KNOWLEDGE OF CAESARIAN SECTION in Ghana.

LEVEL OF KNOWLEDGE OF CAESARIAN SECTION AMONG PREGNANT WOMEN

1. DETERMINING THE TREND AND LEVEL OF KNOWLEDGE OF CAESARIAN SECTION AMONG PREGNANT WOMEN IN THE BEREKUM MUNICIPALITY. MARY KORANTENG FAUSTINA DEI LETICIA AMARFIO-ARYEETEY 2023

2. INTRODUCTION Child birth is the only means through which human population is replaced. There are two major processes of child delivery - natural/vaginal birth and Caesarean sections. (Boz, Teskereci & Akman, 2016). Access to necessary Caesarean section (C-section) is a hallmark of an effective essential and emergency obstetric care. As a result, in order to attain the Sustainable Development Goal (SDG) 3 on reducing maternal and infant mortality and morbidity, there has been prioritization of emergency obstetric care (Molina et al., 2015).

3. Statement of the Problem The changing trends in child delivery pose essential public health challenges to many high-, middle-, and low-income countries. Evidence show that the number of cesarean section being done globally has increased to unprecedented levels, currently at 19 percent of all births worldwide (Temmerman, 2016). esarean sections are intended to be used as a life saving procedure for the mother and/or her baby when there are difficulties with spontaneous vaginal delivery. A number of uncompulsory indications such as the option for women to choose an elective cesarean section, and the decreasing option of vaginal births after cesarean section for women led to its overuse in recent years, with lack of awareness of outcome adverse effects like unnecessary wound, anesthesia effect to both the mother and the newborn, and high costs to the mother and to the health facilities (Keen, 2014).

4. Statement of the Problem Scholars estimate that annually, 18.5 million C-sections are performed globally, however 3.2 million additional C-sections were needed in 54 countries and 6.2 million unnecessary C-sections were done in 69 countries The rate of CS in Ghana was 6.9% from 2000-2008, and increased to 13% in 2014, 14.6% in 2015 and 16% in 2016 in all hospital deliveries (Ghana Health Service, 2016; Gulati, & Hjeldi, 2018). limited exposure to information on CS can result in high level of ignorance, impacting on decision making, thus posing danger to both the mother and baby it is imperative for pregnant women to understand issues relating to CS, have adequate knowledge on the indications, risks and associated benefits.

5. Objective of the Research The general objective of the study was to determine the prevalence and level of knowledge and perception of caesarian among pregnant women among the Berekum Municipality. Specific Objectives To determine the prevalence of caesarian section deliveries in the Berekum Municipality. To assess the knowledge level of the pregnant women on the indications and procedure of caesarian section deliveries. To assess the perception of the pregnant women on caesarian section deliveries.

6. Significance of the Study The findings of the study would help complement efforts in the attainment of SDG 3 and the subsequent realization or near realization of the rest as the health of humans pivots the realization of the remaining 16 goals in the study area. The finding will also equip nurses and midwives with knowledge on the meaning, beliefs, and behaviour of women towards caesarean sections. The study is also beneficial to population scientists who can use this study’s outcome as a guide in the analysis of health disparities among the various sub-populations in a holistic manner. Also, it was to inform policy makers and Non-Governmental Organizations (NGOs), who have interest in addressing public health issues such as child and maternal health in Ghana on where to target health interventions, in order to achieve value for resources.

7. METHODOLOGY Study Design A descriptive study design that used a quantitative method to investigate and collect information on the prevalence of caesarian section among pregnant women in the Berekum municipality and assessed their knowledge and perception on cesarian sections in pregnancy. Study Population The target population of the study included all the pregnant women that visited the obstetrics department of the Holy Family Hospital, Berekum throughout the period of the study.

8. METHODOLOGY Sample size and technique A convenience non-probability sampling technique was employed to obtain 151 eligible pregnant women at the facility until the sample size was achieved and structured questionnaires for the study was administered to the selected respondents. Data Collection tool A semi-structured questionnaire was used to gather information from the participants. The questionnaire was generated based on the objectives of the study and what the work seemed to address

9. METHODOLOGY Section ‘A’ deal with demographic characteristics of the respondents, Section ‘B’ focuses on participant’s knowledge on caesarian sections in areas with the indications and process of the procedure. Section ‘C’ deal with articipant’s perception and perception towards caesarian sections In determining the prevalence of caesarian section deliveries in the community, preexisting records on in caesarian section deliveries that were done in the past five years was consulted from the Holy Family Hospital and analyzed.

10. Ethical Consideration the researcher ensured that respondents were respectful of their privacy, confidentiality and anonymity. All respondents were told that the information they gave out would be kept confidential and used for academic purposes only. The information provided by the participants will be kept in a secure place and used only for academic and policy implementation purposes. The respondent’s dignity and privacy would be maintained and respected throughout the research process. All the information that were collected would be treated confidentially

11. Results and discussions 1 st objective : Prevalence of caesarian section deliveries among pregnant women in the Berekum Municipality. Statistical data was obtained from the health information personnel in the Holy Family hospital regarding the statistics on the obstetrics and gynaecology department spanning from 2018 to 2022 concerning the total number of caesarian section deliveries of pregnant women within the years.

12. 2 nd objective : Knowledge of Pregnant women about Cesarean Section The overall knowledge level of respondents on the caesarian section. Majority of the respondents (89.0%) had a good knowledge on the caesarian section while a lesser percentage (11%) had a poor knowledge on caesarian section Pertaining to the delivery method of last birth, 5.3% and 40.4% of women who had had caesarian sections had poor knowledge and good knowledge respectively. A chi-square test revealed a chi-squared value of 33.340 and a p-value of 0.000 indicating there is statistical significance between the variables

13. 3 rd objective: Perception of Pregnant women about Cesarean Section 107 (71%) strongly agreed that It is right to undergo CS with medical reasons while only 28 (18.5%) strongly disagreed It is right to undergo CS with medical reasons 90 (59.7%) strongly agreed that weak women undergo CS but 31.5% disagreed to that statement and 13 (8.9) were not sure . On the statement “Lazy women undergo CS”, 18 (12.1%) strongly disagreed, 16 (10.5%) were not sure while 117 (77.5%) strongly agreed. 17 (11.3%) strongly agreed Cs is expensive, 52 (34.7%) were not sure, 82 (54.0%) strongly disagree. 32 (217%) strongly agreed CS is associated with a lot of complications, 49 (32.3%) weren’t sure CS is associated with a lot of complication.

14. Overall Perception of Pregnant women about Cesarean Section

15. DISCUSSION This study results revealed a total average delivery of 6679 for the period 2018 to 2022. Within the same period, normal deliveries were 4663 (70% of the total). A total of 2016 caesarean sections were conducted during the five years with a prevalence rate of 30.2%. This is same as some studies done among African countries which shown that CS rates among African countries range from 0.6% - 18% (Worjoloh, 2018). Also is the same as the other study done in Tanzania at Muhimbili National Hospital (MNH) which revealed the rates of CS has been steady increasing (Pembe, 2020). The cesarean section rate of 30.2% found in this study is similar to the findings of other studies conducted at health facilities in other parts of the world (Daniel et al., 2014; Nkwo & Onah, 2020) and that of Prah et al. (2017). which had a 26.9% prevalence rate.

16. The study found high knowledge (89.0%) among pregnant women in the Berekum Municipality. This means that pregnant women in the Berekum Municipality are exposed to information on CS. They either receive some form of education at the clinic, through the media, and possibly from friends and family on the indications, benefits and risks associated with CS The findings of the study agreed with a study conducted in Nigeria where 79% of the respondents had high knowledge on CS (Jerimiah et al., 2018). The reason for the agreement may be due to the fact that majority (98.5%) of the respondents in the study by Jerimiah et al. (2018) had tertiary and secondary education The study was also consistent with another study conducted in Nigeria by Robinson-Bassey and Uchegbu (2016), where 62.42% of the respondents had high knowledge on CS DISCUSSION

17. The findings of the study showed that majority 68% (n = 103) of the pregnant women in the Berekum Municipality have positive perception towards CS. Once pregnant women have positive perception towards CS, they are likely to accept medically indicated CS to promote health, and also accept CS if they feel it’s safe for them. The findings of the study was consistent with a study conducted in Nigeria by Owonikoko et al. (2015), where 54% of the respondents (400) had positive perception towards CS. This is because the study involved both pregnant women and their spouse whereas the current study involved only pregnant women. The findings of the study disagreed with the findings of a study conducted in Nigeria by Robinso-Bassey and Uchegbu (2016), where 58% and 42% of the respondents (325) had negative and positive perceptions, respectively, towards CS. The negative perception could be attributed to the respondent’s level of education. DISCUSSION

18. Conclusion The percentage of pregnant women who had knowledge Caesarean section was high with 89% and those who had poor knowledge was as low with only 11%. The study revealed there is a correlation between pregnant women last delivery method and their knowledge Caesarean sections. It can be concluded that if pregnant women have knowledge on CS, they will accept CS if indicated to reduce maternal and infant morbidity and mortality However, the study also showed a positive perception of respondents towards Caesarean sections in pregnancy; (68%) had a positive perception on the caesarian section while a lesser percentage (32%) had a negative perception on caesarian section

19. Recommendations Based on the findings of this study, the following are recommended: 1.There should becontinuous education of pregnant women on the indications, benefits and risk of CS and vaginal delivery at the antenatal clinics by the midwives in the Berekum Municipality. This is imperative because it will build on the client’s knowledge; provide first hand information to clients and also clear misconceptions regarding CS. 2.There is the need for programs to increase the understanding of women and the community about CS as a method of delivery in the Berekum Municipality. This will help them to accept CS as a delivery method. 3..Religious institutions need to encourage pregnant women to undergo medically indicated CS where necessary.

20. References Boz, I., Teskereci, G., & Akman, G. (2016). How did you choose a mode of birth? Experiences of nulliparous women from Turkey. Australian College of Midwife, 29(4), 359-367. Ghana Health Service (2016.). National Assessment for Emergency Obstetric and Newborn Care. Keen, K. (2014). Factors influencing differences in primary cesarean section rates in midwife compared to physician practices. Molina, G., Weiser, T. G., Lipsitz, S. R., Esquivel, M. M., Uribe-Leitz, T., Azad, T., KN, S. (2015). Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. JAMA, 314(21), 2263. https://doi.org/10.1001/jama.2015.15553 Owonikoko, K. M., Akinola, S., Adeniji, O. A., & Bankole, A. O. (2015). Women’s perception and experience of caesarean delivery in Ogbomoso, Southwest Nigeria. Journal of Pregnancy and Child Health, 2(3), 1-6. Pembe, A. B & Othman, M. K. (2020). Pregnancy outcome after one previous caesarean section at a tertiary university teaching hospital. Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 12, 3. Temmerman, M. (2016). Caesarean section surgical techniques: all equally safe. Comment 8 Www.Thelancet.Com, 388. .

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