Differences in the average Caesarean section rate across levels of hospital care in Gauteng, South Africa

Abstract

Caesarean section rate is expressed as a percentage, and is calculated by dividing the total number of Caesarean sections by the total number of deliveries within a specified period. This indicator is used to track obstetric performance. The objective of this study was to document and differentiate Caesarean section rates within the different levels of hospital care and four central hospitals in Gauteng. A retrospective cross-sectional review was carried out on secondary audited data from the Department of Health's Annual Performance Plans (2014/2015 to 2016/2017) for Gauteng province. All public sector hospitals in Gauteng were included. There are distinct differences with regard to the average Caesarean section rate across levels of hospital care in Gauteng province. There is a trend of a rising Caesarean section rate at the regional and tertiary hospitals, stabilisation thereof in the central hospitals and a decline in the rate at the district hospitals in Gauteng. Further research needs to be conducted to determine the norms for an acceptable Caesarean section rate across all levels of health care. In the interim, the average Caesarean section rate should continue to be monitored and evaluated, since it may be indicative of changes to the burden of disease profile, the complexity of maternal cases and access to maternal health care. When comparing the Caesarean section rates of hospitals in the same category, interpretation of the results must be contextualised through consideration of factors, such as the packages of services rendered, the supporting infrastructure in the hospital, differences pertaining to geographical service area, transportation routes and level of affluence within the population.