Forecasting of Caesarean Births in the University of Cape Coast Hospital, Ghana
DOI:
https://doi.org/10.47672/ajsas.944Keywords:
Caesarean section, Time series modelling, Stationarity, Box-Jenkins Methods, Unit root testing, Forecasting.Abstract
Background: The increasing phenomenon in caesarean sections at the global as well as the national level is a public health concern. Periodic variations in Caesarean Sections incidences at the University of Cape Coast Hospital is currently unclear and the model that can best represent its movement is unknown. This study sought to model and predict the monthly incidence of Caesarean Sections at the hospital.
Methods: The study employed a monthly periodicity of 115 time-series data sourced from District Health Information Management Systems Two on Caesarean Section births at the University of Cape Coast Hospital over a 9-year period. The autoregressive integrated moving average models of the classical Box-Jenkins methods of Time Series Analysis were used to analyse the data. Analysis was performed in EViews 12 and R (version 4.0.4)
Results: There were six non-seasonal tentative candidate models for the hospital. The model autoregressive integrated moving average (1, 1, 2) with a first-order autoregressive and second-order moving average with one order of nonseasonal differencing emerged as the best fit model. The findings revealed an overall rising trend in the incidence of Caesarean section rates in the hospital over the study period with an average of 30.54% per month. This is expected to increase to over 40% per month over the next five-year period of August 2021 to July 2026 according to projections.
Conclusion: Non-Seasonal autoregressive integrated moving average (1,1,2) was identified as the best model that describes monthly expected Caesarean Sections births at the University of Cape Coast Hospital. Using this model to forecast the expected number of Caesarean Section births will facilitate health policy formulations and allow for the prudent use of available obstetric services.
Recommendations: Clinicians should be trained to improve their skills in the use of instruments in deliveries as well as in the safe conduct of vaginal breech deliveries.
Downloads
References
Pallasmaa N. Cesarean Section - Short Term Maternal Complications. 2014. Accessed on 2nd December, 2021. Available: Cesarean section - short term maternal complications related to the mode of delivery | Semantic Scholar
World Health Organization. Appropriate Technology for Birth. The Lancet. 1985; 2, 436-437. Retrieved from doi: 10.1111/j.1471-0528.1992.tb13867.x.
Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, Tunçalp Ö, Mori R, Morisaki N, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Qureshi Z, Gülmezoglu AM, Temmerman M; WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015 May;3(5):e260-70. doi: 10.1016/S2214-109X(15)70094-X. Epub 2015 Apr 9. PMID: 25866355.
Ye J, Betran AP, Vela MG, Souza JP, Zhang J. Searching for the Optimal Rate of Medically Necessary Cesarean Delivery. Birth. 2014;41(3):237-43. Retrieved from doi: 10.1111/birt.12104
Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betrán AP. Association between rates of caesa¬rean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. An International Journal of Obstetrics and Gynaecology. 2015; 123(5):745-53. Retrieved from https://doi.org/10.1111/1471-0528.13592.
Bosson-Amedenu S, Otoo J, Eyiah-Bediako F. Time Series Analysis and Forecasting of Caesarian Section Births in Ghana. Biomedical Statistics and Informatics. 2019; 4(1), 1-9. Retrieved from https://doi.org/10.11648/j.bsi.20190401.11
Essuman R, Nortey E, Aryee G, Osei-Asibey E, Darkwa EO, Djagbletey R. Modelling births at a tertiary health-care facility in Ghana: Box-Jenkins time series approach. Journal of Biostatistics and Epidemiology. 2017; 3(1):13-22.
Pradhan B, Bhandary S. Forecasting cesarean deliveries with robust time series models in a tertiary care hospital. Journal of General Practice and Emergency Medicine of Nepal. 2016;(6) 8: 2363-1168
Prah J, Kudom A, Afrifa A, Abdulai M, Sirikyi I, Abu E. Caesarean section in a primary health facility in Ghana: Clinical indications and feto-maternal outcomes. Journal of Public Health in Africa. 2017;8(2): 704. Retrieved from https://doi.org/10.4081/jphia.2017.704
Betrán AP, Torloni MR., Zhang JJ, Gülmezoglu A, Aleem H, Althabe F, Bergholt T, de Bernis L, Carroli G. WHO statement on caesarean section rates. International Journal of Obstetrics and Gynaecology. 2016; 123:667–70.
Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA, Haynes AB. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. JAMA. 2015 Dec 1;314(21):2263-70. doi: 10.1001/jama.2015.15553. PMID: 26624825.
Shah A, Fawole B, M'imunya JM, Amokrane F, Nafiou I, Wolomby JJ, Mugerwa K, Neves I, Nguti R, Kublickas M, Mathai M. Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa. Int J Gynaecol Obstet. 2009 Dec;107(3):191-7. doi: 10.1016/j.ijgo.2009.08.013. Epub 2009 Sep 27. PMID: 19782977.
Souza JP, Gülmezoglu A, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, Ruyan P; WHO Global Survey on Maternal and Perinatal Health Research Group. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med. 2010 Nov 10;8:71. doi: 10.1186/1741-7015-8-71. PMID: 21067593; PMCID: PMC2993644.
Yanovitzky I, VanLear A. Time series analysis: traditional and contemporary approaches. In Hayes AF, Slater MD, Snyder LB. (Eds.), The SAGE sourcebook of advanced data analysis methods for communication research. 2008; 89-124. Sage Publications, Inc., https://www.doi.org/10.4135/9781452272054
Box PE, Jenkins GM. Time Series Analysis: Forecasting and Control, revised ed., Holden-Day, Oakland, California, USA, 1976: 2nd edition.
United States National Vital Statistics Reports. Births: Final data for 2016. Vol. 67, No. 1, January 31, 2018. Accessed on 5th December, 2021. Available: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf
Geidam AD, Audu BM, Kawuwa BM, Obed JY. Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria. Annals of African Medicine. 2009;8(2):127-32 Retrieved from https://www.annalsafrmed.org/text.asp?2009/8/2/127/56242
Lin H-C, Xirasagar S. Institutional factors in cesarean delivery rates: policy and research implications. Obstetrics & Gynecology. 2004; 103(1):128–36. Retrieved from https://doi.org/10.1097/01.AOG.0000102935.91389.53
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 McAdams Abu Bakr, Esther Rhoda Ababio, Richard Pinkrah, James Kojo Prah
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
