Prevalence and determinants of caesarean sections among women in selected health facilities in Njombe region, Tanzania

When medically required, Caesarean sections (CS) can help to reduce maternal and newborn mortality significantly. However, excessive or non-indicated CS causes serious health hazards. Tanzania's national CS rate is 13%, with the Njombe area reporting a significantly higher rate of 29% in 2022 nearly double the WHO-recommended maximum of 15%. This study investigated the prevalence and risk factors for CS among postpartum mothers in Njombe health facilities. A facility-based cross-sectional investigation was carried out utilizing a multistage cluster sampling method. A total of 567 post-delivery women aged 15-44 years from six health facilities were surveyed using Kobo Collect structured questionnaires. Demographic data were analyzed using descriptive statistics. Modified Poisson regression was used to investigate the relationships between independent variables and CS delivery. The multivariable model included variables with p-values < 0.2 from the bivariable analysis. Statistical significance was set at p < 0.05. Participants' average age was 25.8 years (SD = 5.86). The CS prevalence was 45.5% (95% confidence interval: 41.0-49.9%). Factors associated with higher likelihood of CS delivery included being single (aPR = 1.25; 95% CI: 1.01-1.74), late first ANC visit (aPR = 1.52; 95% CI: 1.10-1.42), maternal height ≤ 150 cm (aPR = 1.24; 95% CI: 1.01-1.63), birth weight > 4.1 kg (aPR = 1.67; 95% CI: 1.07-2.27), gestational age ≥ 43 weeks (aPR = 1.49; 95% CI: 1.05-2.20), and referral from health centers (aPR = 2.10; 95% CI: 1.50-3). Delivering in private facilities also increased the likelihood of CS, albeit not significantly (aPR = 1.13; 95% CI: 0.75-1.67). The CS rate in Njombe substantially exceeds national and worldwide averages. Targeted initiatives are urgently required to encourage evidence-based decision-making, improve ANC scheduling, and strengthen monitoring of health insurance and private sector influences on CS delivery. Policy changes should focus on enforcing clinical criteria and increasing accountability in maternity healthcare.