Date of Conferral



Doctor of Public Health (DrPH)


Health Services


Heba H. Tawfik


The increasing cesarean section (CS) rate in Ghana has severe public health implications as it results in significant maternal and child morbidity and mortality. An assessment of the factors contributing to the increasing CS rate in different settings is imperative to guide the development of interventions. The purpose of this study was to identify the sociodemographic and obstetric predictors of CS in a major referral health facility in Accra, Ghana. This research was grounded in the systems thinking approach and involved the use of a case-control design whereby 2,704 pairs of cases (delivered by CS) and controls (delivered by vaginal delivery) were randomly sampled from pregnant women who attended the major referral health facility between January and October 2017. Secondary data that were routinely collected at the health facility were used. Bivariate and multivariable logistic regression analyses of the data revealed higher odds of having CS with increasing maternal age, low income (p < 0.01, 95% CI = 1.148, 2.358), previous CS (p < 0.001, 95% CI = 9.230, 13.198), and low fetal weight (p < 0.05, 95% CI = 1.009, 1.496). Lower odds were found among women with secondary education (p < 0.001, CI = 0.626, 0.894) and antenatal care nonattendants (p < 0.001, 95% CI = 0.349, 708). No significant association was observed between mode of delivery and gestational age or parity. Tailored interventions and strategies including health education and financial incentives programs, provision of and adherence to health protocols, and improvement of data collection procedures are recommended. These may reduce the existing burden of CS and improve maternal and child health, thus contributing to the bridging of the inequity gap and bringing about positive social change.