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. 2024 May 18;43(1):69.
doi: 10.1186/s41043-024-00563-x.

Caesarean delivery and neonatal mortality: evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study

Abdur Razzaque  1 , Razib Chowdhury  2 , Ahm Golam Mustafa  2 , Md Arif Billah  2 , Shakera Naima  2 , Sohana Shafique  2 , Bidhan Krishna Sarker  2 , Mohammad Zahirul Islam  3 , Minjoon Kim  4 , Margub Aref Jahangir  5 , Ziaul Matin  6 , Jannatul Ferdous  5 , Maya Vandenent  5 , Anisur Rahman  2
Affiliations

Caesarean delivery and neonatal mortality: evidence from selected slums in and around Dhaka city, Bangladesh- A prospective cohort study

Abdur Razzaque et al. J Health Popul Nutr. .

Abstract

Background: This study examined the neonatal mortality for newborn of women who delivered by caesarean section or vaginally using a prospective cohort.

Methods: A total of 6,989 live births registered from 2016 to 2018, were followed for neonatal survival from the selected slums of Dhaka (North and South) and Gazipur city corporations, where icddr,b maintained the Health and Demographic Surveillance System (HDSS). Neonatal mortality was compared by maternal and newborn characteristics and mode of delivery using z-test. Logistic regression model performed for neonatal mortality by mode of delivery controlling selected covariates and reported adjusted odd ratios (aOR) with 95% confidence interval (CI).

Results: Out of 6,989 live births registered, 27.7% were caesarean and the rest were vaginal delivery; of these births, 265 neonatal deaths occurred during the follow-up. The neonatal mortality rate was 2.7 times higher (46 vs. 17 per 1,000 births) for vaginal than caesarean delivered. Until 3rd day of life, the mortality rate was very high for both vaginal and caesarean delivered newborn; however, the rate was 24.8 for vaginal and 6.3 per 1,000 live births for caesarean delivered on the 1st day of life. After adjusting the covariates, the odds of neonatal mortality were higher for vaginal than caesarean delivered (aOR: 2.63; 95% CI: 1.82, 3.85). Additionally, the odds were higher for adolescent than elderly adult mother (aOR: 1.60; 95% CI: 1.03, 2.48), for multiple than singleton birth (aOR: 5.40; 95% CI: 2.82, 10.33), for very/moderate (aOR: 5.13; 95% CI: 3.68, 7.15), and late preterm birth (aOR: 1.48; 95% CI: 1.05, 2.08) than term birth; while the odds were lower for girl than boy (aOR: 0.74; 95% CI: 0.58, 0.96), and for 5th wealth quintile than 1st quintile (aOR: 0.59, 95% CI: 0.38, 0.91).

Conclusion: Our study found that caesarean delivered babies had significantly lower neonatal mortality than vaginal delivered. Therefore, a comprehensive delivery and postnatal care for vaginal births needed a special attention for the slum mothers to ensure the reduction of neonatal mortality.

Keywords: Bangladesh; Caesarean delivery; Health and Demographic Surveillance System; Neonatal mortality; Slum.

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Conflict of interest statement

There are no conflict of interest. Besides funding the whole project the authors of this manuscript from the funding agency (UNICEF) are also participated in reviewing and editing the manuscript and it raises no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the sample selection of the study
Fig. 2
Fig. 2
Rate of neonatal mortality per 1,000 live births by age at death and mode of delivery
See this image and copyright information in PMC

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