the women were civil servants 429(55.7%), while about 31.3% of them were unemployed 241(31.3%). Majority of the women 484(62.9%) had tertiary education. About 48% of them delivered through caesarean section while 53.9% booked within 14-28weeks gestation. Delivering through caesarean section and gestational age at booking predicted preterm delivery. Un-booked mothers have about 7times odds of having PTB when compared to those that booked at ≥28 week’s gestation. Conclusion: The prevalence of PTB is still high in Nigeria. Booking status of the mother and C/S delivery were found to be strongly associated with preterm delivery. Key words: Enugu State, Nigeria, Preterm delivery, Prevalence, Tertiary health facility.

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