C. Mazimpaka1, E. Uwitonze1, T. Cherian2, B. Hedt-Gauthier2, R. Riviello2,3, S. Hakizimana1,5, Z. El-Khatib4, G. Magdalena2, K. Sonderman3, C. Habiyakare5, F. Kateera1, T. Nkurunziza1 1Partners In Health,Kigali, KIGALI, Rwanda 2Harvard School Of Medicine,Global Health And Social Medicine,Brookline, MA, USA 3Brigham And Women’s Hospital,Boston, MA, USA 4Karolinska Institutet,Public Health Sciences,Stockholm, STOCKHOLM, Sweden 5Ministry of Health,KIGALI, KIGALI CITY, Rwanda
Introduction: Cesarean sections (c-sections) are essential in reducing maternal and neonatal deaths. There is a paucity of research regarding c-section care and outcomes in rural African settings. This study aimed to describe the characteristics of women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda, the clinical care provided to them, and the maternal and neonatal outcomes
Methods: This cross-sectional study included all adult women who are residents of Kirehe District and received c-sections at KDH during April 1-September 30, 2017. Demographic and clinical characteristics of these women were extracted from the mother study dataset, and newborn outcomes data were retrospectively extracted from medical charts. Descriptive analyses were performed and frequency and percentages were reported
Results: Of the 621 women included in the study, most were 25-34 years old (45.7%; n=284), married (42.2%; n=262), had only primary education (67.5%; n=419), and were farmers (75.7%; n=470). Burundian refugees from Mahama Refugee Camp comprised 13% (n=86) of the study population. The most common indication for c-section was a previous c-section (31.9%, n=198), followed by acute fetal distress (30.8%, n=191). About 68% spent 3 days or less at the hospital post-surgery and over 95% did not have any postoperative complications prior to discharge. Approximately 10% of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n=31)
Conclusion: Our findings shed light on c-section deliveries at a rural district hospital in sub-Saharan Africa. KDH represents a typical rural health facility serving residents with low economic and education level. Unique to KDH catchment population is refugees from Mahama Refugee Camp. Previous c-section as the primary indication for c-section will result in high future demand for this surgery. This highlights the need to explore appropriateness and uptake of Vaginal Birth After Cesarean in rural district hospitals.