K. Garber1,2, R. Groen4,5, O. Ogedengbe3, D. DeUgarte1, A. Kushner2,5 5Surgeons OverSeas (SOS),NEW YORK, NY, USA 1University Of California, Los Angeles,Department Of Surgery,Los Angeles, CA, USA 2Johns Hopkins Bloomberg School Of Public Health,Baltimore, MD, USA 3University Of Lagos,Department Of Obstetrics And Gynecology,Lagos, , Nigeria 4Johns Hopkins Hospital,Department Of Obstetrics And Gynecology,Baltimore, MD, USA
Introduction: Access to surgical delivery (c-section) is critical for reducing maternal and neonatal mortality rates, which are key aims of the UN Sustainable Development Goals 2030. The Lancet Commission on Global Surgery also recognized c-sections as an important benchmark procedure. Despite the importance, data on actual numbers of procedures performed in sub-Saharan Africa (SSA) is limited. The goal of this study was to estimate the met and unmet need for c-sections in SSA to help plan interventions and inform future policy decisions.
Methods: Two approaches were used to estimate c-section need. First, annual births for each SSA country in 2015 were calculated using population data from the UN Population Database and crude birth rates from the World Bank Development Indicators. Then, using the World Health Organization optimal c-section rate of 10% and a recently published (Molina et al 2015) higher optimal rate of 19%, the range of c-section need for each country and region was estimated. To determine unmet need, the most recently published actual c-section rates for these countries were obtained (Bertran et al 2016) and raw totals for performed cesarean sections were calculated. Then these numbers were subtracted from the overall need. To support the findings, a second methodology to recalculate SSA c-section needs was used. Data on the prevalence of major maternal conditions (hemorrhage, obstructed labor, sepsis, hypertension, abortion) were obtained from the Institute for Health Metrics and Evaluation 2013 Global Burden of Disease study. Using previously calculated surgical incidence rates for various diseases (Hider et al 2015), the number of needed operations for each maternal condition was estimated, excluding abortions, on the assumption that the overwhelming majority of surgeries for these conditions would be c-sections. Results were summed for each country to provide overall estimates of need.
Results: Using optimal c-section rates of 10-19%, we estimated that 3.6-6.8 million c-sections are needed annually in SSA, with at least 1.8 million, and as many as 4.8 million, of those operations currently unmet. Using 2013 GBD data, a similarly estimated 5.2 million c-sections are needed, well within the range of the first estimate. Regionally, the largest met and unmet needs were seen in Eastern and Western Africa.
Conclusion: A large need and correspondingly large unmet need exist for c-sections in SSA. These data can help inform policymakers of the magnitude of obstetric surgical need in the region as they seek policies to improve maternal and neonatal health. As efforts to improve surgical care in low and middle-income countries increase, planning for and devoting resources to undertake c-sections must be a priority.
