Caesarean sections among east African refugees and their host population: a 20-year retrospective study in western Tanzania

Abstract

Background: Half of the 35.3 million refugees worldwide are women and a third are of childbearing age, making reproductive healthcare in humanitarian settings indispensable. Caesarean section (CS) is the most common operation worldwide, accounting for 18.6% of births.

Objective: This study provides a descriptive analysis of caesarean sections (CS) in a protracted refugee setting.

Methods: This study is a retrospective review of CS recorded in logbooks between November 2000 and September 2020, inclusive. Data was abstracted from paper logbooks and included date, nationality, sex, age, and indication. Analysis was performed in STATA.

Results: 8,461 CS were performed over the 20-year period. The average age was 24.6 years. Tanzanian patients made up 25% (n=2,116) of the population. The most common indications for CS for both Tanzanians and refugees were cephalopelvic disproportion (CPD), previous scar, and fetal distress. There was a significant difference in the proportion of adolescent and adult patients for the indications of CPD, previous scar, fetal distress, malposition, placenta previa, prolapse, and antepartum hemorrhage (APH).

Conclusion: There is a significant amount of CS performed in this humanitarian setting. Refugees and Tanzanians utilize these services. Outcome data are needed to identify if CS in this setting reduces neonatal and maternal morbidity and mortality.

Funding: American Society of Tropical Medicine and Hygiene; Ruth L. Kirschstein National Research Service Award T32 (Award: 2T32AR67708-6); Association for Academic Surgery.

Keywords: Refugee health; Tanzania; caesarean section; global surgery; humanitarian setting.

Figure 1

Caesarean sections in refugees versus host population over time