The maternal mortality rate following a C-section in Africa may be 50 times higher than that of high-income countries, according to a study of more than 3,500 mothers from 22 African countries, published in The Lancet Global Health journal. Maternal deaths following C-section in African countries averaged 5.43 per 1000 operations while they average only .1 per 1000 operations in the UK. The study also showed African women were three times more likely to develop complications during surgery than women in the US.
The study also highlighted the lack of specialist care available, with an average of only .7 specialist per 100,000 people. Almost 1 in 4 women received anaesthesia from a non-specialist, which contributes to high mortality rates. The neonatal mortality rate after c-section in Africa was found to be double the global average.
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Commenting on the generalisability of their findings to Africa as a whole, the authors note that the study included fewer than half of the countries in Africa and two thirds of the study population were from middle-income countries, whilst several of the continent’s poorest countries were not included. The authors also note that their study includes a disproportionate number of government hospitals, compared with district ones. Government hospitals tend to provide a higher level of care and be better resourced than district hospitals, which typically act as the first providers of care for mothers when giving birth. These factors may mean the maternal mortality rates in the study are conservative.
Writing in a linked comment, Dr Anna J Dare, University of Toronto, comments on the importance of improving C-section provision in Africa: “Despite persistently low reported caesarean section rates in sub-Saharan Africa, caesarean section was still the most common surgical procedure performed in the larger ASOS cohort, making up a third of all operative procedures… As such, a strong argument can be made for coordinated efforts to improve and standardise the quality of care around caesarean delivery, while simultaneously working to improve access… Substantial progress has been made over the past 20 years in reducing maternal mortality, including in Africa, yet global disparities persist across all levels of obstetric care.”
