Caesarean
section (C-section) considered as a public health problem, is one of the most
common surgeries in the world 1. The procedure is often performed without medical necessity,
hence putting mothers and their neonates at risk of short- and long-term health
problems. Recently, it has been reported that the rates of C-section continue to
skyrocket, particularly in high- and middle-income countries 12. The international healthcare community considered
the ideal rate for cesarean sections to
be between 10% and 15% 12 3. Malawi follows the United Nations (UN) process
indicators, which recommend that a minimum of 5% and a maximum of 15% of all
births should be delivered by C-section 4. However, the World Health Organization (WHO)
underscores the importance of focusing on the needs of the patient and discourages
the practice of aiming for target rates 2. C-section may be necessary when vaginal delivery
might pose a risk to the mother or neonate particularly due to fetal distress, prolonged
labor, or because the baby is presenting in an abnormal position 13. Unfortunately, the procedure can lead to significant
problems, disability or death, predominantly in settings that lack the
facilities to conduct safe surgeries or treat potential complications 23.

Previous
studies in many settings have reported that the causes of an increase in C-sections are multifactorial and poorly
understood 5. Notably, changes in mothers characteristics (i.e.
higher educational education, rise in mothers age, prior cesarean section, prolonged
labor, and increasing maternal Body Mass Index) 56, infant characteristics (i.e. baby weight – suspected
low infant birthweight or macrosomia, length of the baby) 67 and professional practice styles, increasing
malpractice pressure – private hospital status, as well as economic,
organizational, social and cultural factors have all been implicated in an increase in C-sections 5.

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Cesarean
section is one of the most important risk
factors for postpartum maternal infection
which account for approximately 10% of pregnancy-related mortality and it carries a risk of infection 5
to 20 times that of vaginal delivery 8910. It. In Malawi, since 1992, the rates of C-sections
have been on the rise as it was reported
that only 3% of births occurred with C-section in 1992-2000 compared with 5% in
2010 and 6% in 2015-16 11. To the best of our knowledge, few studies have until
now been conducted to address the factors that affect C-section in Malawi. For
better results on C-sections, it is necessary to contextualize the
sociocultural determinants in addition to the current healthcare model. Thus, the
present study aimed to investigate the associated factors of C-sections from 2004 to 2015 using the population-based data. 

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