Evidence on prevalence of caesarean sections and factors influencing uptake in Ghana: a scoping review

Ghana’s caesarean section (CS) rate has increased from 16% in 2017 to 21% in 2022 which matches the global CS rate (Ghana Demographic and Health Survey 2022) (Ghana Health Service 2016 Annual REport. 2017). Given that the World Health Organisation (WHO) recommends a range of 10% to 15% per live birth, Ghana, as of 2017, joined other countries that have exceeded this range (WHO Statement on Caesarean Section Rates. 2015) (Journal of Public Health (Germany) 25(5):557–64, 2017). This review set out to explore the prevalence of CS across regions of Ghana and to understand influences on CS uptake. The Joanna Briggs Institute methodological guidelines for scoping reviews were followed, and the review was reported in line with the Preferred Reporting Items for Systematic and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Literature searches were conducted in MEDLINE, PsycINFO, EMBASE, Web of Science and CINAHL (EBSCO). The review included primary qualitative, quantitative, mixed methods studies, systematic reviews, scoping reviews, and grey literature. Narrative synthesis was used to present CS prevalence. The Theoretical Domains Framework (TDF) was used to assess factors influencing CS uptake. Substantial variation in CS uptake is evident across Ghana regions, ranging from 15.7% (Menoufia Medical Journal 35, 2022) to 26% (BMC Pregnancy and Childbirth 19(1), 2019) in the Northern and 6.6% (BMC Pregnancy and Childbirth 18(1), 2018) to 40.6% (Texila International Journal of Public Health 11(2), 2023) across the Southern sector. Quantitative factors such as maternal age (older women), free maternal healthcare policy, and high household socio-economic status were among the specific factors influencing CS uptake in Ghana (Pan African Medical Journal 29, 2018), (BMC Pregnancy Childbirth 21(1), 2021), (BMC Pregnancy Childbirth 22(1), 2022), (Health Services Insights 2024), (Glob J Health Sci 6(4):9–21, 2014). Despite this, and several reports on clinical and demographic factors associated with CS uptake, there is very little in-depth evidence published on the nature of the barriers and facilitators to CS uptake; thus, future qualitative research is warranted. The review found variation in CS prevalence across regions of Ghana, ranging from 6.6% to 40.6%. The reason for this variation is not well understood. The limited evidence demonstrating potential influences on CS uptake in Ghana is mainly quantitative. Hence, we recommend further qualitative research with a range of stakeholders to better understand in-depth contextual issues influencing CS uptake in Ghana.