{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:40:02Z","timestamp":1790293202138,"version":"4.1.0"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The global rise in caesarean section (CS) delivery has raised significant public health concerns, particularly regarding drivers and potential health implications. Although the World Health Organization (WHO) recommends CS rates between 5% and 15%, global averages exceed this range, with regional disparities and medically unjustified procedures contributing to the increase. In Ghana, similar trends are emerging amid infrastructural and referral system limitations, yet limited studies have used nationally representative data to track changes over time. This study used data from the 2003, 2008, 2014, and 2022 Ghana Demographic and Health Surveys (GDHS) to examine trends and determinants of CS among women aged 15\u201349 years who had a live birth in the five years preceding the survey. Weighted descriptive statistics and multilevel logistic regression were employed to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors, accounting for the complex survey design. Key variables included survey year, antenatal care (ANC) attendance, maternal education, household wealth, birth size, multiple births, maternal age, and birth order. CS prevalence rose from 4.4% in 2003 to 20.1% in 2022 (p\u2009&lt;\u20090.001). Clinical predictors included multiple births (OR\u22485.0), first-order births and larger perceived birth size. Non-clinical factors also strongly influenced CS use: higher education, maternal age\u2009\u2265\u200930 years richest wealth quintile (OR\u22483.5), frequent antenatal care attendance, and urban residence increased odds, while rural residence reduced odds. Temporal effects remained strong even after adjustment, underscoring a systemic rise in CS. CS delivery in Ghana has risen sharply over two decades, driven by both clinical and non-clinical factors, including socioeconomic status, education, and healthcare access. Policy interventions should focus on monitoring CS indications, ensuring equitable access, and safeguarding against medically unnecessary procedures.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005473","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:30:17Z","timestamp":1763145017000},"page":"e0005473","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Determinants of caesarean section use in Ghana: A trend analysis of 2003\u20132022 DHS data"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1813-3792","authenticated-orcid":true,"given":"Johnson","family":"Sam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kasu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"issue":"4","key":"pgph.0005473.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2010.06.058","article-title":"Contemporary cesarean delivery practice in the United States","volume":"203","author":"J Zhang","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"pgph.0005473.ref002","doi-asserted-by":"crossref","first-page":"104359","DOI":"10.1016\/j.ijnurstu.2022.104359","article-title":"Prediction models of vaginal birth after cesarean delivery: A systematic review","volume":"135","author":"B Deng","year":"2022","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"pgph.0005473.ref003","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12884-023-05396-w","article-title":"Predictors of successful vaginal birth after a cesarean section in Ethiopia: a systematic review and meta-analysis","volume":"23","author":"BD Mekonnen","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pgph.0005473.ref004","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/1471-0528.13526","article-title":"WHO Statement on Caesarean Section Rates","volume":"123","author":"WHO Working Group on Caesarean Section","year":"2016","journal-title":"BJOG"},{"issue":"1","key":"pgph.0005473.ref005","first-page":"190","article-title":"Prevalence and socioeconomic predictive factors of caesarean section delivery in Ghana","volume":"35","author":"AR Alhassan","year":"2022","journal-title":"Menoufia Med J"},{"issue":"11","key":"pgph.0005473.ref006","doi-asserted-by":"crossref","first-page":"4182","DOI":"10.4103\/jfmpc.jfmpc_585_21","article-title":"Changing scenario of caesarean section delivery in India: Understanding the maternal health concern and its associated predictors","volume":"10","author":"N Roy","year":"2021","journal-title":"J Family Med Primary Care"},{"issue":"2","key":"pgph.0005473.ref007","first-page":"704","article-title":"Caesarean section in a primary health facility in Ghana: Clinical indications and feto-maternal outcomes","volume":"8","author":"J Prah","year":"2017","journal-title":"J Public Health Afr"},{"issue":"3","key":"pgph.0005473.ref008","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1080\/14767058.2017.1285888","article-title":"Predictors of caesarean section - a cross-sectional study in Hungary","volume":"31","author":"L R\u00e9nes","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"1","key":"pgph.0005473.ref009","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3109\/00016340903418777","article-title":"Changed indications for cesarean sections","volume":"89","author":"YV Stjernholm","year":"2010","journal-title":"Acta Obstet Gynecol Scand"},{"key":"pgph.0005473.ref010","doi-asserted-by":"crossref","first-page":"20","DOI":"10.11604\/pamj.2018.29.20.13917","article-title":"Predictors of caesarean section in Northern Ghana: a case-control study","volume":"29","author":"PA Apanga","year":"2018","journal-title":"Pan Afr Med J"},{"issue":"6","key":"pgph.0005473.ref011","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: global and regional estimates","volume":"6","author":"AP Betran","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pgph.0005473.ref012","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1186\/s12884-023-05622-5","article-title":"Prevalence and determinants of caesarean section deliveries in the Kintampo Districts of Ghana","volume":"23","author":"D Gyaase","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"pgph.0005473.ref013","volume-title":"Caesarean section rates continue to rise, amid growing inequalities in access [Internet]","author":"World Health Organization","year":"2021"},{"key":"pgph.0005473.ref014","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/1471-2393-12-114","article-title":"Individual and institutional determinants of caesarean section in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey","volume":"12","author":"V Briand","year":"2012","journal-title":"BMC Pregnancy Childbirth"},{"key":"pgph.0005473.ref015","article-title":"Ghana demographic and health survey 2014","author":"Ghana Statistical Service, Ghana Health Service, ICF International","year":"2015"},{"key":"pgph.0005473.ref016","article-title":"Population and Housing Census","author":"Ghana Statistical Service, Ghana Health Service","year":"2021"},{"key":"pgph.0005473.ref017","article-title":"Ghana demographic and health survey 2008","author":"Ghana Statistical Service, Ghana Health Service, ICF Macro","year":"2009"},{"key":"pgph.0005473.ref018","article-title":"Ghana demographic and health survey 2003","author":"Ghana Statistical Service, Noguchi Memorial Institute for Medical Research, ORC Macro","year":"2004"},{"issue":"7","key":"pgph.0005473.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0254777","article-title":"Caesarian section (CS) delivery in Bangladesh: A nationally representative cross-sectional study","volume":"16","author":"F Ahmmed","year":"2021","journal-title":"PLoS One"},{"issue":"11","key":"pgph.0005473.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0188074","article-title":"Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh","volume":"12","author":"T Begum","year":"2017","journal-title":"PLoS One"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T18:30:20Z","timestamp":1763145020000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005473"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005473","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]}}}