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Abstract：
BACKGROUND: Over 80,000 pregnant women died in Nigeria due to pregnancy-related complications in 2020. Evidence shows that if appropriately conducted, caesarean section (CS) reduces the odds of maternal death. In 2015, the World Health Organization (WHO), in a statement, proposed an optimal national prevalence of CS and recommended the use of Robson classification for classifying and determining intra-facility CS rates. We conducted this systematic review and meta-analysis to synthesise evidence on prevalence, indications, and complications of intra-facility CS in Nigeria.
METHODS: Four databases (African Journals Online, Directory of Open Access Journals, EBSCOhost, and PubMed) were systematically searched for relevant articles published from 2000 to 2022. Articles were screened following the PRISMA guidelines, and those meeting the study\'s inclusion criteria were retained for review. Quality assessment of included studies was conducted using a modified Joanna Briggs Institute\'s Critical Appraisal Checklist. Narrative synthesis of CS prevalence, indications, and complications as well as a meta-analysis of CS prevalence using R were conducted.
RESULTS: We retrieved 45 articles, with most (33 (64.4%)) being assessed as high quality. The overall prevalence of CS in facilities across Nigeria was 17.6%. We identified a higher prevalence of emergency CS (75.9%) compared to elective CS (24.3%). We also identified a significantly higher CS prevalence in facilities in the south (25.5%) compared to the north (10.6%). Furthermore, we observed a 10.7% increase in intra-facility CS prevalence following the implementation of the WHO statement. However, none of the studies adopted the Robson classification of CS to determine intra-facility CS rates. In addition, neither hierarchy of care (tertiary or secondary) nor type of facility (public or private) significantly influenced intra-facility CS prevalence. The commonest indications for a CS were previous scar/CS (3.5-33.5%) and pregnancy-related hypertensive disorders (5.5-30.0%), while anaemia (6.4-57.1%) was the most reported complication.
CONCLUSIONS: There are disparities in the prevalence, indications, and complications of CS in facilities across the geopolitical zones of Nigeria, suggestive of concurrent overuse and underuse. There is a need for comprehensive solutions to optimise CS provision tailor-made for zones in Nigeria. Furthermore, future research needs to adopt current guidelines to improve comparison of CS rates.
METHODS: Four databases (African Journals Online, Directory of Open Access Journals, EBSCOhost, and PubMed) were systematically searched for relevant articles published from 2000 to 2022. Articles were screened following the PRISMA guidelines, and those meeting the study\'s inclusion criteria were retained for review. Quality assessment of included studies was conducted using a modified Joanna Briggs Institute\'s Critical Appraisal Checklist. Narrative synthesis of CS prevalence, indications, and complications as well as a meta-analysis of CS prevalence using R were conducted.
RESULTS: We retrieved 45 articles, with most (33 (64.4%)) being assessed as high quality. The overall prevalence of CS in facilities across Nigeria was 17.6%. We identified a higher prevalence of emergency CS (75.9%) compared to elective CS (24.3%). We also identified a significantly higher CS prevalence in facilities in the south (25.5%) compared to the north (10.6%). Furthermore, we observed a 10.7% increase in intra-facility CS prevalence following the implementation of the WHO statement. However, none of the studies adopted the Robson classification of CS to determine intra-facility CS rates. In addition, neither hierarchy of care (tertiary or secondary) nor type of facility (public or private) significantly influenced intra-facility CS prevalence. The commonest indications for a CS were previous scar/CS (3.5-33.5%) and pregnancy-related hypertensive disorders (5.5-30.0%), while anaemia (6.4-57.1%) was the most reported complication.
CONCLUSIONS: There are disparities in the prevalence, indications, and complications of CS in facilities across the geopolitical zones of Nigeria, suggestive of concurrent overuse and underuse. There is a need for comprehensive solutions to optimise CS provision tailor-made for zones in Nigeria. Furthermore, future research needs to adopt current guidelines to improve comparison of CS rates.
摘要：
背景：2020年，尼日利亚有超过80,000名孕妇死于妊娠相关并发症。证据表明，如果进行得当，剖腹产（CS）降低了产妇死亡的几率。2015年，世界卫生组织(WHO)在一份声明中，提出了CS的最佳国家流行率，并建议使用Robson分类法进行分类和确定设施内CS率。我们进行了系统评价和荟萃分析，以综合有关患病率的证据，适应症,以及尼日利亚设施内CS的并发症。
方法：四个数据库(非洲在线期刊，开放存取期刊目录，EBSCOhost,和PubMed）系统地搜索了2000年至2022年发表的相关文章。根据PRISMA指南筛选文章，符合本研究纳入标准的人员被保留进行审查。纳入研究的质量评估采用改良的JoannaBriggs研究所的关键评估清单进行。CS患病率的叙事综合，适应症,和并发症以及使用R对CS患病率进行荟萃分析。
结果：我们检索了45篇文章，大多数(33(64.4%))被评估为高质量。尼日利亚各地设施中CS的总体患病率为17.6%。我们发现，与选择性CS（24.3％）相比，急诊CS（75.9％）的患病率更高。我们还发现，与北部（10.6％）相比，南部（25.5％）的设施中的CS患病率明显更高。此外，我们观察到实施WHO声明后,机构内CS患病率增加了10.7%.然而,没有一项研究采用CS的Robson分类来确定机构内CS率.此外,护理等级(三级或二级)和设施类型(公立或私立)均不显著影响设施内CS患病率.CS最常见的适应症是既往瘢痕/CS（3.5-33.5％）和妊娠相关的高血压疾病（5.5-30.0％）。而贫血(6.4-57.1%)是报告最多的并发症。
结论：患病率存在差异，适应症,以及尼日利亚地缘政治地区设施中CS的复杂性，暗示同时过度使用和使用不足。需要全面的解决方案来优化为尼日利亚地区量身定制的CS规定。此外，未来的研究需要采用目前的指导方针，以提高CS率的比较。
方法：四个数据库(非洲在线期刊，开放存取期刊目录，EBSCOhost,和PubMed）系统地搜索了2000年至2022年发表的相关文章。根据PRISMA指南筛选文章，符合本研究纳入标准的人员被保留进行审查。纳入研究的质量评估采用改良的JoannaBriggs研究所的关键评估清单进行。CS患病率的叙事综合，适应症,和并发症以及使用R对CS患病率进行荟萃分析。
结果：我们检索了45篇文章，大多数(33(64.4%))被评估为高质量。尼日利亚各地设施中CS的总体患病率为17.6%。我们发现，与选择性CS（24.3％）相比，急诊CS（75.9％）的患病率更高。我们还发现，与北部（10.6％）相比，南部（25.5％）的设施中的CS患病率明显更高。此外，我们观察到实施WHO声明后,机构内CS患病率增加了10.7%.然而,没有一项研究采用CS的Robson分类来确定机构内CS率.此外,护理等级(三级或二级)和设施类型(公立或私立)均不显著影响设施内CS患病率.CS最常见的适应症是既往瘢痕/CS（3.5-33.5％）和妊娠相关的高血压疾病（5.5-30.0％）。而贫血(6.4-57.1%)是报告最多的并发症。
结论：患病率存在差异，适应症,以及尼日利亚地缘政治地区设施中CS的复杂性，暗示同时过度使用和使用不足。需要全面的解决方案来优化为尼日利亚地区量身定制的CS规定。此外，未来的研究需要采用目前的指导方针，以提高CS率的比较。
