Abstracto

Congreso de Salud Pública 2018: Tendencia de los partos por cesárea en Egipto y sus factores asociados: evidencia de encuestas nacionales, 2005-2014 - Rami H Al-Rifai - Universidad de los Emiratos Árabes Unidos

Rami H. Al-Rifai  

Abstracto

Planteamiento del problema: El aumento continuo de partos por cesárea plantea un importante problema de salud pública en todo el mundo.

Metodología y orientación teórica: Se analizó la tendencia de los partos por cesárea entre 2005 y 2014 y se analizaron los factores asociados con el aumento de los partos por cesárea entre las madres egipcias, de 2005 a 2014, según el lugar del parto. Se encuestó a un total de 29.000 madres egipcias en 2005, 2008 y 2014.

Resultados: Las cesáreas en instituciones aumentaron en 40,7 puntos desde la EDHS2005 a la EDHS-2014 (ORa, 3,46, IC del 95 %: 3,15-3,80, tendencia P < 0,001). En comparación con las madres con un nivel socioeconómico (NSE) bajo, las madres con un nivel socioeconómico alto tuvieron mayores probabilidades (ORa, 1,78, IC del 95 %: 1,25-2,54, P = 0,001) de cesárea, pero solo en la EDHS-2005. Se encontró que la tendencia ajustada de cesáreas fue 4,19 veces (IC del 95 %: 3,73-4,70, P < 0,001) mayor en el sector privado, mientras que en el sector público fue 2,67 veces (IC del 95 %: 2,27-3,13, P = 0,001) mayor, en la EDHS2014 en relación con la EDHS-2005. Este aumento en el sector privado se explica por aumentos significativos entre las madres que potencialmente tienen bajo riesgo de cesáreas; madres de 19 a 24 años frente a ???35 años (aOR: 0,31; IC del 95 %: 0,21-0,45; en la EDHS-2005 frente a 0,43, IC del 95 %: 0,33-0,56, en la EDHS-2014, P < 0,001); madres primigrávidas vs. madres con ???4 hijos (aOR: 1,62; IC del 95%: 1,12-2,34, en EDHS-2005 vs. 3,76, IC del 95%: 2,94-4,80 en EDHS-2014) y entre bebés con peso al nacer normal en comparación con los de alto riesgo (aOR: 0,79; IC del 95%: 0,62-0,99 en EDHS-2005 P<0,05 vs. 0,83; IC del 95%: 0,65-1,04 en EDHS-2014, P>0,05).

Conclusion: The steady rise in C-sections in Egypt has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of C-section deliveries, particularly in the private sector, is warranted.  Discussions:  The study estimated trend of c-sections among Egyptian mothers sampled in 2005, 2008, and 2014. There was a substantial rise in trend of institutional-based c-sections by more than three-fold, over the study period. The private sector appears to be the driver of the rising csections in Egypt, a substantial increase was also observed in use of this surgical procedure in public sector. The more than 4-folds increase in c-sections in the private sector was driven by substantial increases in csections among mothers who are potentially at low risk for c-section delivery. In Egypt, the nearly 60% population-based proportion of csections performed in 2014 greatly exceeds the threshold of 10–15% recommended by WHO. A populationbased proportion of c-sections >10% did not lead to health improvements for mother or newborn. Although the observed over time increase in c-section rate in Egypt is in line with what has been noted in many national and international studies, this over time increase places Egypt as a country with the highest c-sections performed worldwide, after Brazil (45.9%). The institutional-based proportion (67.3%) of c-sections recorded in Egypt in 2014 is 2.2-time and 2.7-time higher than that recently recorded in Jordan (30.3%)  and in Saudi Arabia (25%), respectively. The decline in homebased deliveries by over 60% merely reflects an improvement in provided health care services in Egypt. Over the past decade, per capita total expenditure on health increased from US$75.8 in 2000 to US$123.2 in 2010. However, improving administered health care services should not justify the massive increase in csections. This exponential rise in csections indicates an overuse for this surgical procedure that might be due to many c-sections may increasingly be performed without any medical indication. This rise in c-sections would pose further economic burden in a resource limited-setting such as Egypt, which is already burdened with different economic difficulties where 26.3% of Egyptians live below the poverty line In 2008, the WHO estimated that 253,890 unnecessary c-sections had been performed with a total cost of US$ 41,085,585 per year. Referring to the obtained results, the discernible increase in c-sections in Egypt in 2014, this study assumes that the unnecessary csections and its associated spending at least would double the ones estimated in 2008. Furthermore, the increased c-sections would pose further unfavorable health outcomes as a result of adverse outcomes associated with c-sections in a country already burdened with a relatively high MMR and NMR in addition to other infectious diseases mainly hepatitis C virus that infect nearly 15% of the 15 to 59 years old Egyptian people. This disease alone consumes about 20% of the Ministry of Health and Population total annual budget to treat infected individuals. Rigorous institutional-based study is needed to assess the impact of this high proportion of csections and identify the exact medical and non-medical needs for csection deliveries for future planning and effective policy interventions. In the three surveys, childbearing at ≤18 years or ≥35 years, living in high SES, maternal overweight/obesity, pregnancy with high-risk birth weight or multiple babies, delivery in a private sector were found as significant factors associated with c-section delivery in Egypt except for SES in EDHS-2014. 

Conclusiones: Los resultados obtenidos demuestran que la proporción de cesáreas en Egipto ha aumentado de forma constante en los últimos años y ha alcanzado un nivel alarmante. La proporción de cesáreas documentadas en la última Encuesta de Salud y Servicios Humanos de 2014 cuadriplicó el umbral máximo recomendado por la OMS. El aumento del número de partos en el sector privado parece estar asociado a un cambio hacia los partos en instalaciones privadas. Este aumento en el sector privado, en particular entre las madres que potencialmente tenían un riesgo bajo de cesáreas, requiere una necesidad urgente de adoptar políticas y estrategias críticas que puedan detener el aumento constante de las cesáreas en Egipto y mejorar la salud reproductiva y los resultados de salud de las madres y los bebés. Mientras tanto, también es necesario un estudio institucional en profundidad que recopile datos sobre las indicaciones exactas asociadas con las cesáreas en Egipto.  

rrifai@uaeu.ac.ae