Spatial Analysis of Cesarean Section Rates in Nigeria

Cesarean section (CS) is an essential means of preventing maternal and child mortality globally. Nigeria has one of the highest rates of maternal mortality in the world, and increased CS use has the potential to reduce the rate. This study explored the spatial variation and pattern of CS rates in Nigeria, and the relationship of the rates with women’s job types, median age at first birth (MAFB), and percentage-teenage-mothers. The data of deliveries by CS 5 years before the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed retrospectively, using descriptive statistics, simple and multiple linear regression analyses, and Moran’s I statistics. CS rates in Nigeria were space-dependent (Moran’s I = 0.426; p < .001), irrespective of whether elective (Moran’s I = 0.431; p < .001) or emergency (Moran’s I = 0.273; p = .002), with northern states exhibiting lower rates. There were positive significant moderate associations between CS, elective-CS, and emergency-CS, and: professional/technical/managerial ( R 2 = 0.34; R 2 = 0.28; R 2 = 0.32), clerical ( R 2 = 0.37; R 2 = 0.26; R 2 = 0.37), and unskilled-manual ( R 2 = 0.14; R 2 = 0.13; R 2 = 0.10) job types. MAFB had a strong positive significant association with the CS variables ( R 2 = 0.68; R 2 = 0.61; R 2 = 0.57), while the percentage-teenage-mothers had a strong negative statistically significant association with the variables ( R 2 = 0.56; R 2 = 0.46; R 2 = 0.52). The clerical job type and MAFB were the significant contributors ( p < .050) to the CS variables. During antenatal care, pregnant women should be assessed to determine the suitability of CS, and unskilled workers should be given special consideration to identify high-risk pregnancies. Policies and advocacy should focus on addressing the various economic and socio-cultural norms that hinder mothers from embracing the procedure whenever necessary.