Caesarean sections in Sierra Leone after introduction of free health care services for pregnant and lactating women
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Background: Sierra Leone is one of the poorest countries in the world. In 2011, the gross national income (GNI) per capita was $460. In 2008, the maternal mortality was 857 per 100.000, and the under five mortality was 17·4 %. In 2010, Sierra Leone only had 14 surgeons to cover a population of 6·0 million people. The same year, Sierra Leonean government introduced the Free Health Care Initiative, aiming to give pregnant and lactating women as well as children under five years free health care services. This present study seeks to compare Caesarean sections performed in 2008 with Caesarean sections performed in 2012. Our hypothesis (H0) was that there were no difference in Caesarean section rates between 2008 and 2012. Methods: Four research teams, each consisting of one Norwegian and one Sierra Leonean medical student, visited facilities performing surgery. The teams got access to the Operation Theatre logbooks and entered all the data from these into a spreadsheet using Microsoft Excel 2011. Findings: We found the overall Caesarean section rate in Sierra Leone in 2012 to be 2·2 %. This is an increase of 46·7 % compared to 2008. (P<0·0001). Interpratation: The overall Caesarean section rates in 2012 were higher than those in 2008. The survey from 2008 is based on interviews with a representative probability sample of 7758 households. In this study we visited hospitals and clinics performing surgery to gather data about Caesarean sections. The main difference between the two tudies is the method.