{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:55:46Z","timestamp":1792014946217,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T00:00:00Z","timestamp":1620345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Caesarean section (CS) can be life\u2010saving for both mother and child, but in Nigeria the CS rate remains low, at 2.7% of births. We aimed to estimate the rate of CS and early neonatal mortality in Nigeria according to obstetric risk and socio\u2010economic background and to identify factors associated with CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the 2018 Nigeria Demographic and Health Survey, encompassing 33\u00a0924 live births within the last 5\u00a0years, to estimate the CS rate and early neonatal mortality rate (ENMR) by obstetric risk group, informed by the Robson classification. The CS rate and ENMR were assessed within each Robson group and stratified by socio\u2010economic background. Logistic regression analyses were used to explore determinants of CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Almost three\u2010quarters (72.4%) of all births were to multiparous women, with a singleton baby of normal birthweight, thus a low\u2010risk group similar to Robson 3, and with a CS rate of 1.0%. CS rates in the two high\u2010risk groups (multiple pregnancy and preterm\/low birthweight) were low, 7.1% (95% CI: 5.2\u20139.7) and 1.8 % (95% CI: 1.4\u20132.4), respectively. The ENMR was particularly high for multiple pregnancy (175 per 1000 live births; 95% CI: 131\u2013230). Greater number of antenatal visits, unwanted pregnancy, multiple pregnancy, household wealth, maternal education, Christians\/Others versus Muslims and referral during childbirth were positively associated with CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Inequitable access to CS is not limited to socio\u2010economic determinants, but also related to obstetric risk factors, calling for increased efforts to improve access to CS for high\u2010risk pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13579","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T12:29:20Z","timestamp":1617020960000},"page":"775-788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Caesarean section rate in Nigeria between 2013 and 2018 by obstetric risk and socio\u2010economic status"],"prefix":"10.1111","volume":"26","author":[{"given":"Sofia","family":"Berglundh","sequence":"first","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Benova","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine Antwerp Belgium"},{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys","family":"Olisaekee","sequence":"additional","affiliation":[{"name":"The Palladium Group Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Global Public Health Karolinska Institutet Stockholm Sweden"},{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31930-5"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31928-7"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0043-6"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30241-9"},{"key":"e_1_2_10_8_1","unstructured":"WHO.Robson classification: Implementation manual.Geneva 2017[Available from:https:\/\/www.WHO.int\/reproductivehealth\/publications\/maternal_perinatal_health\/robson\u2010classification\/en\/]"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0014566"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41256-018-0074-y"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)70094-X"},{"key":"e_1_2_10_12_1","unstructured":"National Population Commission (NPC) [Nigeria] ICF.Nigeria Demographic and Health Survey 2018 \u2010 Final Report.Abuja Nigeria and Rockville Maryland:NPC and ICF;2019."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-019-2682-z"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7151-0"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2014.09.029"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15700"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-016-0158-4"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0050-7"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-013-3063-x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.03.036"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.4103\/1119-3077.164350"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-217"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0300-1652.160360"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0174369"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221778"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2018.1443107"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027273"},{"key":"e_1_2_10_28_1","unstructured":"National Population Commission (NPC) [Nigeria] ICF.Nigeria Demographic and Health Survey 2018.NGKR7AFL.DTA.Abuja Nigeria and Rockville Maryland:NPC and ICF [Producers]. 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