MINISTRY OF HEALTH

MBEYA COLLEGE OF HEALTH AND ALLIED

SCIENCES

(MCHAS)

RESEARCH TITLE: CAUSES AND RISK FACTOR OF CESEREAN SECTION

AMONG WOMEN DELIVERED AT IGAWILO CITY HOSPITAL

STUDENT NAME: ALISON P HENGEKA

REGISTRATION NUMBER: NS0138/0003/2019

SUPERVISOR: MADAM MKOLA

ACADEMIC YEARS: 2022/2023

Contact

Phone; +255764918177

Email; ntivyironkahengeka@gmail.com.

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ACKNOLWLEDGEMENT

First of all, I would like to take this opportunity to give thanks to almighty god for giving me a
life and protections throughout my studies. I solely express my gratefully to my research
supervisor madam Mkola also tutor of leadership and management in health who has been
extremely helpful instructor throughout the whole period of study.

This work is result of different collective’s resources otherwise it could have been difficult to be
done without that effort. Also thanks a principle of Mbeya college of health and allied sciences
and academic officer, furthermore a head department of clinical medicine for their guidance and
emphasis me in every aspect of study to whole period of being available at school. Special
thanks going to my parents and other sponsor who help me economically and make lives well
during a whole time of field work.

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LIST OF ABBREVIATIONS
ANT –Antenatal Clinic

C/S - Caesarean Section.

GA- Gestational Age

WHO - World Health Organization.

USA - United State of America

MCHAS- Mbeya College of Health and Allied Sciences.

KCMC- Kilimanjaro Christian Medical Center

MNH - Mhimbili National Hospital

MTUHA - Mfumo Wa Taarifa Za Uendeshaji Wa Huduma Za Afya

APGAR - Appearance. Pulse. Grimace. Activity. Respiration.

NHIF - National Health Insurance Fund

D.O.A - Date of Admission

DOD - Date of Delivery

DEFINITION OF TERMS
Caesarean section; is the procedure of delivering the baby by making surgical incisions in the

Woman’s abdominal wall and uterus (moves, 2014).

Caesarean section rate; is the number of caesarean deliveries over the total number of live
births within a period of time, and is usually expressed as a percentage (betrán et al., 2007).

Elective caesarean section; is the type of cs where the decision to carry out the procedure has
been taken during the pregnancy before labor has started (michaluk, 2011).

Emergency caesarean section; is the type of cs carried out when adverse conditions develop
during pregnancy or labor which indicates need for emergency/urgent caesarean (oguta, 2015).

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Parity; the number of born children delivered by one woman (ukeme, 2014).

Gravida; the number of the pregnancy that the woman is in (ukeme, 2014).

Operational definition

Obstetric factors: these are pregnancy related conditions which may arise during pregnancy or
labor which affect pregnancy and delivery process and predispose a patient to cs delivery. These
factors can be maternal, foetal or combined foetal and maternal factors.

Non-obstetric factors: these are non-pregnancy related situations that influence mode of
delivery or performance of caesarean section.

Extreme ages: these are ages below eighteen (18) and above thirty-five (35) which predispose
women to undergo caesarean section

Extreme birth weight: is the low birth below 2.5 kg and birth weight above 4.0 which can
predispose women to undergo caesarean section.

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ABSTRACT SUMMARY
The cause and related risk factor associated with caesarean section among women delivered at
Igawilo city hospital.

Caesarean section has been on the rise among pregnant women attending the maternity and labor
wards in Igawilo city hospital. The purpose of this study is to find out the cause and risk factor of
caesarean section among pregnant women delivered at Igawilo. The study design to be used is
descriptive cross sectional and the sampling technique will be probability sampling under
random sampling method. The sample size will be 264; this is due to limited time and scarce
financially resources.

Observational checklist, questionnaire and interview schedule will be used to gather information
from the maternity ward, labor wards, and reproductive health theatre registers and client files.
Data will be collected, coded, edited, clarified, analyzed and be presented in form of table, pie
charts and bar graphs.

Conclusion and recommendations will be drawn according to the findings of the research.

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 TABLE OF CONTENTS
ACKNOLWLEDGEMENT.............................................................................................................i

LIST OF ABBREVIATIONS.........................................................................................................ii

DEFINITION OF TERMS..............................................................................................................ii

ABSTRACT SUMMARY..............................................................................................................iv

TABLE OF CONTENTS................................................................................................................v

CHAPTER ONE..............................................................................................................................1

1.1 Introduction...........................................................................................................................1

1.2 Background Information.......................................................................................................1

1.3 Statement of the Problems..................................................................................................2

1.4 Rationales of the Research.........................................................................................................4

1.5 Objectives..................................................................................................................................4

1.5.1 General Objectives..................................................................................................................4

1.5.2. Specific Objectives................................................................................................................4

1.6. Research questions....................................................................................................................5

1.7.0 Variable...................................................................................................................................5

1.7.1 Dependent Variable................................................................................................................5

1.7.2 Independent Variables............................................................................................................5

1.8.0 Hypothesis..............................................................................................................................6

1.8.1 Alternate Hypothesis..............................................................................................................6

1.8.2 Null Hypothesis......................................................................................................................6

2.0 CHAPTER TWO.......................................................................................................................7

LITERATURE REVIEW................................................................................................................7

2.1 Introductions..............................................................................................................................7

2.2 Conceptual Model......................................................................................................................8

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2.3 Classifications C/S...................................................................................................................10

2.4 Indications For C/S..................................................................................................................12

2.5 Risk Factor Related to C/S......................................................................................................12

2.6 Why We Do C/S......................................................................................................................13

2.7 Complications of C/S...............................................................................................................13

3.0 CHAPTER THREE.................................................................................................................14

METHODOLOGY........................................................................................................................14

3.1 Introductions............................................................................................................................14

3.2 Study Area...............................................................................................................................14

3.3 Study Design............................................................................................................................15

3.4 Study Populations....................................................................................................................15

3.5 Selections Criteria....................................................................................................................15

3.5.1 Inclusions Criteria.................................................................................................................15

3.5.2 Exclusion Criteria.................................................................................................................15

3.6 Sampling Procedure.................................................................................................................15

3.7 Sample Size Determinations....................................................................................................15

3.8 Data Collection Techniques / Tools........................................................................................16

3.9 Data Processing and Analysis..................................................................................................17

3.10 Dissemination of Results.......................................................................................................17

3.11 Ethical Considerations...........................................................................................................17

3.12 Study Limitation and Delimitations.......................................................................................17

References......................................................................................................................................18

APPENDICES...............................................................................................................................20

Annexure I: Work Plans................................................................................................................20

Annexure II: Estimated Budget.....................................................................................................21

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Annexure III: Questionnaire – English Versions...........................................................................22

Kiambatanisho IV: Dodoso - Swahili Version..............................................................................27

Section C: Interviews Focused Question With H/C Providers......................................................35

Annexure V: Informed Consent - English Version.......................................................................35

Kiambatanisho VI : Ridhaa Ya Kushiriki Katika Utafiti..............................................................38

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 CHAPTER ONE

1.1 Introduction
On this chapter it comprises a background information’s, problem statement, rationale of the research,
broader/general and specific objectives, research questions, dependent and independent variables,
hypothesis formulations include both alternate and null hypothesis.

1.2 Background Information

Cesarean section is the delivery of the fetus, placenta, and membrane through an abdominal and uterine
incision. It may be performed of the maternal or fetal problems, obstetric or medical conditions, either
maternal request or choice. When it’s necessary, it can be more a life saving techniques for both
mother and baby.

However, the procedure is very expensive to both hospital and expected mother. A cesarean section
poses document medical risk to mother health including infections, injury to other organs, anesthesia
complication, psychological problems, and maternal mortality two to four times greater than that of
vaginal delivered. An elective cesarean section increases the risk to baby of premature birth and
respiratory distress syndromes, both of them are likely associated with multiples complications,
intensive care unit and burdensome financial cost. Even a mature baby the absences of labor increases
the risk of breathing problems and others complications. Cesarean sections can be delayed the
opportunity for early mother newborn interactions, breastfeeding and the establishment of family
bonds.

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The world health organization’s(who) states that no regions in the world would justified to having the
cesarean sections rate greater than 15% (1985) but the figure are based on theoretical estimations ,two
recent observations studies have supported that the recommendations (althabe,2006),(villar,2005) both
of studies assessed that the association between the c/s rates and mortality and morbidity in mother and
neonates have no any reductions in these indicators when the frequencies of c/s was more than 15%
but one studies shown that and increases of rate of c/s have directly to rates of interventions have
associated with high mortality and morbidity in mother and neonates (vilar,2005). Until further
research gives a new evidence rates greater than15% that my resulted to more harm than what expected
good, its therefore important to research on the cause and associated risk factor of cesarean section
among pregnant women delivered at Igawilo city hospital as to compared with the rates of who rates
and of other hospital around the world and to inform the policy maker and provide recommendations
for improving obstetric care practices.

1.3 Statement of the Problems

Despite of the effort provided by who, non-organization and government on natural childbirth
(spontaneous vaginal delivery) through educational emphasis on early antenatal visit, care and
treatment provided free, training of the pregnant women and family on benefit of natural birth, training
of obstetrician, applying of experienced person on training session on benefit of natural birth and side
effect of cesarean section. Managerial strategies like, to ensure a natural birth performed free, to
encourage a natural birth with spread painless, studying and making decision for cesarean section by
experienced physician in hospital with good facility and equipment, good observation and follow up of
criteria based audit(cba-who) on procedure for diagnosis ,treatment, use of resources available and
what are quality of life post cesarean section women and use of robson classification system on
strategy and implementation on causes of c/s.

In Tanzania, studies on caesarean section have been conducted in two referral hospitals. At
Kilimanjaro Christian medical Centre (kcmc), the trends of caesarean section deliveries from 2005 to
2010 ranges from 29.9% to 35.5%. The leading indication for operation was previous caesarean
section (worjoloh et al., 2012). While at muhimbili national hospital (mnh) the trend of caesarean
section rates from 2002 to 2011 raised from 19% to 49% (litorp, kidanto, nystrom, darj, & essén,
2013). The caesarean section rates of the two-referral hospital exceed the limit recommended by who
(nilsen et al., 2014).

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However, there is limited study on caesarean section which have been conducted and published at
Mbeya zonal referral hospital (mzrh) which is one of the referral hospitals of Tanzania located in
southern highland zone. According to hospital report of 2014 and 2015 the averages of caesarean
section rates per month ranges from 36% to 42%.

Among factors attributed can be obstetrics and non-obstetrics which are social, demographic, cultural
and economic characteristics of pregnant women and medical practice and preferences of specific
organization (orsi & chor, 2006).

However, cesarean section among pregnant women delivered at Igawilo city hospital are rising
gradually from 4% to 9% in the last years and now days there is high number of pregnant women
delivered by cesarean section compare to the spontaneous vaginal delivered.

The aim of this study is intended to find out what are the cause and risk factor contributed to cesarean
section to women delivered at Igawilo city hospital, to assess the knowledge of health care provider on
behalf of delivered procedure and competences (examination, different maneuver employed in labor
ward, use of partograph to monitor labor progress and decision making on when to perform c/s ), to
find the obstetric indication of the c/s(obstructed labor ,fetal distress ,active infection on birth canal,
breech positions or cord prolapsed), to obtain a social-cultural practices related on c/s(alcohol,
smoking, psychological factor), to obtaining of health nutritional status related to the c/s(obesity,
height of mother) at Igawilo city hospital in Mbeya. This will contribute in the body of knowledge and
provide context specific recommendations on appropriate interventions to improve medical practice
particularly caesarean section.

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1.4 Rationales of the Research

This study finding will be essential in planning of the reproductive health services, development of
protocol to be addressed in hospital and allocation of resources to maternity and reproductive health
theater. I anticipate that this study finding will help to improve of the antenatal mother management
due to the emergence obstetric and neonatal care (eonc), and will increase quality of life to patient,
baby and to provides recommendations on interventions and to develop policy brief on improving
obstetric practice especially reducing unnecessary caesarean section and finally going along to meet a
millennium development goal number 4 & 5(to reduce child mortality under five years, to improves
maternal health).

Also, this study will be the foundation for more studies to be conducted.

1.5 Objectives

1.5.1 General Objectives

To identify the causes and risk factor contributing to the cesarean section of pregnant women
delivered at Igawilo city hospital.

1.5.2. Specific Objectives

 To assess the knowledge and competent of health care provider in the labor ward.
 To identify the obstetric causes contributed to cesarean section delivered of pregnant women at
Igawilo city hospital.
 To determine the social-cultural practice related to cesarean section delivered of pregnant
women at Igawilo city hospital.
 To identify the nutrition status of pregnant women related to cesarean section at Igawilo city
hospital.

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1.6. Research questions

The question to which will guide on carried out my research will be as follow bellow;

i. What are competence and procedure required to reduce the number of pregnant women
delivered by cesarean section at Igawilo city hospital?
ii. What are the obstetric conditions causing the cesarean section of pregnant women delivered at
Igawilo city hospital?
iii. What are the nutritional related risk factors of the cesarean section of pregnant women
delivered at Igawilo city hospital?
iv. What are the social-cultural practices related to cesarean section of pregnant women delivered
at Igawilo city hospital?

1.7.0 Variable

1.7.1 Dependent Variable

The cesarean section carried out among the pregnant women delivered at Igawilo city hospital.

1.7.2 Independent Variables

1. Qualification of the health personnel on labor ward at Igawilo city hospital.

a. The competence required for healthcare personnel.
b. The experience of the procedure carried out at labor ward.

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 2. Obstetric condition related to cesarean delivered of pregnant women at Igawilo city hospital.
a. Fetal condition related causes fetal distress
b. Medical related condition like dm, anemia, epilepsy.
c. Maternal related cause obstructed labor.
3. The nutritional status related to cesarean delivered of pregnant women at Igawilo city hospital.
a. Height of the pregnant women.
b. Proportional of mass per square height (obesity).
4. The social-cultural practices related to cesarean section delivered of pregnant women at Igawilo
city hospital.
a. Alcohol
b. Smoking
c. Psychological problem
d. Age

1.8.0 Hypothesis
1.8.1 Alternate Hypothesis
i.There is chance of increased rate of pregnant women carried out cesarean section at low
experienced and competence health personnel.
ii.There increased rate of cesarean section to pregnant women whom will experience an obstetric
condition compared to normal.
iii.The obese and low height pregnant women have a high chance of carried out cesarean section
compared to normal.

1.8.2 Null Hypothesis

i. There is no relationship between a social- cultural and cesarean section to pregnant women.
ii. There is decreased chance of cesarean section to low height and obese pregnant women.

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 2.0 CHAPTER TWO
LITERATURE REVIEW
2.1 Introductions
The caesarean section is a surgical procedure for delivering a baby, placenta and the placenta
membranes by cutting through the abdominal muscles to the uterus. The first modern caesarean section
was performed by dr James Barry in cape town, south Africa on 25 th July 1826 (cronjé, 2012.).
Caesarean section is usually performed when the normal vaginal would be risk for the mother or the
baby, however nowadays mother have always requested to be done caesarean section when there are
no indications, this has led to increase in its rates (cronjé, 2012.). Different countries have different
rates.eg china 40%, united states of America 33%, Italy 40% many Asian, European, and Latin
America countries the rates are around 25%. In these countries the rates also vary from hospital to
hospital e.g. In USA in 2009 in ranged been 6.9% to 69.9 % (peskin eg, 2002; ). The average rate of cs
deliveries is 3.5% in Africa, with highest rates in south Africa (15.4%), Egypt (11.4%) and Tunisia
(8%). Chad (0.4%), Madagascar, Niger and Ethiopia (0.6%) show the lowest cs rates in the world.
Central African Republic, Burkina Faso, Mali and Nigeria all show cs rates below 2%. In east African
countries it is 2.3% (world health organization, 1985 2:436-437.).
In Tanzania, the caesarean section rates are still low about 5% in 2010 (tdhs, 2010) and 6% in 2015
(tdhs, 2015). However, the health facility-based rates are still high compared to population-based
estimates (Nilsen et al., 2014).
The study conducted in Tanzanian referral hospital between 2005 and 2010 showed that the trend of
caesarean section rates has been increasing from 29.9% to 35.5%% (worjoloh et al., 2012). Litorp et al.
(2013) study revealed that the trend of caesarean section rates from 2002 to 2011 rose from 19% to
49%. And c/s recent study shown that there is increased from 2% in1996 to 6% in 2015-16, the main
mechanism sustaining the large increased of c/s was doubling in the monthly volume of it carried out
in the public hospital, to how overall 90% procedure was in public hospital than fbo institutions with
meet the requirement of the pregnant women (bjm open, 2018).
WHO has put caesarean section rates at 15% but it is not restricting it there? It gives every woman a
chance to deliver through it, if it is the best intervention at the time of her delivery. (world health
organization, 1985 2:436-437.)

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2.2 Conceptual Model
This is a building block of existing knowledge through different literature review.
The conceptual model on determinants of caesarean section deliveries was modified from conceptual
model developed by tom joseph oguta in 2015 which describes the psychosocial determinants of
caesarean section deliveries.
Oguta’s (2015) conceptual model is based on social epidemiology theories which describes the
convergence of factors such as psychological state, personal traits, sexual behaviors, social experiences
and social interaction that link social conditions to important health outcomes.
This conceptual model is the joint of multiple factors that affect decision of caesarean section
deliveries at different levels of social environment which include individual, interpersonal, community,
organizational and public policy.
The conceptual model provides the basis for determining factors associated with caesarean section
deliveries. Hence, the concepts have been used in data collection tool and analysis to establish
determinant factors of caesarean section deliveries.

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 Figure 1. The figure below shows the conceptual model on the determinations of the caesarean
section’s delivery (oguta, 2015)

Determination of the Intervening variables

caesarean section Outcome or

delivery dependent variables

Interpersonal factor influenced

by friends, peers, collegues,
relatives and partner social
support
Non obstetric factor

Individual factor; social-

economic status, fear of
vaginal birth experiences,
educations level, occupations Mode of delivery
and belief (vaginal or caesarean
Indications for caesarean section section delivery

Maternal & fetal

indications of caesarean
sections delivery

Obstetric factor Maternal age, obstetric

history, parity,
gestations age and co-
morbidity medical
illness

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2.3 Classifications C/S
There are several categories of the c/s but most is based on characteristic of the mother as parity, model
of carried out procedures, onset of labor, gestational age, fetus presentations and number of fetus as by
Robson classifications (WHO, figure 02), however also can be listed as below;
 classical caesarean section, which involves midline longitudinal incision which allows a larger
space to deliver the baby. It is rarely performed today, as it is more prone to complications.
 An unplanned caesarean section is performed after labor pains have begun due to unexpected
labor complications.
 A crash/emergent/emergency caesarean section is performed in an obstetric emergency, where
complications of pregnancy suddenly are known during the process of labor, requiring swift
action to prevent the deaths of mother, child or both.
 A planned caesarean (or elective/scheduled caesarean), is arranged ahead of time, mostly due to
medical reasons and ideally as close to the due date as possible.
 A caesarean hysterectomy is a caesarean section followed by the removal of the uterus. This
may be done in cases of intractable bleeding or when the placenta cannot be separated from the
uterus.
 Traditionally, other forms of caesarean section have been used, such as extra peritoneal
caesarean section. (steven g. Gabbe n.d.)
 a repeat caesarean section is one that is done when a patient had a previous caesarean section.
Typically, it is performed through the old scar.
 The latitudinal caesarean section which involves a lower uterine segment section is the
procedure most commonly used today; it involves a transverse cut just above the edge of the
bladder and results in less blood loss and is easier to repair . (american congress of
obstetricians and gynecologists,n initiative of the abim foundation american congress of
obstetricians and gynecologists), , august 1, 2013,)

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figure 02 . Robson classifications (who,2015)

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2.4 Indications For C/S
The indications of caesarean section are also many as the clients to be performed on, some of them
include the following
 Large baby weighing more than 4000gm
 dystocia or prolonged labor
 Fetal death
 umbilical cord prolapsed and umbilical cord abnormalities, multilobate including bilobate and
succenturiate-lobed placentas, filamentous insertion
 uterine rupture.
 Increased maternal blood pressure and in the baby after amniotic rupture
 Increased heart rate in the mother or baby after amniotic rupture
 placental problems like low laying placenta or placenta accreta
 Abnormal presentation which can be breech or transverse positions
 Failed labor induction
There are also conditions that complicate pregnancy thus contribute to caesarean section; e.g.
 Pregnancy induced blood pressure.
 hypertension that existed before pregnancy only to complicate later in the pregnancy
 multiple births, having more than one baby in single pregnancy
 Previous scar most likely due to ruptured uterus.
 human immunodefiencyvirus infection of the mother
 Sexually transmitted infections, such as genital herpes (which can be passed on to the baby if
the baby is born vaginally or may cause obstruction during delivery
 Previous classical caesarean section.
 Prior problems with the healing of the perineum e.g. Crohn's disease)
 bicornuate uterus

2.5 Risk Factor Related to C/S

 Age >25years
 Height <150cm
 Bmi >29kg/m2
 Alcoholism
 Smoking
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  Psychological problems like depression and anxiety
 Maternal inquest for c/s
2.6 Why We Do C/S
Cesarean section is meant to assist women avoid complications that occur because of pregnancy and
birth, have safe delivery and increase the chance of the baby to survive the risks, if it were delivered
through the normal vaginal delivery, however there are risks that come around with this procedure that
can either be maternal or fetal risks.
The maternal risks have been evaluated in several countries, and they include maternal death, the
postoperative risk may be adhesions in the abdomen, incision hernia, wound infections, other are
anesthetic risks because mother are taken into theatre as emergency, some patients having not been
stuffed, others get postural spinal headaches. Patient may lose a lot of blood during operation as well.
Other maternal risk may become in the next pregnancy these include malpresentation, placenta previa
and uterine rupture. The conclusion is that these risks are minimal compared to the risks the mother
would have undergone if she would have been left to deliver through vaginal delivery. In united states
of America, the maternal mortality in caesarean section stands at 20 per 1,000,000. (liu s, (2007))

2.7 Complications of C/S

Maternal complication of ceserean sections can be injury to the organ, hemorrhage , infections, wound
complications, anaedhesia hazard, intestinal obstructions shock and eventually death due to shock.
(dutta’s2015)
When the baby is delivered by caesarean before the gestation age of 39 weeks it may get risks like
respiratory distress syndrome, increased jaundice, low blood sugars and later in life may have
developmental problems like slow learning in reading and mathematics, (anon., 2012).
According to literature reviews on caesarean section deliveries globally. It provides the impression
that, there is substantial growth of caesarean section deliveries in most of the countries around the
world. This is influenced by advance in medical technology, maternal and fetal status, demographic,
socio economic and cultural factors of women however other factors may be still unknown which need
more studies for exploring to complement with other studies in the body of knowledge.

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 3.0 CHAPTER THREE
METHODOLOGY
3.1 Introductions
This will give the information on how the research would be carried out in respect to the description of
the study area, study or research designing, study populations that would include in the research based
on inclusions and exclusion, sampling procedure, sample size determinations, data collection
techniques, tools data processing, and analysis, disseminations of the results, ethical considerations as
well as study limitations.

3.2 Study Area

The study will be conducted at Igawilo city hospital involving maternity department (labor ward, post-
natal ward and antenatal ward). Igawilo city hospital is among of the city hospital of Mbeya regions
located southern highland of Tanzania nearby uyole road to kyela. It’s had an Outpatient and Inpatient
Department Health Services, RCH, Maternity Department, Radiology, Laboratory, CTC,
Ophthalmology, Dental and Pharmacy Department.
Women admitted in the labor and antenatal ward are cared by nurse midwives, who assess the pregnant
women by taking history, conduct physical examination and initiates partograph when women are in
true labor, and then continue to monitor progress of labor, maternal and fetal condition. Also, there is a
team of medical doctors on call and specialist who reviewing the women in labor in collaborations of
nurses and midwifes. The team decides on the patient management including caesarean section, and
when the decision to perform caesarean section is made, the woman is counseled, prepared and taken
to operating theatre for surgery.
All information including history taking, physical examination, labor management, maternal and foetal
assessment and investigations are recorded and attached to patient’s files, also time and date is
recorded. After discharging the patients, the files are safely stored at the medical records office. All
deliveries are recorded in health management information system (HMIS) delivery register book
number 12 (MTUHA book number 12). This hospital saves a million of peoples around Igawilo,
uyole, and different village. The majority of the people living in this place are nyakyusa by tribe and
main activities is found to be
maize agriculture during cold conditions as a main weather conditions and much of them are
controlling a small venture.

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3.3 Study Design
The study will be used a analytical cross-sectional study in which information’s will obtained about a
cause of CS and descriptive study will be used on to identify risk factor related to the raised rate of c/s
at Igawilo city hospital.
3.4 Study Populations
The study will involve all delivered pregnant women at Igawilo city hospital who admitted at
post-natal ward to collect the information’s.

3.5 Selections Criteria

3.5.1 Inclusions Criteria
All women at post-natal ward who will be delivered based on my study and health care providers at
labor ward and postnatal.
3.5.2 Exclusion Criteria
Women who are very sick and mothers who will lose their babies will be excluded, also women who
are cognitively impaired, delivered before arriving at the hospital (baby – born before arrival) and
home deliveries will be excluded.

3.6 Sampling Procedure

Randomly sampling will be used on to select a sample to the women will be easily at post-natal ward.
The participant will be selected using a mixed small pieces of paper of written number from 1 up to 20
for every who pick one pieces of paper a number from 1 up to 10 will be included to participate and
who will pick 11 up 20 will be excluded in the study, and purposeful sampling will be used on
selection of health care provider based on my study issues.

3.7 Sample Size Determinations

In spite of large number women carried out c/s I will choose a small number who will be represent the
whole populations. And I use the following formula to determine the sample size required to complete
the research.
Sample size determination will be based on Andrew fisher’s method 1994 to obtained desired sample
size.

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 n
Formula: nf =
1+n /N
Where nf = is the desired sample size
n = is the estimated total population less than 10, 000 and
n = is the estimated sample when the estimated total population (n) is greater or equal to
10, 000.
If n = 384 and now n is 839, what is nf?
nf = 384
1+ 384
839 =263.4 approximately 264
Then I will decide on randomly sampling procedure to obtain the participant of my study.

3.8 Data Collection Techniques / Tools

The data will be collected through patient files, and administered questionnaires with both closed
ended questions in which the responses will be either ‘yes’ or ‘no’ and open ended questions in which
the respondents will respond in a narrative form based on women. The tools that will be used to collect
the information will be paper, pen, note book and questionnaires.
All women in post-natal ward will be randomly selected and interviewed by using structured
questionnaire to acquire their socio demographic characteristics, obstetric and non-obstetrics factors
associated to caesarean sections. Other information will be acquired from patient’s file such as
medical conditions and indication for caesarean section.
The questionnaire will include demographic data, maternal characteristic such as parity, gestational age
at delivery, mode of delivery, indications of cs, obstetrical and non-obstetrical factors of caesarean
delivery. Indications of cs including cephalopelvic disproportion (cpd), prolonged labor, placenta
previa, placental abruption, cardiac disease, malpresentation, foetal distress, macrosomia and multiple
fetuses. Obstetrical factors included parity, co-morbid illness, gestation age of delivery and foetal birth
weight. Non obstetrical factors included maternal request of cs, age, height, mbi, preference on the
mode of delivery, perceived safety and interpersonal influence, time and day of delivery.
The client’s data will be obtained through review of client’s records and interview using structured
questionnaire in Swahili version (annexure iv) which will be translated from English version
(appendix iii) constructed by the researcher.

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24
3.9 Data Processing and Analysis
In this study I’ll be use both qualitative and quantitative. Data will be obtained from this research study
will be manually calculated using scientific calculator and entered into a computer program of
Microsoft excel - worksheet where data will be processed and analyzed. Descriptive statistics will be
carried out to measure incidence rates and relative risk of the variables involved during the study.
3.10 Dissemination of Results
Final results of the study will be submitted to Mbeya College of health and allied science (MCHAS),
department of clinical medicine. It will be disseminated to Igawilo city hospital and finally will be
presented to the department of clinical medicine.
3.11 Ethical Considerations
The study will seek the ethical approval from MCHAS research ethic and review committee where the
permission to conduct this research will be obtained. Prior on providing questionnaire to respondents
the study should be explained to them with the purpose, benefits together with the rights of the
participants or any further clarification concerning the study will be asked.
Participants will be further given the consent form to read and for those who are unable to read will be
assisted and those who are willing to participate will sign the consent form before interview.
Confidentiality and privacy should be strictly observed, questionnaires number and initials should be
written instead of names, the information will be used for research purpose only and the participants
can be given advice.

3.12 Study Limitation and Delimitations

In a short period of time of 4 weeks will conducting the research was not enough to fulfil the research
process by 100%; the funded budget also was not enough for the whole research process.
This study will cover patients who delivered through caesarean section at Igawilo city hospital
despite presences of other hospitals that offer the similar service. The provision of letter of introduction
of the researcher to the institution where the research would be done, and I hope that everything would
go smoothly.

25
CHAPTER FOUR

4.0 PRESENTATION OF RESEARCH FINDINGS AND DATA ANALYSIS

This section describes the study findings. The description of socio demographic characteristics of
respondents are presented first followed by independent variables which are obstetrics and non obstetrics
factors associated with caesarean section deliveries. The associations between independent variables with
mode of delivery are described by using Pearson Chi square test. The logistic binary regression model is
used to estimate the impact of independent variables on CS.

4.1 Socio-Demographic Characteristics

A total of 400 respondents were interviewed and their age ranged from 15 to 43 years with the mean age of
26.81 years (SD: 6.338). 20

Demographic distribution

Age groups Frequency Percentage

15 – 24 162 40.5

25 – 34 182 45.5

35 – 44 56 14.0

Education level

No formal education 26 6.5

Primary education 154 38.5

Secondary education 168 42.0

College and above 42 13.0

Occupation status

Employed 221 55.25

Petty business 69 17.25

26
Unemployed 110 27.5

Current marital status

Married** 355 88.75

Not Married* 45 11.25

Admission category

Institutional Referral 74 18.5

Self Referral 326 81.5

Payment category

NHIF 384 1.75

Cash 9 2.25

IPPM 7 96

The majority of respondents 182 (45.5%) aged between 25 and 34, About 168 (42%) had secondary
education, and 290 (72.5%) were employed, majority of mothers 355 (88.75%) were married. Also
majority of mothers about 326 (81.5%) came direct from home (self referral) and few about 74
(18.5%) were referred from lower level hospitals. On payment category majority of mothers about
384(96%) were using National Health Insurance Fund (NHIF), 9 (2.25%) cash were using and 7
(1.75%) were under Intramural Private Practice Mbeya (IPPM) / (Fast track).

Table 2: Antenatal Clinic attendance (N = 400) ANC Attendance

Attendance Frequency Percentage

27
Attended 400 100.0

Not Attended 0 0.0

Number of visits

1–3 161 40.3

4–6 230 57.5

7+ 9 2.3

GA at first visit

4 – 12 91 22.8

13 – 24 255 63.8

25 – 36 54 13.5

Attended Private ANC

Attended 50 12.5

Not Attended 350 87.5

Attended by her special doctor

Yes 21 5.3

No 379 94.8

28
29
30
31
32
33
34
53.5%

46.5%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%

54.0%

56.0%

Vaginal delivery

Caesarean section

Mode of delivery
All women reported to attend ANC clinic with mean number of visits of 3.9 (SD =1.236) and the mean of
gestational age at first booking is 18 weeks (SD = 6.365). Also 50 (12.5%) of women were attending
private clinic and 21 (5.3%) of women were attended by special doctors when admitted for delivery.

Figure 2: Rate of caesarean section

The rate of caesarean section among 400 postnatal mothers was 186 (46.5%).

35
36
37
38
39
Demographic Rate of CS (%) P – Value
distribution

Age groups 0.00027

15-24 162 67 (41.4)

25-34 182 79 (43.4)

35-44 56 40 (71.4)

Education 0.172

No formal Education 26 15 (57.7)

Primary Education 154 69 (44.8)

Secondary Education 168 72 (42.9)

College and Above 52 30 (57.7)

Employment status ≤ 0.05

Employed 69 41 (59.4)

Petty business 221 99 (44.8)

Unemployed 110 46 (41.8)

Marital Status 0.010

Married 355 157 (44.2)

Not Married 45 29 (64.4)

Admission Category 0.027

Self Referral 326 143 (43.9)

Institutional Referral 74 43 (58.1)

Payment category 0.014

NHIF 384 174 (45.3)

40
Cash 9 5 (55.5)

IPPM 7 7 (100)

41
4.2 Obstetrics factors associated with caesarean section

Table 4: Obstetric factors; maternal height, parity, GA during delivery, birth weight and Apgar score of
infants (N = 400) Factor
Variable Frequency Percentage (%)

Height

Below 150 37 9.3

150 and Above 363 90.8

Parity

1–3 333 83.3

4+ 67 16.8

GA during delivery

28 to 36 119 29.8

37 to 42 281 70.3

Number of Newborn delivered

Single 396 99.0

Twins 4 1.0

Birth weight of the newborn

Below 2.5 kg 46 11.5

2.5 kg and above 354 88.5

Apgar Score of the newborn

7 to 10 381 95.3

4 to 6 15 3.7

0 to 3 4 1.0

Co-morbid medical conditions

42
None 361 90

PIH 16 4

Pre-eclampsia & 4 1
eclampsia

Genital warts 7 2

HIV/AIDS 12 3

Table 5: Association between obstetric factors and mode of delivery Variable

Mode of Total Chi square (χ2) P-value

delivery

Vaginal delivery (%) Caesarean section (%)

Age

15 to 24 95 (58.6) 67 162 16.410 0.000273

(41.4)

25 to 34 103 79 (43.4) 182

(56.
6)

35 to 44 16 40 (71.4) 56
(28.
6)

Height

Below 150 19 (51.4) 18 37 0.076 0.783

(48.6)

150 and Above 195 168 (46.3) 363

(53.
43
 7)

Parity

1–3 187 (56.2) 146 333 5.638 0.018

(43.8)

4+ 27 40 (59.7) 67
(40.
3)

GA during delivery

28 to 36 72 (57.1) 54 126 0.981 0.322

(42.9)

37 to 42 142 132 (48.2) 274

(51.
8)

Number of Newborn delivered

Single 212 (53.5) 184 396 0.20 0.888

(46.5)

Twins 2 2 (50) 4
(50)

Birth weight of the newborn

Below 2.5 kg 21 (38.2) 34 55 6.015 0.014

(61.8)

2.5 kg and above 193 152 (44.1) 345

(55.
9)

APGAR Score of the newborn

7 to 10 206 (54.1) 175 381 1.168 0.558

44
 (45.9)

4 to 6 6 9 (33.3) 15
(66.
7)

0 to 3 2 2 (50) 4
(50)

7 to 10 206 (54.1) 175 (45.9) 3 1.168 0.558

8
1

4 to 6 6 (66.7) 9 15
(33.3)

0 to 3 2 (50) 2 (50) 4

conditions

PIH 1 (6.3) 15 (93.8) 16 < 0.001

Pre-eclampsia & 0 (0.0) 4 (100.0) 4

Eclampsia

Maternal Infections 0 (0.0) 7 (100.0) 7

(Genital warts)

HIV/AIDS 7 (58.3) 4 (41.7) 12 > 0.05

Number of ANC visits

1 to 3 82 (53.6) 71 (46.4) 153 37.713 < 0.001

4 to 6 128 (62.1) 78 (37.9) 206

7+ 4 (9.8) 37 (90.2) 41
45
46
The results show that the increase of caesarean section rate is associated with obstetric factors, the
factors which are statistical significant are; increase of maternal age (χ 2 = 16.410, df = 2, P < 0.001),
extreme maternal age / below 18 and above 35 years (χ 2 = 41.149, df = 1, P < 0.001), increase in parity
(χ2 = 5.638, df = 1, P < 0.05), extreme birth weight of below 2.5 kg and above 4.0 kg (χ 2 = 6.015, df =
1, P < 0.05), co morbid medical conditions such as PIH, pre-eclampsia, eclampsia and maternal
infections (P < 0.0001) and increase number ANC elective CS (χ2 = 37.713, df = 2, P < 0.001).

Other obstetric factors are not statistical significant such as; maternal (χ 2 = 0.076, df = 1, P > 0.05),
gestation age during delivery (χ2 = 0.981, df = 1, P > 0.05), APGAR score of the newborn (χ 2 = 1.168,
df = 2, P > 0.05), number foetuses delivered (χ2 = 0.20, df = 1, P > 0.05) and HIV/AIDS was not
statistical significant (P > 0.05)

74.2%

25.8%

Type of caesarean section

Emergency CS

Elective CS

4.4 Indications of caesarean section delivery

This section comprise description of following is made; types of CS, number of CS done, indications of CS
and client’s satisfaction of the procedure.

Figure 3: Type of caesarean section

The majority of caesarean section conducted were emergency CS which accounted for 138 (74.2) while 48
(25.8) were elective caesarean section.

Table 6: Number of caesarean section done

47
Number of CS Frequency Percentage (%)

1 117 62.9

2 60 32.3

3 8 4.3

4 1 0.5

Total 186 100.0

48
of caesarean section (N = 186)

Indications Frequency Percentage (%)

Previous scar 69 37.1

Cephalo-Pelvic 35 18.8
Disproportional (CPD)

Non reassuring foetal status 22 11.8

(foetal distress)

Malpresentation 22 10.7

PIH 16 8.6

Prolonged labour 15 8.1

Genital warts (Maternal 7 3.8

infection)

Bad Obstetric History 6 3.2

Pre-eclampsia & Eclampsia 4 2.1

Cord around the neck 2 1.1

Polyhydromnious 1 0.5

Cancer of the cervix 1 0.5

Calcified placenta 1 0.5

49
Client satisfaction on CS Frequency Percentage (%)
decision Client satisfaction

Information on benefits & Risks of CS

Yes 27 14.5

No 159 85.5

Understood all information

Yes 23 12.4

No 163 87.6

Had opportunity to ask questions

Yes 21 11.3

No 165 88.7

Information help to consent for CS

Yes 27 14.5

No 159 85.5

Satisfied with decision of CS delivery

Yes 181 97.3

No 5 2.7

Prior consenting for CS, most of clients of about 159 (85.5%) were not given enough
information on risks and benefits of CS and didn’t understand what they were told, however
181 (97.5%) of the women were satisfied with the decision of undergoing CS.

1
4.6 Bivariate analysis of non obstetric factors associated with caesarean section deliveries

Cross tabulation of non obstetric factors and mode of delivery using chi-square was conducted to
establish the association, P – value was set to be statistical significant at cut of point of 0.05.

Table 9: Association between non obstetric factors and mode of delivery

Variable Mode of Total Chi square (χ2) P-value

delivery

Vaginal delivery (%) Caesarean section (%)

Time of delivery

Day time 164 (51.6) 154 (48.4) 318 2.317 0.128

Night time 50 (61) 32 (39) 82

Day of delivery

Weekdays 171 (53.9) 146 (46.1) 317 0.121 0.728

Weekend 43 (51.8) 40 (48.2) 83

Marital status

Married 198 (55.8) 157 (44.2) 355 6.563 0.010

Not married 16 (35.6) 29 (64.4) 45

Payment category

Cash 4 (44.4) 5 (55.6) 9 8.568 0.014

NHIF 210 (54.7) 174 (45.3) 384

IPPM 0 (0.0) 7 (100.0) 7

Employment status

Employed 28 (40.6) 41 (59.4) 69 5.857 005

Small business 122 (55.2) 99 (44.8) 221

2
Unemployed 64 (58.2) 46 (41.8) 110

Education level

No formal 11 (42.3) 15 (57.7) 26 5.002 0.172

Education

Primary Education 85 (55.2) 69 (44.8) 154

Secondary Education 86 (57.1) 72 (42.9) 168

College and Above 12 (28.8) 30 (71.4) 42

The results show that the increase of caesarean section rate is associated with non obstetric
factors, the factors which are statistical significant are; marital status, CS rate is higher among
unmarried women (χ2 = 6.563, df = 1, P < 0.05), CS rate is higher among women with high
economic status under fast track (χ2 = 8.568, df = 2, P < 0.05) and women who are employed

(χ2 = 5.857, df = 3, P ≤ 0.053).

The other factors were not statistical significant such as; time of delivery (χ 2 = 2.317 df =1, P >
0.05), day of delivery (χ2 = 0.121 df =1, P > 0.05) and education level (χ2 = 5.002 df =3, P >
0.05)

67.7%

3
64.5%

19.4%

6.5%

6.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Previous birth

experience

Prior CS delivery

Fear of vaginal

birth

Fear of losing

the baby

History of Intra

Uterine Fetal

Death

Factor influencing CS pref

4
The factor which influenced women to prefer caesarean section delivery are; previous birth
experience 21 (67.7%), prior CS delivery 20 (64.5%), Fear of vaginal birth 6 (19.4%), fear of
losing the baby 2 (6.5%) and having history of Intra Uterine Foetal Death (IUFD) 2 (6.5%).

Table 10: Individuals influencing choice of delivery among women

Influencing people Frequency Percentage (%)

Individual choice 342 85.5

Health care provider 222 55.5

Friends 90 22.5

Relatives 14 3.5

Partner 10 2.5

Colleagues 1 0.25

women about 18 (4.5%) perceived caesarean section as safe mode of delivery while the
majority 382 (95.5%) perceive vaginal birth as the safe mode of delivery.

Table 11: Reason for perceiving CS as the safe mode of delivery

Reasons for perceived Frequency Percentage (%)

safety of CS

Reassurance of getting a 13 72
live baby

No labour pain 3 17

CS prevents 9 50
unnecessary neonate
5
death

Fear of labour pain / 32 8.0

vaginal birth

Desire for their 32 8.0

vaginal to remain
intact

Desire for the baby 4 1.0

with high IQ

Lack of exercise and 112 28.0

laziness during
pregnancy

Health problems 119 29.8

during pregnancy

Prevention of 36 9.0
neonatal death during
delivery

Use of herbs 1 0.3

Use of contraceptives 20 5.0

Teenage pregnancy 14 3.5

Prevention of 5 1.3
transmission of
infection to infant.

Obesity 45 11.3

Influence of Health 7 1.8

Care Provider

Fear of losing the 1 0.3

6
babies

Desire to deliver few 2 0.5

babies

Participants had reported several factors which influences increase of caesarean section
deliveries such as fear of labour pain / vaginal birth 32 (8%), desire for their vaginal to remain
intact 32 (8%), desire for the baby with high IQ 4(1%), lack of exercise and laziness during
pregnancy 112 (28%), health problems during pregnancy 36 (9%), prevention of neonatal death
during delivery 36 (9%), Use of herbs 1 (0.3), use of contraceptives 20(5%), teenage pregnancy
14 (3.5%), prevention of transmission of infection to neonates 5 (1.3%), obesity 45 (11.3%),
influence of Health Care Provider 7 (1.8%), Fear of losing the babies 1 (0.3) and desire to
deliver few babies 2 (0.5%)

Logistic regression on factors associate with Caesarean Section

Factor Crude OR 95% CI P –Value Adjusted 95% CI P – Value

OR

Maternal 5.296 3.086 – 0.0000 4.456 2.404 – 0.000

age 9.091 8.258

Occupation 0.982 0.782 – 0.873 2.303 1.135 – 0.021

1.232 4.672

Birth 0.271 0.271– 0.016 1.564 0.798 – 0.193

weight 0.872 3.066

Parity 0.527 0.309 – 0.019 1.006 0.508 – 0.986

0.899 1.991

Marital 0.437 0.229 – 0.012 0.367 0.173 – 0.009

status 0.834 0.780

Number of 0.066 0.023 – 0.00 0.071 0.029 – 0.000

ANC visits 0.192 0.029

7
Payment 2.170 0.752 – 0.152 0.000 0.000 0.999
category 6.260

Time of 0.682 0415 – 0.129 1.774 0.980 – 0.058

delivery 1.118 3.212

For identifying true predictors of CS, logistic binary regression model by using Hosmer and
Lemeshow Test was done. Women with extreme age (below 18 years and above 35 years) were
4 times likely to deliver by CS (AOR = 4.456, 95% CI: 2.404 – 8.258, P < 0.001), also
employed women were 2 times likely to delivery by CS (AOR = 2.303, 95% CI: 1.135 –
4.6721, P < 0.05), other factors like extreme birth weight (AOR = 1.564, 95% CI: 0.798 –
3.066) and high parity (AOR = 1.006, 95% CI: 0.508 – 1.991) show the risk of caesarean
section deliver although was not statistical significant (P > 0.05). Other factors didn’t show the
risk of CS deliver and were not statistical significant.

Factor Crude OR 95% CI P –Value Adjusted 95% CI P – Value

OR

Maternal 5.296 3.086 – 0.0000 4.456 2.404 – 0.000

age 9.091 8.258

Occupation 0.982 0.782 – 0.873 2.303 1.135 – 0.021

1.232 4.672

Birth 0.271 0.271– 0.016 1.564 0.798 – 0.193

weight 0.872 3.066

Parity 0.527 0.309 – 0.019 1.006 0.508 – 0.986

0.899 1.991

Marital 0.437 0.229 – 0.012 0.367 0.173 – 0.009

status 0.834 0.780

Number of 0.066 0.023 – 0.000 0.071 0.029 – 0.000

ANC visits 0.192 0.029

8
Payment 2.170 0.752 – 0.152 0.000 0.000 0.999
category 6.260

Time of 0.682 0415 – 0.129 1.774 0.980 – 0.058

delivery 1.118 3.212

For identifying true predictors of CS, logistic binary regression model by using Hosmer and
Lemeshow Test was done. Women with extreme age (below 18 years and above 35 years) were
4 times likely to deliver by CS (AOR = 4.456, 95% CI: 2.404 – 8.258, P < 0.001), also
employed women were 2 times likely to delivery by CS (AOR = 2.303, 95% CI: 1.135 –
4.6721, P < 0.05), other factors like extreme birth weight (AOR = 1.564, 95% CI: 0.798 –
3.066) and high parity (AOR = 1.006, 95% CI: 0.508 – 1.991) show the risk of caesarean
section deliver although was not statistical significant (P > 0.05). Other factors didn’t show the
risk of CS deliver and were not statistical significant

CHAPTER FIVE
5.0 DISCUSSION

This study aimed at assessing factors associated with caesarean section deliveries which are
obstetric factors and non obstetrics factors. Among 400 post natal mothers who were
interviewed 186 (46.5%) delivered by caesarean section.

Obstetric factors associated with caesarean section deliveries were as follows;

The results revealed that rate of caesarean section increase with increase in age, from 41% in
age group 15 to 24 to 71% in age group of 34 to 44. This study can be comparable to the study
conducted at MNH by (Muganyizi et al., 2008) which showed that the age group of 30 to 34
had highest risk of caesarean deliveries. Also is supported by another study conducted in UK
9
which revealed that the risk of caesarean section is increasing with maternal age (Black et al.,
2005). Pregnancy in older adults is accompanied with the risks such as; pre term births,
pregnancy induced hypertension, pre –eclampsia, foetus with genetic abnormalities, these risks
predispose them to caesarean section delivery.

Moreover this study showed the risk of caesarean section delivery is four times higher in
women aged below 18 and above 35 years. Also the results shows that, the rate of caesarean
section for under 18 is very high about 93.3% (P<0.001), this is due to the risks of premature
labour, low birth weight, pregnancy induced hypertension, poor progress of labour and social
consequences increases the risks of caesarean section delivery.

Another factor is parity which shows that the caesarean delivery rate increases with parity,
mothers who are para four and above have high rate of caesarean section. High parity has been
associated with pregnancy complications which predispose women to caesarean section
delivery. This study is also comparable to the study conducted at MNH by (Muganyizi et al.,
2008) which shows nulliparous mothers have lowest caesarean section rates while those with
previous caesarean deliveries have more than double risk of delivering by caesarean section. 39

Another obstetric factor is birth weight; findings showed that the rate of caesarean section
increases with increase extreme birth weight (below 2.5 kg and above 4.0 kg) the rate is 62%
while normal birth weight of 2.4 kg to 4.0 kg the rate is 44%. The study is related to the study
conducted in Oman by (Busaidi et al., 2012) which shows that extremes of neonatal birth
weight (<2.50 kg and ≥4.00 kg) were positively associated with caesarean section delivery.
Also the study by (Yoshioka-Maeda et al., 2016) revealed that women delivering babies with
low birth weight are at high risks of caesarean deliveries which can contributed by adverse
conditions like pregnancy induced hypertension and pre-term birth. Moreover is supported by
the study conducted in Lagos by (Olusanya et al., 2016) which showed low birth weight is
associated with the risk of caesarean delivery.

The results show that gestation age during delivery, maternal height and Apgar score of the
newborn had no significant in associating with caesarean delivery. This study is in contrast
with the study by (Yoshioka-Maeda et al., 2016) which showed that mothers with height below
150 cm are at risk of caesarean section deliveries. However this study had few participants with
maternal height below 150cm, mean height of respondents was 153.53cm.

10
Another factor is co-morbid illness which is associated with high risks of caesarean deliveries
such pregnancy Induced Hypertension (PIH) 93.8%, pre-eclampsia / eclampsia 100%, genital
warts 100%, however HIV/AIDS had low contributions to caesarean section deliveries of about
41.7%. The co morbid illness is explained by large number of caesarean deliveries as almost
95.7% of were under medical indications; the co-morbid illness has been associated with
pregnancy and labour complications which increases the risks of caesarean deliveries.

Furthermore, the results show that increase of caesarean section rate is associated with
increased number of ante natal visits (P < 0.001), the higher rate was elective caesarean section
as compared to emergency caesarean section (P < 0.001). This explains that co-morbid illness
contributed to many caesarean section deliveries as high risks pregnancy were closely observed
by nurse and midwives hence had many ante natal visits. 40

Indications of caesarean section deliveries were as follows;

Majority of caesarean section conducted were emergency and accounted for 138 (74.2%) while
elective caesarean sections were 48 (25.8%). This study is similar to the study conducted at
MNH, which revealed that majority of caesarean section deliveries were by emergency
caesarean section which indicates that some women could have been delivered by elective
caesarean section (Mdegela et al., 2012). This also explains the reason why 95.7% of caesarean
section was conducted under medical indication while 4.3% were under maternal request
however was medically justified.

The leading indications of CS were previous scar 69 (37.1%), CPD 35 (18.8%), foetal distress
22 (11.8%), PIH/Pre-eclampsia 20 (10.8%), malpresentation 22 (10.7%) and prolonged labour
15 (8.1%) , this study is corroborates with the study conducted in Sub Saharan by (Kathyrin-
Chu et al., 2016) which revealed that; the most common indications of caesarean deliveries
includes; obstructed labour (31%), malpresentation (18%), previous Caesarean section (14%)
and foetal distress (10%), uterine rupture (9%) pre- eclampsia/eclampsia and ante partum
haemorrhage.

The non obstetric factors associated with caesarean deliveries include the following;

Socio economic status which is explained by category of payment and occupation which
reveals that the rate of caesarean section is higher among women with high socio economic
status as the rate for IPPM/fast track category of payment was 100% and employed women

11
59% compared to other category of payment and employment status. This can be compared
with Tanzania Demographic and Health Survey, 2016 which shows that women with high
socio economic status are eight times likely to deliver by caesarean section.

It is observed that the rate of caesarean section is higher among single women (61%) than
married women (45%). This can explain that social and economic support from the partners
reduces risks of caesarean section delivery. However the study is in contrast with the study by
(Inyang-Otu, 2014) revealed that there is no statistical significance in association between
marital status and mode of delivery. 41

Another factor is maternal request and preference. The study reveals that very few women
about 8 (4.3%) request caesarean section as well as very few preferred 31 (7.8%) caesarean
section delivery. This is similar to the study conducted in Italy which shows 6.4% preferred
caesarean delivery while majority preferred vaginal birth ( Gamble, Health, & Creedy, 2001),
also is supported by the study conducted in Dar es salaam which shows that majority of women
preferred vaginal birth (Litorp, 2015). Furthermore the study revealed that majority of women
about 170 (91.4%) has desire for vaginal delivery after undergoing caesarean section. Most
women prefer and desire vaginal birth because it is natural process with fewer complications
and are healed within short time compared to caesarean section delivery.

Among few women who preferred caesarean deliveries they are influenced previous birth
experience, prior caesarean section delivery, fear of vaginal birth, fear of losing the baby and
having history of Intra Uterine Foetal Death (IUFD). These factors have been attributed by
influence of friends, health care provider and relatives and previous birth experience which
influences them to have favourable attitude towards caesarean section deliveries.

Also majority of women about 85.5% reported to have individual choice on the mode of
delivery, 55.5% are influenced by health care provider, 22.5% influenced by friends and the
rest were influenced by relatives, partners and friends. Hence health care provider plays the
major role in influencing women on the mode of delivery. This study is supported by the study
done by (Litorp, 2015) which reveals that health care provider has emphasis in counselling
women on mode of delivery especially caesarean section.

Moreover few women about 18 (4.5%) perceived caesarean section as safe mode of delivery.
The reason for their perception is related to their previous birth experience such as; reassurance
of getting a live baby and prevention of unnecessary neonate death.
12
Moreover the factors associated with caesarean delivery explored from women were such as
fear of labour pain / vaginal birth this is supported by the study by (Storksen et al., 2001) which
reveals that fear of vaginal birth and previous birth experience contributes to caesarean
delivery. Also other explored factors were desire for their vaginal to remain intact (concern on
42

sexual practices), desire for the baby with high IQ, lack of exercise and laziness during
pregnancy, Health problems during pregnancy, Prevention of neonatal death during delivery,
Use of herbs, Use of contraceptives, teenage pregnancy, Prevention of transmission of infection
and diseases to infant during delivery, Obesity, Influence of Health Care Provider, fear of
losing the babies. The factors reported by women are due to their previous birth experience,
interpersonal and social influence and perception of caesarean delivery with the community.

These factors are moderate similar to the study conducted by (Oguta, 2015) on psychosocial
determinants of caesarean section delivery which are fear of child birth, concern on sexual
function, also another comparable study revealed that previous negative birth experience,
previous caesarean delivery, complicated pregnancy are associated with caesarean deliveries
(Handelzalts, Fisher, Lurie, Shalev, & Golan, 2011)

According to the conceptual model guided this study on the determinants of caesarean section
delivery. The study had identified that most of the obstetric factors such as maternal age,
parity, and co-morbid medical illness had contributed to caesarean section deliveries and non
obstetric factors involved economic status and social support and indications remained to be
foetal and maternal indications.

5.1 Conclusion

The rate of caesarean section at Mbeya Zonal Referral hospital is relatively high. There is the
need to reduce to the reasonable/optimum rate; this can be achieved by reducing unnecessary
cesarean deliveries among women with low risks. Health care providers should be aware of the
risks of unnecessary caesarean section as well as women should be fully informed on benefits
and risks of caesarean section

13
2 Study limitation and strength

Study limitation

The study was conducted in public referral hospital only which might miss some of the non
obstetric factors in private hospitals. The results may not be generalized to other settings of lower
level and general population.

Missing some information which was acquired from patients records such as maternal height, birth
weight, Apgar score and gestation age during delivery.

Strength

The rate of caesarean section in Tanzania is 6% and the rate of caesarean section at Mbeya Zonal
Referral Hospital is 46.5%. This was the appropriate setting to assess factors associated with
caesarean section. Also due to limited published studies conducted at Mbeya Zonal Referral
Hospital, this study is the foundation for other studies to be conducted.

5.3 Recommendations

The study shows that caesarean section deliveries have been largely contributed by medical
indications whereby leading indication was previous scar, so prevention of unnecessary primary
caesarean section may reduce caesarean section deliveries; also maternal age and parity are factors
which mainly contributed to caesarean section delivery however majority of women prefers vaginal
delivery even after caesarean section. This may enhance conducting safe vaginal birth after
caesarean section. To improve the practice of conducting caesarean section the following is
recommended.

1. Ministry of Health, Community Development, Gender, Elderly and Children may incorporate the
Midwives Model of Care in Reproductive and Child Health (ANC and Post partum care) services
which focuses holistically on the well being of the mother throughout the pregnancy and
postpartum as emphasis natural birth and reduces the number of high risk pregnancies and the need
for caesarean section.

44

2. Ministry of Health, Community Development, Gender, Elderly and Children may consider
strengthening family planning services to increase coverage and emphasis on youth friendly

14
reproductive health services; this will reduce high parity and teenage pregnancy and hence reduce
caesarean section deliveries.

3. Ministry of Health, Community Development, Gender, Elderly and Children - Training

department should advocate to incorporated midwifery care model in medical and nursing training
at all levels to ensure students are well prepared to provide holistic care to pregnant women.

4. Mbeya Zonal Referral Hospital should develop and operationalise guideline for safe conduct of
vaginal birth after caesarean section as leading indication for CS is previous scar.

5. Mbeya Zonal Referral Hospital management should consider regular coaching of staff on
appropriate foetal monitoring.

6. Mbeya Zonal Referral Hospital management may plan to conduct audit for caesarean section.

7. Health Care Provider (Midwives and Doctors) should provide psychological support to women
throughout pregnancy until delivery and emphasis on natural birt

15
REFERENCE

aidan m, e. G. (n.d.). Tanzania mothers’ cultural belief and misinformation regarding the
reason for caesareans sections. Aku.
Alan h. Decherney, m. L. (n.d.). Current diagnosis and treatment in obstetrics and
gynaecology. S.l.:s.n.
Andrea b.p, f. O. (n.d.). Caesarean section provisions and readiness in tanzania: analysis of
cross-sectional survey of women and health facility over times .bmj open access.
Betran, a. P. (n.d.). Who statement on caesarean section rates. Bjog: an international journal
of obstetrics & gynaecology.
Cronjé, h. 2. (n.d.). "clinical obstetrics. A south african perspective". 3rd ed. In: s.l.:s.n., p. 3:
345..
Dc dutta’s (2015), t. O. (n.d.). Editions 8, by jaypee bmp, chapter 37, pg 692-702.
Esteves-pereira, a. P.-t.-p.-c. (2016). Caesarean delivery and postpartum maternal mortality: a
population-based case control study in brazil. Plos one, 11(4), e01533.
H., a. ((2017), ... ). Improving the quality of caesarean sections in low-resources setting. An
intervention by criteria –based audit at a tertiary hospital, dar es salaam, tanzania.
Liu s, l. R. (n.d.). Maternal mortality and severe morbidity associated with national
collaborating centre for women's and children's health., 2004. Caesarean section: .
Louse c, j. E. (n.d.). 20 editions, chapter 13, and pg 446- 476.
Oguta, t. J. (n.d.). Psychosocial determinants of elective cesarean section deliveries in selected
obstetric facilities in nairobi, kenya (doctoral dissertation, walden university, 2015).
Walden dissertations and doctorial studies, 12(04).
Orsi, e. D. (n.d.). (2006). Factors associated with cesarean sections in a public hospital in rio
de janeiro , brasil, 22(10), 2067–2078.
Peskin eg, r. G. (n.d.). . What is the correct caesarean rate and how we get there?. Obstetrical
& gynaecological survey , pp. 57:189-190..
Report, m. Z. ((2015).). Annual hospital deliveries report of 2015, mbeya, tanzania.
Souza, r. D. (n.d.). Best practice & research clinical obstetrics and gynaecology caesarean
section on maternal request for non-medical reasons : putting the uk national institute
of health and clinical excellence guidelines in perspective. Ybeog, 27(2), .
Thomas j, p. S. (n.d.). Royal college of obstetricians and gynaecologists clinical effectiveness
support unit. The national sentinel caesarean section audit, london, united kingdom::

16
 rcog press.
Worjoloh, a. ,. (n.d.). Trends in cesarean section rates at a large east african referral hospital
from 2005-2010. Open journal of obstetrics and gynecology, 2(03), 255.
World health organization, 1. 2.-4. (n.d.). Appropriate technology for birth., geneva: lancet ;. .
Ye, j. Z. (n.d.). Association between rates of caesarean section and maternal and neonatal
mortality in the 21st century: a worldwide population‐based ecological study with
longitudinal data. Bjog: an international journal of obstetrics & gynaecology,
1111/1471-0528, 13592.

17
 APPENDICES
Annexure I: Work Plans

Activities Time Responsible

Date First week Second week Third week
Travelling to the study 07-08 November Researcher and
site supervisors
09-10 November District hospital
Orientation staff and researcher
Preparation of title and 28 norvember-3 Researcher and
objective of the research December supervisor
proposal
Preparation of research 4-12 December Researcher and
proposal supervisor
Adapting changes in 4-19 December Researcher and
research proposal supervisor
Presentation and 19-23 December Researcher and
submission of research supervisors
proposal
Data collection 26-3 January Researcher
Data analysis and data 4-6 January Researcher
processing
Report writing 6-12 January Researcher
Report presentation and 12-24 February Researcher and
submission supervisors

Table o1: Projected work plan

18
Annexure II: Estimated Budget
Items Days Quantity unit cost total cost
Stationeries        
Pen   5 200.00 1,000.00
Rubber   1 500.00 500.00
Pencil   5 100.00 500.00
Ruler   1 500.00 500.00
Notebook   2 1,000.00 2,000.00
Duplicating paper (ream)   1 15,000.00 15,000.00
Stapler pins   1 1,000.00 1,000.00
Correction fluid   1 1,000.00 1,000.00

Secretarial services      
Printing and photocopying research
proposal   1 5,500.00 5,500.00
Printing and photocopying research work   1 15,000.00 15,000.00
Binding research work and research
proposal   1 1,000.00 1,000.00
Meals 28   1,000.00 28 ,000.00
Transportation  28   1,400.00 39,200.00
Accommodations 28   1,500.00 42,000.00
Communications 28   500.00 14,000.00
Contingency fund       10,000.00
Grand total       167,200.00
Table 2: estimated budget

19
Annexure III: Questionnaire – English Versions
Section A: Demographic
(encircle one’s correct answers)
Age

Marital status 1. Married

2. Divorced
3. Widowed
4. Single

Educational level 1. Primary level

2. Secondary level
3. A level
4. University
5. Uneducated

Occupation 1. Government job

2. Business woman/man
3. Farmer
4. Other
5. Unemployed.

Are you living with father of your child or husband? 1.yes

2. No

Category of payment 1.NHIF

2.cash

3.examptions

20
 Section B: Assessment of C/S
(tick where it is no or yes and writing were indicated)
Part 1. Obstetric information’s
Month of admission _____________study number ----------------- ADM-
NO___________________ age- (years) ____________
D.O.A ________________time. _______________D O D__________________.
Weight------------------------------
Highest level of education 1. none ________ 2. primary ________3. secondary________
4 tertiaries__________ _occupation_____________
Residence of patient’s location__________________
Parity ________________previous abortions_____________
gravidity_______________________________________________

Part 2. Antenatal Clinic Information’s

Did you attend antenatal clinic? Yes-----------2. No ------------------
If yes, how many visits did you attend anc? (check the anc card) _________________
What was the gestational age at first booking? (check the anc card) ________________.
Do you have been attending and visits in private clinic?
1) yes -----------------2) no---------------

Do you have currently attended by your special doctor?

1) Yes ----------------2) no-------------

Part 3: Obstetric Factor Associated to Caesarean Section Delivery

Height of the mother (check antenatal card) ____________ date of diagnosis of c/s_____
section________________________ What was the gestational age during delivery? (check the file) _________

What was the birth weight of the newborn(s)? (check the file) _______________________

How many infants did you gave birth 1) single tone fetus ------------2) multiple fetuses--------

Did you have any medical conditions? (check file & records multiple responses)

21
1) none-------- 2) gestational diabetes mellitus ---------

Cardiac disease -----------------4) pregnancy induced hypertension------------

5) pre – eclampsia /eclampsia -----------------6) HIV / aids -----------------

7) infections --------8) others specify_____

What was your mode of delivery?1) vaginal delivery-------2) caesarean section delivery---------

Part 4: Indications of Caesarean Section Delivery

If you have delivered by caesarean section answer the following question;

when was cs planned

1) before labor (elective cs) ------ (2. During labor (emergency cs) -----------

how many times have you undergone cs? ________________

Before coming to hospital, what was the mode of delivery did you expect to deliver? 1)
vaginal delivery___________2) caesarean section delivery________

Indication of c/s
________________________________________________________________

C/s done by 1) consultant_________ 2) medical officer_______ 3) medical officer

intern______ 4) clinical officer________

Time of c/s____________ not indicated. _____________duration of

c/s_____________________________

What was the foundation of decision making? 1) medical indication____2) maternal

request_________

If medical indication, what was the indications of cs? (check file)

__________________________________

Who made decision of conducting cs? 1) health care provider______2) client_____3) client’s
partner____4) other ____________________

22
Did your doctor or midwife explain to you the benefits and risks of cs? 1) yes ____2)
no________

Did you understand all information? 1) yes _____2) no_________

Did you have opportunity to ask questions? 1) yes_____ 2) no______

Did the information help you to consent for operation? 1) yes______2) no_____

Were you satisfied with decision of caesarean section delivery? 1) yes _______2)
no______

Interoperation complication

1. None_____________ 2.
Complications______________________.3.not
indicated______________________

Outcome of c/s

Mother a) alive. ________________b) death. _____________c) cause

_____________________.

Baby

. An alive______ Apgar. Score.

1min________2min__________10min________________

a. Asphyxia _______________c) death_____________ cause

___________________________

Post-Operative Care of The Mother

Duration in the ward (days)---------- reasons for the stay a) cannot afford to pay
_____. b) child sick .c) premature _____________d) other complications

b. complication in the ward none a) _______b) bleeding__

23
 ______c) infections_______d) burst abdomen___________

E) vesical -vaginal fistula________f) delayed would healing___g)

others ________________________

Do you have desire for vaginal delivery after this caesarean section delivery?
1) yes______ 2) no___________

Par 5: Non-Obstetric Factors Associated with Caesarean Section Delivery

(tick √ in the box the appropriate answer)

What was the time of delivery? (check file)

_________________________

What was the day of delivery? E.g. (Monday, Saturday and Sunday)

_____________________________

Which mode of delivery was your best choice?

1) vaginal delivery_______2) caesarean section_______

If your choice was cs, what influenced your decision? (tick all that applies) 1) previous birth
experience_____2) fear of vaginal birth (ask why?)
_____________________________________________________________

3) prior caesarean section delivery________________4) others____________

Who influenced your choice? (tick all that applies)

1) Health care provider ____________2) partner__________

3) friends _________4) co- workers_________5) relative

6) individual’s choice______7) others_______

Which mode of delivery did you believe was safe for you and the baby?
1) vaginal delivery _______2) caesarean section______3) none______

If you think cs is safe, why?

24
If you are advising a relative, friend or colleague on safe mode of delivery, which mode
will you influence her to opt? 1) vaginal delivery______
2) Caesarean section ____________

What do you think causes women to deliver by caesarean section?

_________________________________________________________

25
Kiambatanisho IV: Dodoso - Swahili Version
Sehemu A: Taarifa Binafsi

(weka alama ya tiki (√) katika boksi la jibu ulilochagua)

Una umri gani?_____________________

Kiwango chako cha elimu?

1) sijasoma ______2) elimu ya msingi_______3) elimu ya sekondari___________

4) elimu ya juu – chuo________

Je, unafanya kazi gani?

1)umejiajiri_______2)umeajiriwa_______3)mfanakazi wa afya _____4)sina

kazi

Hali yako ya ndoa ? 1)umeolewa _______2) hujaolewa__________3)

talaka______4) mjane______

Je unaishi na baba wa mtoto au mume wako?

1) ndiyo__________2) hapana_______

Umekuja hapa hospitali ni kwa mfumo upi?

1) rufaa (referral)________ 2) umetoka nyumbani (self-referral) __________

Unalipia huduma kwa mfumo gani

1) unalipia fedha (cash)______ 2) bima ya afya______4) msamaha

(exemption) _______

26
Sehemu Ya B: Uchunguzi Wa Kujifungua Kwa Upasuaji

(weka alama ya tick(√) pale ambapo ni ndiyo au hapana na vile

unavyotakiwa kuandika jibu)

Sehemu ya 1. Taarifa za mimba

Mwezi uliokuja hospitalini _____________namba ya ngapi -----------------

namba ya kuingia hospitalini ___________________ mwaka ____________

Siku ipi ________________muda _______________siku ya

kujifungua__________________. Uzito------------------------------

Kiwango cha elimu ya juu 1.sijasoma ________ elimu ya msingi

________elimu ya sekondari________

Elimu ya chuo__________unafanya kazi ipi_____________

Unaishi wapi __________________

Una watoto wa ngapi ________________umeshawahi kutoa mimba

_____________ idadi ya mimba ulizowahi kuwa nazo
_______________________________

Sehemu ya 2. Taarifa za kliniki ya ujauzito

Je, ulihudhuria kliniki ya ujauzito (anc)?

1) ndiyo_________2) hapana________

Je, ulianza kliniki mimba ikiwa na wiki ngapi (ga)? (angalia kadi ya kliniki)
_______________________

je ulikuwa unahudhuria kliniki ya binafsi kabla ya kujifungua?

1) ndiyo_______2) hapana________

Kama ndiyo, ulihudhuria mara ngapi? (angalia kadi ya

kliniki)__________________

27
Je kwa sasa hapa hospitalini, unahudumiwa na daktari wako maalumu?

1) ndiyo________2)hapana________

Sehemu Ya 3: Sababu Za Kiafya (Obstetric Factors) Zinazosababisha Kujifungua Kwa Njia

Ya Upasuaji

(weka tiki √ katika boksi la jibu sahihi)

Urefu wako ni sentimita ngapi) (angalia kadi ya kliniki) ____________

Siku uliambiwa utajifungulia kwa upasuaji___________ muda ulioambiwa utajifungulia

utajifungulia kwa upasuaji ________________________

Je, hii ni mimba ya ngapi? __________

Je, ulijifungua mimba ikiwa na umri gani (gestational age)? (angalia faili______________

Uzito wa mtoto / watoto: ________________________(angalia faili)

Apgar score ya mtoto: _______________________ (angalia faili)

Umejifungua watoto wangapi? 1) mmoja __________2) mapacha

______

Je ulikuwa na shida yoyote au ugonjwa wakati waujauzito? (angalia faili, jibu zaidi ya moja)
1) hapana______2) kisukari (diabetes mellitus_____3) ugonjwa wa moyo

4) shinikizo la damu wakati wa ujauzito (pih)_____ 5) kifafa cha mimba (pre – eclampsia /
eclampsia)_______ 6) vvu / ukimwi_______7) maambukizi ya mama_____

8) nyinginezo_______________

Je ulijifungua kwa njia gani? 1) kawaida_____2) upasuaji______

28
29
Sehemu Ya 4: Sababu Za Kitaalamu (Indications) Za Kukufanyia Upasuaji

(weka tiki √ katika boksi la jibusahihi)

Kama ulijifungua kwa njia ya upasuaji, jibu swali yafuatayo

Je uamuzi wa kufanya upasuaji ulifanyika wakati gani

1) wakati wa ujauzito (elective)_______ 2) wakati uchungu umeanza

(emergeny)______ ______

Ni mara ngapi umejifungua kwa njia ya upasuaji________________

Je, kabla hujaja hospitali ulitegemea utajifungua kwa njia gani?

1) Njia ya kawaida_________2) upasuaji______

Sababu ya kufanyiwa upasuaji aji

________________________________________________________________

Ulifanywa na nani 1) mshauli aliyebobea _________ 2) daktari_______ 3) daktariari

aliyeko mafunzoni ______ 4) tabibu ________

Muda wa kufanyiwa upasuaji____________ ilikuwa ya lazima____________mudada

ulitumika_____________________________

Je maamuzi ya kufanya upasuaji yalifanyika katika misingi ipi?

1) matatizo ya ujauzito / uzazi (medical indication)_______ 2) uliomba kufanyiwawa

upasuaji (maternal request)_________

Kama ilikuwa ni tatizo la ujauzito / uzazi, ni tatizo gani liilopelekea ufanyiwe upasuaji
(indication of caesarean section)? (angalia faili)

Nani alifanya maamuzi ya kufanya upasuaji?

30
1) daktari au mkunga_______2) wewe (mteja) ______ 3) mwenzi wako / mumeee
wako________
Annexure V: Informed Consent - English Version

Nacte Reg No: Ns 0138/0003/2019

Greetings! My name is ALISON P HENGEKA, an ordinary diploma in clinical medicine
(cmt 06) student at Mbeya College of health and allied science, department of clinical
medicine. Is my pleasure to seek a permission to conduct research study at igawilo city hospital
concerning a causes and factors associated with caesarean section delivery among women
delivering igawilo hospital in Mbeya region.
Purpose of study
To identify the obstetrics and non-obstetrics causes and factors associated with caesarean
section deliveries.
Sponsor:
Self-sponsored
What participants involve
Your participation in the study will be at your own choice and you are free to decide without
any adverse reactions. Participation will require you to answer questions in relation to factors
contributing to caesarean section rates. It will take about 20 minutes to fill the questionnaire.

31
Confidentiality
All collected information will be kept confidential and this will be maintained by using codes
and no names will be asked or required. Information collected on questionnaire will be entered
into computers with only the study identification number and if the results of the current study
Will be published or presented in a scientific meeting, names and other information that might
identify you will not be used.
Benefits
There will be no direct benefit for your participation; however, the study findings will help to
identify the causes and factors contributing to caesarean section rates and hence strategize way
forward to reduce. That can be achieved by alerting the policy makers on the magnitude of the
situation which will lead to develop policy which will improve the quality of health care
provider decision making to conduct only justifiable caesarean section and fostering vaginal
delivery among women with uncomplicated pregnancies and labor.
Compensation:
There will be no compensation of any kind in participation.
Risk
The study will not harm you physically, psychologically or emotionally.
Rights to withdraw and alternatives
Participation in this study is voluntarily and you have the right to refuse to participate or
withdraw from the study even if you have already given your consent. Refusal to participate or
withdraw from the study will not involve penalty or loss of any benefits to which you are
otherwise entitled.

32
Who to contact?
If you ever have questions about this study, you should contact the head of department madam
Albertina of Mbeya college of health and allied sciences’(MCHAS) and madam mkola my
supervisor of this study by address of po box 1142, MCHAS, Mbeya Tanzania
Signature:
Do you agree to participate? Put √ in appropriate box
Participant agrees participant does not agree
I, ___________________________________ have read the contents in this form. My
questions have been answered. I agree to participate in this study.
Signature of participant ___________________________________date ___________
Signature of the researcher ________________________________date___________

33
Kiambatanisho VI : Ridhaa Ya Kushiriki Katika Utafiti

Namba Ya Usajili:Ns 0138/0003/2019.

Habari, jina langu naitwa ALISON P HENGEKA, ni mwanafunzi wa stashahada ya utabibu
katika chuo cha afya na sayansi shirikishi mbeya. Ninayo furaha kubwa kukuomba ruhusa ya
kufanya utafiti juu ya sababu na vihatarishi vinavyoweza-pelekea akina mama kujifungua kwa
njia ya upasuaji katika hospital ya jiji la Mbeya iitwayo Igawilo Mbeya.
Malengo ya utafiti
Kuchunguza sababu na vihatarishi vinavyoweza sababisha wakimama kujifungua kwa njia ya
upasuaji.
Mfadhili
Mimi mwenyew
Jinsi ya kushiriki
Ushiriki wako katika utafiti huu utakuwa kwa ridhaa yako binafsi na huru pasipo madhara
yoyote. Katika ushiriki wako utahitajika kujibu maswali yana yohusu sababu zinazochangia
kujifungua kwa njia ya upasuaji. Kujibu maswali itakuchukua muda wa dakika 10 hadi 20
kujaza maswali yote.
Usiri
Taarifa zote utakazotoa zitatuzwa katika usiri mkubwa, hutatakiwa kujaza jina lako, taarifa
zitakazo kusanywa zitaingizwa katika komputa kwa namba ya utambulisho pekee na kama
majibu yatatangazwa au kutolewa taarifa katika mkutano wakisayansi hakutatolewa jina au
taarifa yoyote inayokutambulisha wewe.
Faida
Hakutakuwa na faida ya moja kwa moja katika ushiriki wako, japomajibu yatasaidia kujua
sababu zinzaochangia ongezeko la kujifungua kwa njia ya upasuaji na kuweka mikakati ya
kupunguza akina mama kujifungua kwa kufanyiwa upasuaji. Hii inawezekana kwa kutoa taarifa
kwa watunga sera kwa hali halisi ilivyo ili kuandaa sera itakayoweka mikakati ya kuboresha
utendaji kazi wa watoa huduma kwa kufanya upasuaji kwa sababu zilizo halali tu na kuwasaidia
akina mama wasio na shida kujifungua kwa njia ya kawaida.
Fidia
Hakutakuwa na fidia ya namna yoyote ile katika ushiriki wako.

34
Haki ya kujitoa katika utafiti
Ushiriki wako katika utafiti huu ni hiari yako na una haki kukataa kuto kushiriki au kujiondoa
katika utafiti huu hata kama umetoa kibali cha kushiriki. Kukataa kushiriki au kujiondoa katika
utafiti hutatoa fidia au kupoteza faida zako.
Nani wa kuwasiliana
Kama kuna swali lolote lile kuhusu utafiti huu, wasilliana mkuu wa idara ya Utabibu chuo cha
afya na sayansi shirikishi Mbeya na msimamizi wangu mkuu wa utafiti Sanduku la Posta 1142,
MCHAS, Mbeya-Tanzania.
Je? Unakubali kushiriki,
Weka alama ya tiki (√) katika kisanduku husika
ndiyo hapana
Mimi, ___________________________________ nimeelezwa / nimesoma maelezo yote ya
fomu hii na nimejibiwa maswali yangu yote. Nimekubali kushiriki katika utafiti huu.
Sahihi ya mshiriki _______________________________tarehe ___________
Sahihi ya mtafiti ________________________________ tarehe ___________

35
36