DHB 2006/07 - Health Systems Trust

Section A: Indicator Comparisons by District
4.2 Caesarean Section Rate Peter Barron
The Caesarean section rate measures the proportion of deliveries in which a Caesarean section was
performed. This is a facility-based indicator and not a population-based indicator. In other words it uses
deliveries that take place in a facility (clinic, health centre or district hospital) as the denominator as
opposed to using all deliveries (both facility and home deliveries) as the denominator. The numerator
is the number of Caesarean section operations done in district hospitals.
District View
In 2006/07 the national average for district hospitals in South Africa was
14.7%. This excluded any Caesarean section operations done in level 2, 3
and 4 hospitals. In 2005/06 the national average for district hospitals was
13.7% with a total for all hospitals of 18.4%.
As can be seen in Map 10 and Figure 53 there was a wide variation in the
Caesarean section rates among the 52 districts in 2006/07. At the top end
of the scale was the City of Cape Town (WC) with a rate of 30.6% whilst at
the low end was Siyanda (NC) with 1.3%. There are no district hospitals in
Metsweding (GP) resulting in no data for this district. In addition, the missing
data from Amajuba and Xhariep districts suggest that no Caesarean sections
took place in these districts or that there was a problem in collecting these
data in 2006/07 as there were some data available in 2005/06.
Five of the ten districts with the highest Caesarean section rates were in
KwaZulu-Natal. Probably the high HIV prevalence rates in this province
contributed to these high rates, but it is likely that different districts and
different provinces followed different protocols and guidelines in regard
to Caesarean sections and it would be useful for specific health systems
research to be done to unpack the reasons for these large differences.
There were nine districts with Caesarean section rates over 20% and eleven
districts (excluding Amajuba and Xhariep) with Caesarean section rates
under 10%. Caesarean sections are one of the components of essential
obstetric care (EOC) and such wide differences are indicative of very different
levels in the quality of obstetric care around the country.
There were also wide variations between districts in the same province in
2006/07. A Caesarean section is one of the most basic operations and
should be performed in every hospital. It is therefore likely that sub-optimal
care is being delivered in some districts (i.e. those with low Caesarean
section rates) and over-treatment, with unnecessary complications of the
operation, in some districts (i.e. those with high Caesarean section rates).
The current national target of 11% is clearly not an accurate reflection of
what the reality is or should be. It probably needs a panel of experts to
review this target in order to develop a more appropriate guideline.
There were five districts with Caesarean Section rates of 5% or less. These
districts either contained district hospitals which were incorrectly classified
(i.e. they are in reality community health centres) or they were not functioning
adequately with low quality of obstetric care. In either event they need
managerial investigation.
THE DHIS INDICATORS PRESENTED HERE ARE AS RECEIVED FROM THE NATIONAL DHIS AND HAVE NOT BEEN ALTERED BY THE AUTHORS OR HST 57