{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:00Z","timestamp":1787022120129,"version":"build-2736575974"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The world health organization considers cesarean section (CS) prevalence of less than 5% suggests an unmet need. On the other hand, a prevalence of more than 15% may pose to risk to mother and child, however, access to CS in a resource-limited country like Ethiopia was much lower than the aforementioned level, Therefore, this was the first study to determine the trend of CS, and factors that influence it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was done based on the five Ethiopia Demographic and Health Surveys. Trend analysis was done separately for rural and urban. The significance of the trend was assessed using the Extended Mantel-Haenszel chi-square test. The factors on CS delivery were identified based on DHS 2016 data. A multi-level logistic regression analysis technique was used to identify the factors associated with cesarean section delivery. The analysis was adjusted for the different individual- and community-level factors affecting cesarean section delivery. Data analysis was conducted using STATA 14.1 software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      The rate of cesarean section increased from 5.1% in 1995 to 16% in 2019 in an urban area and 0.001 in 1995 to 3% in a rural area, the overall increment of CS rate was 0.7% in 1995 to 2019 at 6%. The odds of cesarean section were higher among 25\u201334 years (AOR = 2.79; 95% CI: 1.92, 4.07) and 34\u201349 years (AOR = 5.23;95% CI: 2.85,9.59), among those educated at primary school level (AOR = 1.94; 95% CI: 1.23,3.11), secondary education (AOR = 2.01; 95% CI: 1.17, 3.56) and higher education (AOR = 4.12; 95% CI: 2.33\u20137.29)with multiple pregnancies (AOR = 11.12; 95% CI: 5.37, 23.), with obesity (AOR = 1.73; 95% CI: 1.22, 2.45), living in an urban area (AOR = 2.28; \/95% CI: 1.35\u20133.88), and increased with the number of ANC visit of 1\u20133 and 4\n                      <jats:sup>th<\/jats:sup>\n                      (AOR = 2.26; 95% CI: 1.12, 4.58), (AOR = 3.34; 95% CI: 1.12, 4.58), respectively. The odds of cesarean section are lower among parity of 2\u20134 children (AOR = 0.54; 95% CI: 0 .37, 0.80) and greater than four birth order (AOR = 0.42;95% CI: 0.21,0.84).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Ethiopia, the CS rate is below the WHO recommended level in both urban and rural areas, thus, intervention efforts need to be prioritized for women living in a rural area, empowering women\u2019s education, encouraging co-services such as ANC usage could all help to address the current problem.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0282951","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T13:47:40Z","timestamp":1678974460000},"page":"e0282951","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Trend and associated factors of cesarean section rate in Ethiopia: Evidence from 2000\u20132019 Ethiopia demographic and health survey data"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4900-3045","authenticated-orcid":true,"given":"Rahel","family":"Mezemir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oladapo","family":"Olayemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadeta","family":"Dessie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"pone.0282951.ref001","unstructured":"(2016) Textbook of Caesarean Section; Jauniaux E, Grobman W, editors: Oxford University Press."},{"key":"pone.0282951.ref002","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(18)31928-7","article-title":"Global epidemiology of use of and disparities in caesarean sections","volume":"392","author":"T Boerma","year":"2018","journal-title":"The Lancet"},{"key":"pone.0282951.ref003","doi-asserted-by":"crossref","first-page":"e0148343","DOI":"10.1371\/journal.pone.0148343","article-title":"The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990\u20132014","volume":"11","author":"AP Betr\u00e1n","year":"2016","journal-title":"PLoS One"},{"key":"pone.0282951.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":"AP Betr\u00e1n","year":"2016","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"key":"pone.0282951.ref005","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/1471-0528.13592","article-title":"Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data","volume":"123","author":"J Ye","year":"2016","journal-title":"Bjog"},{"key":"pone.0282951.ref006","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1001\/jama.2015.15553","article-title":"Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality","volume":"314","author":"G Molina","year":"2015","journal-title":"Jama"},{"key":"pone.0282951.ref007","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5897\/IJNM2014.0144","article-title":"The reasons of rising trend of cesarean section rate year after year. 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