Bivariate Generalized Bernoulli Model for Analyzing Dependence between Antenatal Care and Cesarean Section Births

Abstract

Cesarean section delivery can prevent maternal and child mortality effectively. However, if there is no medical necessity then it has no benefit. During the past two decades, cesarean delivery has been increasing alarmingly both in developed and developing countries. Along with clinical factors, Number of antenatal visits, Antenatal provider and Place of antenatal care has influence on the increase of cesarean section delivery. In this study, the dependence between antenatal care (i.e. number of antenatal visits, from whom received the antenatal and place of antenatal care) and cesarean section delivery is assessed along with some selected demographic-socioeconomic covariates by implying Generalized Bivariate Bernoulli Model. Bangladesh Demographic and Health Survey, 2014 is used in this study to illustrate the model. In this present study prevalence of cesarean delivery in Bangladesh is 24%, though this rate varies from 12.1% to 34.4% in different divisions. Women with advance age were more likely to have cesarean section (OR = 1.83, p-value = 0.01 and OR = 2.84, p-value = 0.03 respectively for age groups “20-34” and “35-49”). Though the risk was higher only if 4 or more than 4 antenatal visits were made and in case the care was received from qualified doctor then women aged 20-34 years likely to have higher risk of CS (OR = 1.79, p-value = 0.05). Higher risk of CS for this group was also found if antenatal care was received from public or private sector (OR = 1.83, p-value = 0.03) and if the care was received from home or NGO sector then women aged 35-49 years were more likely to have CS compared to those aged <20 years. Overweight and obese women risk of having CS delivery was higher compared to those with BMI level below normal and this higher risk was found if the care was received from qualified doctor and from Public or Private sector. If number of antenatal visits were 4 or more than 4, qualified doctor provided antenatal care and received from public or private sector then women living in Chittagong division were less likely to have cesarean section than those living in Barisal division. Women living in Khulna division were more likely to have CS if number of antenatal visit was no or less than 4 and the care was received from public or private sector. Women living in rural areas and with previous female child were less likely to have CS if antenatal care was received from qualified doctor and private or public sector. Women belonging to the higher economical class exposed with higher risk of CS. In case, if number of antenatal vi visits was no or less than 4 and antenatal care was received from qualified doctor only then women with middle economical class were more likely to have CS otherwise not. Dependence was found between antenatal care and cesarean section, which implies how many antenatal visits were made, motive and influence of doctors and antenatal care providers and the place from where the care was received can instigate which type of delivery will be conducted. Interventionist should take proper steps to evaluate management from where women receive antenatal care, even the quality of antenatal care needs to be reviewed.