Cesarean section deliveries in Egypt: Trends, practices, perceptions, and cost

In Egypt, the past decade has witnessed a sharp increase in the prevalence of cesarean section (CS) with the most recent Egypt Demographic and Health Survey documenting a CS rate of 52 percent, suggesting that cesarean delivery might be overused or used for inappropriate indications. This study aimed to explore trends, practices, and costs associated with CS deliveries to women, their families, and the health system, as well as factors that may contribute to increased use of CS in Egypt. Participating physicians and key informants unanimously agreed that the CS mode of delivery was over-used in Egypt. Perceived reasons underlying increased CS deliveries were: financial incentive, doctors’ desire to have better control over their time, doctors’ fear of medical litigation, vagueness of medical protocols regarding indications for use of CS, limited opportunities for junior doctors to practice vaginal deliveries, shortage of pain relief drugs in public hospitals, and shortage of anesthesiologists who are trained in administration of epidural anesthesia which could be used to relieve pain in vaginal deliveries. Recommendations are proposed for rationalizing the use of CS deliveries in Egyp

Fertility preferences and behaviors among younger cohorts in Egypt: Recent trends, correlates, and prospects for change

After years of steady decline, Egypt experienced an increase in the total fertility rate (TFR) from 3.0 births per woman in 2008 to 3.5 in 2014, which was coupled with an increase in desired family size among young people. To better understand this increase in fertility as well as prospects for change, the Evidence Project/Population Council conducted secondary analyses of quantitative data from the Egypt Demographic and Health Survey (EDHS) and the Survey of Young People in Egypt (SYPE) and collected qualitative data from young people and key informants. This report examines the changes in fertility preferences and behaviors among young people aged 15–34, identifies key drivers of the increase in fertility, assesses prospects for change including challenges and opportunities, and proposes recommendations for targeted and sustainable interventions addressing increased fertility among young people in Egypt. Findings suggest that key drivers of increased fertility include decreased use of family planning (FP) among married women with two or more children, a shift towards use of short acting FP methods, and increased contraceptive discontinuation. These factors may be due in part to decreased exposure to FP messages, declines in quality of family planning counseling, and socioeconomic, political, and programmatic changes that Egypt went through between 2008 and 2014. These findings and additional insights will be useful to policymakers, program designers, and health care professionals in addressing increased fertility and delivering more effective voluntary FP services in Egypt

Policy brief: Fertility preferences and behaviors among younger cohorts in Egypt: Recent trends, correlates, and prospects for change [Arabic]

After years of steady decline, Egypt experienced an increase in the total fertility rate (TFR) from 3.0 births per woman in 2008 to 3.5 in 2014, which was coupled with an increase in desired family size among young people. To better understand this increase in fertility as well as prospects for change, the Evidence Project/Population Council conducted secondary analyses of quantitative data from the Egypt Demographic and Health Survey (EDHS) and the Survey of Young People in Egypt (SYPE) and collected qualitative data from young people and key informants. This brief examines the changes in fertility preferences and behaviors among young people aged 15–34, identifies key drivers of the increase in fertility, assesses prospects for change including challenges and opportunities, and proposes recommendations for targeted and sustainable interventions addressing increased fertility among young people in Egypt. Findings suggest that key drivers of increased fertility include decreased use of family planning (FP) among married women with two or more children, a shift towards use of short acting FP methods, and increased contraceptive discontinuation. These factors may be due in part to decreased exposure to FP messages, declines in quality of family planning counseling, and socioeconomic, political, and programmatic changes that Egypt went through between 2008 and 2014. These findings and additional insights will be useful to policymakers, program designers, and health care professionals in addressing increased fertility and delivering more effective voluntary FP services in Egypt

Medical and non-medical reasons for cesarean section delivery in Egypt: A hospital-based retrospective study

Background: Caesarean section (CS) is an important lifesaving intervention that can reduce maternal and newborn morbidity and mortality. The dramatic increase in CS rates globally has prompted concerns that the procedure may be overused or used for inappropriate indications. In Egypt, CS rates are alarmingly high, accounting for 52% of all deliveries. This study sought to (1) explore indications and risk factors for CS in public hospitals in four governorates in Egypt and (2) examine health care provider factors impacting the decision to perform a CS. Methods: We reviewed medical records for all deliveries that took place during April 2016 in 13 public hospitals situated in four governorates in Egypt (Cairo, Alexandria, Assiut and Behera), and extracted information pertaining to medical indications and women’s obstetric characteristics. We also interviewed obstetricians in the study hospitals to explore factors associated with the decision to perform CS. Results: A total of 4357 deliveries took place in the study hospitals during that period. The most common medical indications were previous CS (50%), an “other” category (13%), and fetal distress (9%). Multilevel analysis revealed that several obstetric risk factors were associated with increased odds of CS mode of delivery – including previous CS, older maternal age, and nulliparity – while factors such as partograph completion and oxytocin use were associated with reduced odds of CS. Interviews with obstetricians highlighted non-medical factors implicated in the high CS rates, including a convenience incentive, lack of supervision and training in public hospitals, as well as absence of or lack of familiarity with clinical guidelines. Conclusion: A combination of both medical and non-medical factors drives the increase in CS rates. Our analysis however suggests that a substantial number of CS deliveries took place in the absence of strong medical justification. Health care provider factors seem to be powerful factors influencing CS rates in the study hospitals

Predictors and Prevalence of Pain and Its Management in Four Regional Cancer Hospitals in India

Purpose: More than 1 million new occurrences of cancer are diagnosed in India annually. Among patients with cancer, pain is a common and persistent symptom of the disease and its treatment. However, few studies to date have evaluated the prevalence of pain and the adequacy of pain management in Indian hospitals. This cross-sectional study aimed to assess the prevalence and sociodemographic patterns of cancer pain and pain management among a sample of inpatients and newly registered outpatients at four large regional cancer centers in India. Methods: A sample of 1,600 patients with cancer who were current inpatients or newly registered outpatients were recruited and administered a questionnaire that was based on the Brief Pain Inventory. The survey tool included questions on demographics, medical history, and extent of clinical pain experienced. In addition, a pain management index score was created to link the severity of cancer pain with medication prescribed to treat it. Results: A total of 88% of patients reported pain in the past 7 days, and approximately 60% reported that their worst pain was severe. Several demographic and medical characteristics of the study population predicted severe pain, including the following: lower educational level, outpatient status, and debt incurred as a result of illness. A total of 67% of patients were inadequately treated with analgesics. Inadequate pain management was associated with both treatment hospital and patient type, and patients who reported debt as a result of their illness were more likely to have inadequate pain management. Conclusion: A majority of Indian patients with cancer experience significant pain and receive inadequate pain management. Improvement of pain management for Indian patients with cancer is needed urgently