Caesarean delivery and its correlates in Northern Region of Bangladesh: application of logistic regression and cox proportional hazard model|
Rahman, Mostafizur; Shariff, Asma Ahmad; Shafie, Aziz; Saaid, Rahmah & Md. Tahir, Rohayatimah
Background: Caesarean delivery (C-section) rates have been increasing dramatically in the past decades around the
world. This increase has been attributed to multiple factors such as maternal, socio-demographic and institutional factors
and is a burning issue of global aspect like in many developed and developing countries. Therefore, this study examines
the relationship between mode of delivery and time to event with provider characteristics (i.e., covariates) respectively.
Methods: The study is based on a total of 1142 delivery cases from four private and four public hospitals maternity
wards. Logistic regression and Cox proportional hazard models were the statistical tools of the present study.
Results: The logistic regression of multivariate analysis indicated that the risk of having a previous C-section, prolonged
labour, higher educational level, mother age 25 years and above, lower order of birth, length of baby more than 45 cm
and irregular intake of balanced diet were significantly predict for C-section. With regard to survival time, using the Cox
model, fetal distress, previous C-section, mother’s age, age at marriage and order of birth were also the most independent
risk factors for C-section. By the forward stepwise selection, the study reveals that the most common factors were previous
C-section, mother’s age and order of birth in both analysis. As shown in the above results, the study suggests that these
factors may influence the health-seeking behaviour of women.
Conclusions: Findings suggest that program and policies need to address the increase rate of caesarean delivery in
Northern region of Bangladesh. Also, for determinant of risk factors, the result of Akaike Information Criterion (AIC)
indicated that logistic model is an efficient model.
Caesarean delivery; Risk factors; Logistic regression; Cox model; AIC; Bangladesh